8. Sedation and Monitoring
INTRODUCTION
SEDATION TECHNIQUES
PATIENT MONITORING
RECOMMENDATIONS
CHAPTER REFERENCES
n = number of cases where information was provided

 

POST-ENDOSCOPY RECOVERY

Key point
8% of patients who had their endoscopy in a dedicated endoscopy room went immediately
to a ward without apparent recovery facilities.

Where answered, 76% (1,349/1,786) of patients had their endoscopy in a dedicated endoscopy room. Immediate post-procedural locations are shown in Table 26.

Table 26. Post-procedure location for patients who underwent endoscopy in
a dedicated endoscopy unit
Location
Total
(%)
Dedicated recovery area within the endoscopy unit
1,160
(88)
General or other ward
105
(8)
ICU/HDU
33
(3)
Dedicated recovery area within an operating theatre’s department
18
(1)
Died in the endoscopy suite
5
(<1)
Transferred to surgery
1
(<1)
Sub-total
1,322
Not answered
27
(2)
Total
1,349

The practice of returning a patient directly to a general ward after endoscopy may be unsafe.

Case Study  
A patient with alcoholic liver disease (Childs-Pugh score B), non-insulin dependent diabetes and poor LV function was admitted on a Friday following a haematemesis. Two days later (Sunday morning) they underwent a gastroscopy and injection of oesophageal varices under sedation in a dedicated endoscopy room. Following the procedure the patient was returned directly to the general ward. That evening the patient went into respiratory failure. Chest x-ray was consistent with left and right lower lobe consolidation, and the patient died at 01.30 the following morning.

The organisational questionnaire completed for this hospital indicated that there was
a dedicated recovery unit and the advisors’ view was that had this been used it may have assisted the patient's progress.

It is not acceptable that 8% (105/1,349) of patients who had their endoscopy in a dedicated endoscopy unit went from there directly to a ward, especially those who had received sedation. It represents a failure of organisation for the patient's post-procedure care that should be addressed by the endoscopist and their hospital. Following endoscopy, patients should be nursed in an area that has similar equipment and staff to that recommended for
a recovery facility. This applies regardless of the timing of the procedure. A ward providing level 1 care is an area that is unlikely to have dedicated recovery staff or appropriate facilities. The BSG 6 stress the importance of a fully-equipped recovery area in proximity
to the endoscopy room, which should include pulse oximetry, piped oxygen and suction, electronic blood pressure cuffs, facilities for ECG monitoring and tipping trolleys, as well
as full resuscitation equipment. (For the survey of endoscopy suite facilities see the earlier chapter entitled ‘Organisational issues’).

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