• Charene Wood, Colleen Hurley, Julie Wettlaufer, Michelle Penque, Steven H Shaha, and Kathleen Lillis.
• Women and Children's Hospital of Buffalo, Buffalo, NY 14222, USA. Charene.wood@utoronto.ca
• Pediatr Emerg Care. 2007 Oct 1;23(10):709-12.

ObjectivesTo determine if use of nurse practitioners (NPs) for procedural sedation and analgesia (PSA) compared with physicians (MDs) decreased overall length of stay (LOS) in the pediatric emergency department (PED).MethodsRetrospective chart review was conducted on all children (age <21 years) undergoing procedural sedation and analgesia (PSA) for 36 consecutive months at a tertiary academic children's hospital (n = 690). Data included times values for triage, evaluation by practitioner (NP, MD), sedation, discharge, and total LOS in the PED. Data collected also included medications given, patient diagnosis, and severe airway complications.ResultsResults revealed statistically significant time-related advantages to NP-managed sedations. Both PED LOS and time to sedation were significantly lower for NPs versus MDs across diagnoses (P < 0.01). The diagnoses managed by MDs versus NPs were significantly different for 3 diagnoses: fracture, finger, and lacerations. There were no differences between NP and MD for severe airway complication rates.ConclusionsOverall LOS and time to sedation were significantly improved when NPs independently managed patients requiring PSA without an increase in documented severe airway complication rates.

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