Propofol or process: what really affects efficiency?

Due to increased public awareness, the number of endoscopic procedures performed per year is rapidly increasing. In lieu of expanding endoscopy units, current practices are being reviewed to improve unit efficiency without compromising patient care. Changing from a traditional medication regimen of demerol/versed or fentanyl/versed to propofol for moderate sedation is currently controversial. Studies using propofol are being conducted to measure recovery times, safety of administration by healthcare providers other than anesthesia providers, cost/benefit ratios, and patient satisfaction. In order to measure the benefits of propofol versus a traditional medication regimen, a retrospective review of 1,056 charts was conducted to evaluate the difference in procedure and post-procedure time between sedation groups before and after a process change. In this study, the use of propofol was associated with a statistically significant shorter mean procedure time (p <.001) and nonsignificant post-procedure time (p =.056) than a traditional regimen; however, a statistically significant reduction in mean times was demonstrated by changes in process (p <.001). The use of propofol demonstrated an actual total time savings of 5.3 minutes per case after the process change. This difference was not large enough for the authors to change current practice of traditional medication for moderate sedation when all other issues related to propofol were taken into consideration.