Background and aims:Open-access scheduling is highly utilized for facilitating generally low-risk endoscopies.Preprocedural screening addresses sedation requirements;however,procedural safety may be compromised if scr...Background and aims:Open-access scheduling is highly utilized for facilitating generally low-risk endoscopies.Preprocedural screening addresses sedation requirements;however,procedural safety may be compromised if screening is inaccurate.We sought to determine the reliability of our open-access scheduling system for appropriate use of conscious sedation.Methods:We prospectively and consecutively enrolled outpatient procedures booked at an academic center by open-access using screening after in-office gastroenterology(GI)consultation.We collected the cases inappropriately booked for conscious sedation and compared the characteristics for significant differences.Results:A total of 8063 outpatients were scheduled for procedures with conscious sedation,and 5959 were booked with open-access.Only 78 patients(0.97%,78/8063)were identified as subsequently needing anesthesiologist-assisted sedation;44(56.4%,44/78)were booked through open-access,of which chronic opioid(47.7%,21/44)or benzodiazepine use(34.1%,15/44)were the most common reasons for needing anesthesiologist-assisted sedation.Patients on chronic benzodiazepines required more midazolam than those not on chronic benzodiazepines(P=0.03)of those patients who underwent conscious sedation.Similarly,patients with chronic opioid use required more fentanyl than those without chronic opioid use(P=0.04).Advanced liver disease and alcohol use were common reasons for patients being booked after in-office consultation and were significantly higher than those booked with open-access(both P<0.01).Conclusions:We observed that the majority of patients can be triaged for conscious sedation using a multi-tiered screening process.Importantly,few patients(<1.0%)were inappropriately booked for conscious sedation.The most common reasons for considering anesthesiologist-assisted sedation were chronic opioid,benzodiazepine and/or alcohol use and advanced liver disease.This suggests that these entities could be included in screening processes for open-access scheduling.展开更多
文摘Background and aims:Open-access scheduling is highly utilized for facilitating generally low-risk endoscopies.Preprocedural screening addresses sedation requirements;however,procedural safety may be compromised if screening is inaccurate.We sought to determine the reliability of our open-access scheduling system for appropriate use of conscious sedation.Methods:We prospectively and consecutively enrolled outpatient procedures booked at an academic center by open-access using screening after in-office gastroenterology(GI)consultation.We collected the cases inappropriately booked for conscious sedation and compared the characteristics for significant differences.Results:A total of 8063 outpatients were scheduled for procedures with conscious sedation,and 5959 were booked with open-access.Only 78 patients(0.97%,78/8063)were identified as subsequently needing anesthesiologist-assisted sedation;44(56.4%,44/78)were booked through open-access,of which chronic opioid(47.7%,21/44)or benzodiazepine use(34.1%,15/44)were the most common reasons for needing anesthesiologist-assisted sedation.Patients on chronic benzodiazepines required more midazolam than those not on chronic benzodiazepines(P=0.03)of those patients who underwent conscious sedation.Similarly,patients with chronic opioid use required more fentanyl than those without chronic opioid use(P=0.04).Advanced liver disease and alcohol use were common reasons for patients being booked after in-office consultation and were significantly higher than those booked with open-access(both P<0.01).Conclusions:We observed that the majority of patients can be triaged for conscious sedation using a multi-tiered screening process.Importantly,few patients(<1.0%)were inappropriately booked for conscious sedation.The most common reasons for considering anesthesiologist-assisted sedation were chronic opioid,benzodiazepine and/or alcohol use and advanced liver disease.This suggests that these entities could be included in screening processes for open-access scheduling.
