Caring Wisely FY 2023 Project Contest

Sedation Suite for hem/onc procedures (LPs and BMAs) in Oakland

Proposal Status: 
  • PROPOSAL TITLE: Create sedation suite (either in Hem/Onc Treatment Room or PICU) for BCH Oakland
  • PROJECT LEAD(S): not sure if anesthesia, surgical services or oncology should lead
  • ABSTRACT - One paragraph summary of your proposed initiative – Limit 1500 characters (with spaces) Establish a sedation suite where either anesthesia or PICU attending uses Propofol only for light sedation for Oakland hem/onc/BMT patients requiring lumbar puncture or bone marrow aspirate/biopsy.  This is standard in most pediatric hem/onc centers around the country (including San Francisco/Mission Bay I believe)
  • TEAM - Core implementation team members and titles
  • PROBLEM - Background of the problem.  What is the cost associated with this problem?  Why address this problem now? What is the current condition?  Currently Oakland pediatric Hem/Onc/BMT patients get their LPs and BMAs done in the OR.  OR Block time is very limited and does not always correspond with dates that therapy is due.  Patients (most of whom are 1-10 year old leukemia patients) repeatedly having to wait/remain NPO for extended periods of time.  The OR is extremely inefficient in terms of flow and there are limited resources (rooms, RNs, techs, anesthesiologists) so turnover is very slow.  Hem/Onc provider time also wasted waiting for turnover.  The delays are the #1 complaint lodged by parents of these patients.  The problem has gotten worse in recent months with OR room remodeling and loss of many of our anesthesiologists
  • TARGET -  What is the goal?  What are the expected benefits, both qualitative and quantitative?  Reduce wait time and turnover time for pediatric onc patients who have mutiple procedures throughout their treatment
  • GAPS - Why does the problem exist?  Describe system issues; technological gaps; educational gaps.  No champion to push for creation of designated space for these procedures. inefficiency built into the current system
  • INTERVENTION - Describe your proposed intervention and rationale for approach. Describe your practice setting and target population (e.g. department, unit, clinic, patient characteristics, diagnosis group, procedural group, provider characteristics, staff characteristics, etc.). Describe potential barriers to implementation. What are the possible adverse outcomes that may occur that may affect quality of care and patient safety as a result of your proposed intervention?  Same as abstract
  • PROPOSED EHR MODIFICATIONS Note: EHR modifications are NOT required for a winning proposal
    • What are the clinical problems you are hoping to solve with APeX?
    • What APeX tools (patient lists, reports) or workflows (orders, documentation, alerts) are you using now to achieve this goal? How would you want these modified?  Might need to create a new "location" within Apex since procedure would no longer be in OR.  Probably something already exists since this is the current model at Mission Bay campus
    • What new APeX tools/workflows do you think you need to achieve the goals of your project? none
  • COST - Estimated baseline costs to the health system and projected savings from the proposed project.  I don't have the means to estimate these costs but the current system causes so much extra manual manipulation and coordination that there would be savings from making the system more efficient
  • SUSTAINABILITY - If successful, how will this intervention be sustained beyond the funding year?  Who are the key UCSF process owners?  Once established the sedation suite would perpetuate itself 
  • BUDGET - Line-item budget up to $50,000 - Briefly identify key areas of the project that will require funding, e.g., salaries, software, printing, etc


This is a significant pain point for patients and families that have to get multiple LPs/BMAs throughout their treatment. Having a dedicated sedation suite could decrease NPO and improve patient/family satisfaction. This is standard at most large oncology practices. 

Additional cost savings to consider: procedures that can be safely done in a sedation suite are currently being booked in ORs, freeing up that time would increase revenue potential of the ORs.

This is the way that many high volume centers function with a sedation service providing appropriate anesthesia for patients receiving routine procedures outside of the OR. With sufficient planning and collaboration, I think this would make a huge impact on quality of life for patients, families and providers as well as reduce the burden on the OR. It also may facilitate the involvement of ancillary services (such as child life, etc) in periprocedural management. I strongly support this.

I strongly support this. This is standard at most academic oncology centers. Though requiring planning and collaboration, this would make a huge impact on quality of life for our patients, families, and providers in hematology/ oncology as well as OR providers. Additionally, at the hospital level, after upfront investment in organization and multi-disciplinary support, this should lead to cost savings, as would be cheaper than using ORs, and would free up ORs for OR-requiring procedures.