Emergency department procedural sedation practice in Cape Town, South Africa

BACKGROUND: There are no general policies or protocols for procedural sedation in the emergency department and no literature on present practice in South Africa. AIMS: To investigate procedural sedation (PS) practice in adults in emergency departments (EDs) in Cape Town, South Africa. METHODS: A cross-sectional descriptive study was performed by interviewing all ED managers and ED doctors in Cape Town meeting the criteria (open 24 h a day, staffed by full-time doctors, seeing adult patients and doctors who practice primarily emergency medicine and have performed at least one PS in the last 3 months). RESULTS: Data were collected from 13 units (5 public, 8 private) and 76 clinicians (48 public, 28 private). PS facilities are generally good in the private sector, but poor in the public sector (lacking in equipment, staff and protocols). Monitoring of patients during PS is often substandard, with only two thirds of clinicians using a minimum of blood pressure and pulse oximetry monitors during PS. Commonly used drugs for PS included midazolam, morphine and propofol (91%, 80% and 28%, respectively). Propofol (use of which is increasing in the international ED) is more likely to be used by experienced clinicians and those in the private sector. Surprisingly, almost half of clinicians would like propofol used on themselves hypothetically, although the majority (62%) said they had no or limited knowledge of its use and were concerned with its safety. CONCLUSIONS: The private sector is generally better serviced for PS than the public sector. Most ED clinicians use morphine and midazolam for PS. However, there is widespread awareness of propofol as an alternative and probably superior PS drug. Recommendations for improving PS include development of general protocols for PS, training of doctors at all levels and optimization of ED facilities and staffing.