Reply to Drs Heuss and Beglinger

We thank Dr. Heuss and Dr. Beglinger for their interest in our paper. We would agree, firstly, that sedation forms part of the procedure and does have associated risks, and secondly that complications data should form part of the quality assurance (QA) database. At the time of our data collection, we had a computerized system for endoscopy reporting that included the dose of sedation used, but the nursing staff kept a written record of sedation dose, oxygen saturations, and the need for reversal agents or any other sedation-related complications. We used the system as it stood and collected relevant data by hand, matching written nursing records to printed procedure reports and entering all the QA data manually into a single database. Our aim has since been to computerize this whole process, and we now have nursing pre-assessment, intraprocedural observations, and postprocedural observations recorded on the same computer system and linked to the procedure report. This ensures that any complications occurring within the endoscopy department are picked up. However, as far as we are aware, this type of integrated system is still relatively unusual in everyday practice. Accurate reporting of sedation complications is vital, but as with QA as a whole, it needs effort and resources to ensure success.