Costs of sedation using oral midazolam: Money, time, and parental attitudes

Objective: Many agents suitable for pediatric outpatient sedation have been identified and compared, but less data have appeared on the effect of seda tion use on Emergency Department (ED) length of stay CLOS) or visit costs. We sought to discover the relationship between one commonly used method of sedation, orally administered midazolam, and ED LOS and visit costs. Parent s were then surveyed to determine their attitudes toward sedation given kno wledge of these costs. Methods: All ED patients under 10 years of age seen in a pediatric ED durin g April and May of 1996 for repair of lacerations < 2.5 cm in length were i dentified via retrospective chart review. Children were excluded if they ha d other significant injuries, received sedatives other than oral midazolam, or were repaired by non-ED physicians, Preliminary cost and LOS data from this review was used to create a parental survey measuring attitudes toward the costs of an unnamed form of sedation (not mentioning oral midazolam), A convenience sample of parents in an ED waiting room were asked if they wo uld want sedation administered to a child needing sutures if this increased the visit cost by $100 and/or increased LOS by 30 minutes. Parents were th en asked to re-answer these questions assuming that the sedation medication was effective only 50% of the time. Results: Of 120 patients meeting entry criteria, 57 (48%) received oral mid azolam. Children sedated with this agent mere significantly younger (3.6 vs 4.6 years, P = 0.015), had more layered repairs (30% vs 14%, P = 0.047), a nd more facial lacerations (84% vs 63%, P = 0.01) when compared with nonsed ated patients. Mean LOS for patients with simple lacerations receiving oral midazolam increased by 17.1 minutes (P = 0.03) compared with nonsedated ch ildren; for layered repairs, the mean increase was 30.9 minutes (P< 0.05). The use of oral midazolam did not effect physician charges, but did signifi cantly increase mean combined nurse/hospital charges and total charges by 7 3 to 87 dollars, depending on laceration type (P < 0.001 all cases). Of 81 parents surveyed, 81% said that they would be willing to wait 30 extra minu tes for sedation to be used; this figure fell to 73% if sedation was effect ive 50% of the time. Seventy-five percent of parents were willing to pay $1 00 extra for sedation; 67% if sedation was effective only half the time. Wi llingness to endure a longer LOS or pay increased charges was not associate d with parental sex or insurance status. Conclusion: The use of oral midazolam significantly increases ED visit LOS and cost. This information is important to review with parents when discuss ing sedation options. Up to one third of parents surveyed would not want to wait extra time or pay extra money for sedation to be administered, especi ally if the efficacy of the chosen method was not assured.