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Improving Sedation Selection in GI Endoscopy Using an Evidence-Based Primary Care Screening Tool
Dissertation

Improving Sedation Selection in GI Endoscopy Using an Evidence-Based Primary Care Screening Tool

Jennifer Easler
University of Iowa
Doctor of Nursing Practice (DNP), University of Iowa
Spring 2026
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Abstract

Background: Sedation misclassification at the time of gastrointestinal consult placement can delay identification of patients requiring monitored anesthesia care, contributing to workflow inefficiencies and potential safety risks. National guidelines recommend structured pre procedural risk assessment; however, variability in primary care provider (PCP) understanding of sedation risk criteria contributes to inconsistent decision making at the point of referral. At the project site, GI procedures are often scheduled months in advance, and misclassification is frequently discovered only during the week before procedural review, resulting in delays or cancellations that may postpone care by an additional three to six months. Purpose: The purpose of this quality improvement project was to reduce sedation misclassification during primary care GI consult placement by implementing a standardized sedation screening tool and evaluating its impact on provider reported confidence, understanding of sedation risk criteria, and perceived clarity of the consult workflow. Methods: A pre–post survey design was used to assess PCP confidence, understanding of sedation risk criteria, and workflow clarity before and after implementation. The intervention consisted of a two-part structured sedation screening tool developed for this project, incorporating guideline based clinical safety prompts and the validated High Conscious Sedation Risk (HCSR) score. All 36 PCPs within a primary care group were invited to participate: seven completed surveys (19.4% response rate). Survey responses were measured using six-point Likert type scales and summarized descriptively. Findings: Survey respondents reported low baseline confidence in sedation selection and limited clarity in the existing consult workflow. Following implementation, providers reported improved confidence in identifying sedation risk factors, greater clarity in the revised consult process, and reduced anticipated sedation related delays. All respondents indicated that the screening tool added value to consult placement and supported more consistent decision making. Discussion: Embedding a structured sedation screening tool within the primary care consult workflow standardized sedation risk assessment, supported more consistent evidence-based decision making, and has the potential to reduce downstream delays and cancellations associated with sedation misclassification.
 sedation selection gastrointestinal endoscopy monitored anesthesia care moderate sedation pre-procedure risk assessment clinical decision support

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