Abstract P-425: PROCEDURAL SEDATION OUTSIDE THE OPERATING ROOM: A SURVEY OF PRACTICES IN A TERTIARY CARE CHILDREN’S HOSPITAL WITHOUT A DEDICATED SERVICE
Bibliographic record
Abstract
Aims & Objectives: Providing consistent, high quality pediatric procedural sedation (PS) enables non-invasive or minimally invasive procedures outside the operating room. Prior to implementing quality monitoring or a PS service, we sought to determine current, unregulated practice in a tertiary care children’s hospital. Methods Survey was pilot tested on 10 clinicians and administered to one manager-identified respondent in each clinical area (clinic or inpatient unit). Opinio software was used. Respondents were encouraged to consult paper records and collaborate with other clinicians for completion. Results Response rate was 100% (n=21 areas), with 86% (n=18) of clinical areas performing potentially painful or distressing procedures. PS was performed in 67% (n=14) of clinical areas for 62 different procedures. For 30 (48%) procedures, provision of PS was location-dependent. Unsafe practices identified included; no access to code blue button (7%); no ETCO2 monitoring (50%); no or inconsistent review of history (21%) or physical examination (28%) prior to ordering and administering medications; and baseline vital signs inconsistently/not done (7%). The agents used in the most areas were intranasal midazolam (71%), intravenous fentanyl (57%), oral chloral hydrate (57%), and intravenous midazolam (50%). In areas where procedural sedation is never performed, at least 24 different procedures were identified, with 17 (81%) potentially painful. Conclusions Prior to regulation or implementation of a procedural sedation service at a tertiary care children’s hospital, provision of procedural sedation is widespread, practice is inconsistent and includes several safety concerns, and children do not receive PS for multiple procedures in which it may be warranted.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.006 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".