ACLS and sedation

[SouthwestEM]

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Hi Everyone,

I am an practicing attending and my Hospital (Oklahoma) is pushing to make ER trained/boarded docs have to he a Current ACLS certificate to do moderat&deep sedation.

I want to fight his b/c I think this is ridiculous. I have worked for many years and I have not seen a hospital require ER docs to have ACLS for sedation.

#1 - Is the ACLS requirement common for deep&moderate sedation?
#2 - Is there a policy statement through one of our society ( like ACEP), that recommends or do not recommend the need for ACLS certification?

I would think that being boarded/Trained in EM would superseded the need for ACLS.

Thanks for any input in this

 

[cyclohexanol]

Hi Everyone,

I am an practicing attending and my Hospital (Oklahoma) is pushing to make ER trained/boarded docs have to he a Current ACLS certificate to do moderat&deep sedation.

I want to fight his b/c I think this is ridiculous. I have worked for many years and I have not seen a hospital require ER docs to have ACLS for sedation.

#1 - Is the ACLS requirement common for deep&moderate sedation?
#2 - Is there a policy statement through one of our society ( like ACEP), that recommends or do not recommend the need for ACLS certification?

I would think that being boarded/Trained in EM would superseded the need for ACLS.

Thanks for any input in this

Regulation and credentialing for moderate sedation is left up to local institutions. There isn't a specific ACLS requirement. JCAHO has some guidelines:

http://www.jointcommission.org/stan...x?StandardsFAQId=457&StandardsFAQChapterId=66

Each organization is free to define how it will determine that the individuals are able to perform the required types of rescue. Acceptable examples include, but are not limited to, ACLS certification, a satisfactory score on a written examination developed in concert with the department of anesthesiology, a mock rescue exercise evaluated by an anesthesiologist.

CMS has similar guidelines.



ACEP opposes requirements for ACLS etc for privileging or employment.

http://www.acep.org/Clinical---Prac...ne-as-Criteria-for-Privileging-or-Employment/

hope that helps

 

[EM_Rebuilder]

Who is pushing it?

Is this coming from Anes or from Admin? I think admin would be easier to convince; especially if Anes is on your side and supports EM physician doing sedation. If Anes is blocking/forcing this, its more difficult to change their mind and you would have to convince admin that anes is wrong. Much more difficult to do as most shops, anes is the gatekeeper to all sedation...

How busy is your shop? I would pull all the board EM physicians ACLS/code numbers. If you can show someone the policies mentioned above and the fact that each of you have worked 25 codes over the last year, it seems hard to argue..

 

[Janders]

AAEM has a similar policy statement.
http://www.aaem.org/em-resources/position-statements/1998/acls

We had to craft a separate hospital policy to allow ED procedural sedation (the primary "moderate sedation" policy only allowed opiate + benzo). When I did this, I made sure to list in the pre-amble that ACLS / PALS was a requirement for non-EM boarded physicians, but in EM boarded physicians it was NOT necessary. This caused about 2 minutes of discussion at a committee, where anesthesia and cardiology both agreed an ACLS requirement seemed silly, and wouldn't be too useful for sedation unless you've already killed the patient...

 

[Birdstrike]

Hi Everyone,

I am an practicing attending and my Hospital (Oklahoma) is pushing to make ER trained/boarded docs have to he a Current ACLS certificate to do moderat&deep sedation.

I want to fight his b/c I think this is ridiculous. I have worked for many years and I have not seen a hospital require ER docs to have ACLS for sedation.

#1 - Is the ACLS requirement common for deep&moderate sedation?
#2 - Is there a policy statement through one of our society ( like ACEP), that recommends or do not recommend the need for ACLS certification?

I would think that being boarded/Trained in EM would superseded the need for ACLS.

Thanks for any input in this

This has been going on for decades now. Yes, it is ridiculous for them to require this. In reality, it comes down to this: which is faster?

A-Fighting a policy (successfully or unsuccessfully) that has been entrenched for decades in Hospital departmental politics between the department of Anesthesia and the Department of Emergency Medicine (if your hospital even has one), or

B-Taking and passing an ACLS course.


B is fastest and easiest. A is best, but hardest.

Choose one.

 

[Daiphon]

B-Taking and passing an ACLS course.

B is much easier since you can do it online in about 20 minutes and claim it against your taxes. d=)

One of the best nuggets from one of my residency attendings: Fight the good fight, but always make sure you have a chance of winning...

-d

 

[Tiger26]

Maybe I'm in the minority, but I almost wish anesthesia were forced to come in for sedations--I've had consulting services ask me to do them "because they're too sick for anesthesia right now," they're a time suck in the ED, they lead to loss of situational awareness in the dept, and they don't even bill that well

 

[Daiphon]

Maybe I'm in the minority, but I almost wish anesthesia were forced to come in for sedations--I've had consulting services ask me to do them "because they're too sick for anesthesia right now," they're a time suck in the ED, they lead to loss of situational awareness in the dept, and they don't even bill that well

Wowie... wouldn't touch that with a 10ft. pole. If they're "too sick" for GETA, then IMHO they're too sick to procedurally sedate in the ED. In those cases, time for anesthesia to get creative.

-d

 

[Tiger26]

Wowie... wouldn't touch that with a 10ft. pole. If they're "too sick" for GETA, then IMHO they're too sick to procedurally sedate in the ED. In those cases, time for anesthesia to get creative.

-d

Yeah that's when I look at them and go "so they're too sick for anesthesia ....." In general, I'm fine with the short ones in relatively healthy people but not the longer stuff that bogs you down

 

[WilcoWorld]

You have CMS on your side on this one:
On January 14th, 2011 the Center for Medicare and Medicaid Services (CMS) issued the Revised Hospital Anesthesia Services Interpretive Guidelines. In this memorandum, CMS stated,“emergency medicine- trained physicians have very specific skill sets to manage airways and ventilation that is necessary to provide patient rescue. Therefore, these practitioners are uniquely qualified to provide all levels of analgesia/sedation and anesthesia (moderate to deep to general).”

 

[joeDO2]

This has been going on for decades now. Yes, it is ridiculous for them to require this. In reality, it comes down to this: which is faster?

A-Fighting a policy (successfully or unsuccessfully) that has been entrenched for decades in Hospital departmental politics between the department of Anesthesia and the Department of Emergency Medicine (if your hospital even has one), or

B-Taking and passing an ACLS course.


B is fastest and easiest. A is best, but hardest.

Choose one.

Option C: Take an instructor class and just teach 1 class a year to your department. You satisfy your requirements, have a reason to read up on the latest advances in resuscitation, and have the opportunity of dedicated time to let everyone in your department know how you want the details of your codes to be run. Win win for all.