Department of Otolaryngology-Head and Neck Surgery, McGill University Health Centre, Montreal, Quebec, Canada.
Otolaryngol Head Neck Surg. 2022 Dec;167(6):979-984. doi: 10.1177/01945998211011066. Epub 2021 May 4.
Lengthy wait times for elective surgery is a widespread health care system conundrum that may increase patient distress and jeopardize health outcomes. The primary aim of this quality improvement project was to reduce the surgical wait time in patients undergoing tympanostomy tube insertion.
As of January 2018, our tertiary care institution implemented a novel protocol whereby healthy children may undergo tympanostomy tube insertion in a minor procedure room under ketamine sedation administered by pediatric emergency physicians to address lack of both physical and anesthesia staffing resources. A retrospective study of all children undergoing elective tympanostomy tube insertion was conducted between September 1, 2017, and May 8, 2019, to assess wait time to surgery, as well as anesthesia-related and surgical complications.
Procedural sedation in minor procedure rooms effectively decreased surgical wait times by 53 days (from 134 to 81 days, < .001) at 16 months postimplementation. This new protocol was found to be safe and effective for healthy children, with no major surgical or anesthesia-related complications noted in 113 patients having undergone the procedure in the novel setting.
Although conscious sedation by emergency physicians has been well studied across a variety of surgical procedures, its novel use in pediatric tympanostomy tube insertion requires careful patient selection to enhance accessibility while maintaining anesthetic safety.
This quality improvement project describes a novel combination of processes, using a minor procedure room space and ketamine-based procedural sedation to address surgical wait times in pediatric patients undergoing tympanostomy tube insertion.
择期手术等待时间过长是一个普遍存在的医疗保健系统难题，可能会增加患者的痛苦并危及健康结果。本质量改进项目的主要目的是减少接受鼓膜切开术置管术的患者的手术等待时间。
自 2018 年 1 月起，我们的三级保健机构实施了一项新方案，即健康儿童可在小儿急诊医师进行的氯胺酮镇静下在小型手术室内接受鼓膜切开术置管术，以解决缺乏物理和麻醉人员资源的问题。对 2017 年 9 月 1 日至 2019 年 5 月 8 日期间所有接受择期鼓膜切开术置管术的儿童进行了回顾性研究，以评估手术等待时间以及与麻醉相关和手术相关的并发症。
在实施后 16 个月，小型手术室内的镇静性治疗有效减少了 53 天的手术等待时间（从 134 天减少至 81 天，<0.001）。在 113 名在新环境下接受该手术的健康儿童中，未发现主要手术或麻醉相关并发症，表明该新方案安全有效。
尽管急诊医师的清醒镇静已在各种手术中得到了广泛研究，但在小儿鼓膜切开术置管术中的新用途需要仔细选择患者，以在保持麻醉安全性的同时提高可及性。
本质量改进项目描述了一种新颖的流程组合，使用小型手术间空间和基于氯胺酮的镇静性治疗来解决接受鼓膜切开术置管术的小儿患者的手术等待时间问题。
