Patient and staff perceptions of short procedural sedation with propofol for joint and fracture reductions in the Emergency Department: A qualitative study

Background
Emergency Department (ED) propofol sedation is widely used to facilitate reduction of fractures and dislocations, but little is known about patient and staff perceptions of the practice. Better understanding of these aspects may improve patient care.

Methods
A qualitative exploratory study involving semi-structured patient interviews and ED healthcare professional focus groups. Interviews with adult patients (≥16 years) >1 hour after their sedation episode were audio-recorded, anonymised and transcribed verbatim to an electronic database. Thematic analysis using a general inductive method led to development of codes and themes. ED focus groups recordings were similarly transcribed and triangulated to patient interview outcomes.

Results
Data saturation was reached after 16 patient interviews. Emergent central themes from a patient perspective were: ‘fear of the unknown’ and ‘expressed relief that the procedure was comfortable.’ Key themes included ‘trust in the clinical team,’ ‘efficacy of pain management prior to sedation’ and ‘quality of the information delivered to patients.’ Focus group discussions around patient interview outcomes identified triage, analgesia delivery, communication, and consideration of the environment as areas for improvement.

Conclusions
ED procedural sedation with propofol is generally very well accepted by patients and clinical staff but there is scope to improve patient-focus and increase satisfaction.