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Sedation privileges for ED physicians

Credentialing Resource Center Connection, January 6, 2005

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Dear credentialing colleague:

Recently, I received a question from a Credentialing Connection reader asking about conscious sedation privileges for emergency department (ED) physicians. Defining exactly who should receive these privileges is an important matter for any care facility, and while these privileges should not be handed out to just anyone, the broad spectrum of abilities necessary in emergency treatment dictates the need for a flexible policy.

Physicians practicing in the emergency setting should not be constrained by virtue of the privileges they have been granted.  By definition, an emergency medicine physician must be able to provide any type of care necessary in an emergency.  In fact, most medical staff bylaws specify that in an emergency situation any physician may engage in any type of care designed to resolve the emergency.  If conscious sedation is truly necessary for the treatment of an emergency, then clearly an ED physician must be able to provide that service.  If, however, conscious IV sedation is not necessary in any emergency situation, then emergency physicians should not be permitted to perform this technique as part of core ED privileges unless another patient or institutional need dictates it.

In any event, the practitioner providing conscious IV sedation must be considered competent based upon an assessment of education, training, experience and references in the technique and must follow the institution's protocols for its use.  Such protocols would presumably include requirements for monitoring, dosage limitations, pre-anesthesia assessment, etc.

As conscious IV sedation is part of the routine training received by most residents in Emergency medicine, it is likely that a credentials committee would have little trouble assessing an individual's competency to utilize the technique.

If your privileging issue has an economic origin, the credentials committee's consideration should proceed based upon the "best interest of the patient" and not the best interest of any particular physician or specialty.

That's it for this week

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