Barriers and Facilitators to Implementing an Intensivist-Led Pediatric Sedation Service

Introduction: Pediatric procedural sedations (PPS) continue to expand beyond the operating room, with pediatric intensivists emerging as key leaders in delivering safe, high-quality care. With a national shortage of pediatric anesthesiologists, pediatric critical care medicine physicians are well-positioned to mitigate this gap in care, and currently perform 55% of sedations nationally. However, little is known about how these clinicians perceive the implementation of structured sedation services. This study explores barriers and facilitators to establishing a dedicated pediatric sedation service at a quaternary Children’s Hospital. We hypothesize that variable and modifiable barriers will be elucidated that can inform tailored implementation strategies.


Methods: We performed a qualitative study focusing on current pediatric critical care faculty in our center. Transcripts from a semi-structured interview were inductively coded using grounded theory to create an initial codebook, aided by qualitative software. Thematic analysis was then undertaken. The checklist for consolidated criteria for reporting qualitative research (COREQ) was used.


Results: Ten interviews have been completed to date. Ninety percent of the pediatric intensivists were women with a median experience of 13 years (IQR: 5-22.5 years). The global theme of PPS service implementation revealed three sub themes relating to 1) perceived physical and institutional barriers; 2) personal interest; and 3) perceived competence. Safety concerns related to a new practice area and medication use. Modifiable factors included standardizing monitoring and safety equipment checklists and creating a training curriculum to address patient selection, pharmacology, and emergency response plans.


Conclusions: Thematic categorization of faculty perceptions prior to implementation of a PPS service allows for identification of modifiable barriers and facilitators. A priori knowledge is valuable during the implementation phase, informing training and curricular development. Furthermore, this study may serve as a roadmap at other institutions seeking to implement a pediatric procedural sedation service.