Retrospective comparison of emergency department length of stay for procedural sedation and analgesia by nurse practitioners and physicians

Objectives: To determine if use of nurse practitioners (NPs) for procedural sedation and analgesia (PSA) compared with physicians (MDs) decreased overall length of stay (LOS) in the pediatric emergency department (PED). Methods: Retrospective chart review was conducted on all children (age <21 years) undergoing procedural sedation and analgesia (PSA) for 36 consecutive months at a tertiary academic children's hospital (n = 690). Data included times values for triage, evaluation by practitioner (NP, MD), sedation, discharge, and total LOS in the PED. Data collected also included medications given, patient diagnosis, and severe air-way complications. Results: Results revealed statistically significant time-related advantages to NP-managed sedations. Both PED LOS and time to sedation were significantly lower for NPs versus MDs across diagnoses (P < 0.01). The diagnoses managed by MDs versus NPs were significantly different for 3 diagnoses: fracture, finger, and lacerations. There were no differences between NP and MD for severe airway complication rates. Conclusions: Overall LOS and time to sedation were significantly improved when NPs independently managed patients requiring PSA without an increase in documented severe airway complication rates.