Rethinking sedation: Inside an innovative cross-team collaboration reshaping paediatric eye care

It looks like an ordinary room in the Ophthalmology Clinic at The Hospital for Sick Children (SickKids), with a few exceptions. The lights are low. A nurse adjusts the monitor while an anesthesia assistant checks another. After a gentle kiss goodbye from her mother before she leaves, a child drifts off to sleep on a bed in the middle of the room, her breathing steady and slow. Around her, the clinical team works with tenderness in quiet synchronicity. The room feels calm.

What’s happening is more than a smooth test or a comforting scene. It marks a meaningful shift in how families access ophthalmology care at the hospital.

In this moment, the child is drifting to sleep under IV sedation, an approach never before used in a paediatric ophthalmology clinic of its kind in Canada. Led by nurses within the hospital’s Department of Ophthalmology and Vision Sciences and the Integrated Sedation Service team, the Ophthalmology Expanded IV Sedation Program at SickKids is changing how families experience care in the Ophthalmology Clinic — easing pressure on the operating room, shortening wait times, and bringing procedures to more familiar, comfortable spaces.

Like many hospitals across the country, SickKids continues to manage high surgical volumes, meaning even simple ophthalmology cases could face lengthy waits for the OR.

“Before, many tests or procedures requiring IV sedation would have to be done in the OR. Being able to do it in clinic can be less anxiety-provoking,” said Jennifer Colaco, a Registered Nurse in the Ophthalmology Clinic who helped facilitate the new program. “The kids know us. The families know us. And they’re not waiting months for a spot.”

In the Ophthalmology Clinic, sedation can be a crucial way to help keep young patients still, calm, and safe.  For complex diagnostic exams and procedures that require a deeper level of anesthesia, known as general anesthesia, patients are referred to the OR where staff are equipped to deliver it safely.  

For minor procedures requiring sedation in clinic, oral medication — most commonly chloral hydrate, a syrupy liquid known for its bitterness — had been used for decades.  

“It’s standard for clinic sedation, but for some it can be tough to take because of the taste,” says Dr. Tobias Everett, who is the Associate Chief (Clinical) of the Department of Anesthesia and Pain Medicine. “And it doesn’t reliably give a good sedative effect, in which case families would need to be sent home and rebooked for another attempt.” 

The proposed model, IV sedation in the clinic, offered a middle ground. The team could provide a deeper, more reliable level of sedation than oral medication, but not as deep as a general anesthetic. 

The idea was sparked by nursing leadership. Katie Anawati, Senior Clinical Manager for the Operating Room and Ophthalmology, saw potential for a new approach. She went to Dr. Everett with a question in July 2024: Could anesthesia assistants collaborate with nurses to provide IV sedation right in the Ophthalmology Clinic? It was a simple hallway conversation, but one with big implications. 

“We were looking at a growing waitlist, and I remember thinking, ‘why can’t we do this differently?’” said Anawati. “We had the right people, the right training, and the motivation to improve the experience for kids. It just made sense to try.” 

Clinic nurses, who were already sedation trained, stepped up to receive additional IV insertion training and completed their Pediatric Advanced Life Support (PALS) certification.  Anesthesia assistants Courtney Gregorian and Christine Le represented the Integrated Sedation team in the development and implementation of the project and began rotating into the clinic.  From idea to implementation, this interprofessional team of nurses, anesthesia assistants and ophthalmologists identified a need, shaped the model, and collaborated closely to ensure a smooth launch.  

A few months later, in September 2024, the Ophthalmology Expanded Sedation Program was born. Now, the team offers IV sedation in the clinic once per week.  

Making eye care easier for children and youth 

The method is not only more comfortable, but more efficient: up to five patients can now be seen in a day — in the clinic, not the OR. Since launch, the program has supported more than 88 successful cases, reallocated more than 22 days of OR time which helped lower the surgical waitlist, and earned the team the 2025 Nursing Excellence Award for Innovation.  

“It’s a more comfortable space, and it saves them time. Here, caregivers are part of the experience. They can accompany their child in the room until the procedure begins,” says Li Lim, a registered nurse in the clinic who also facilitates the program.  

For Dimple Patel and her five-year-old daughter Mila, who lives with global developmental delay, the change was tangible. Mila had been to the  Ophthalmology Clinic before, but prior visits ended in frustration and rebooking.  

“She was there to get her eyes checked, but it's hard for her to sit still,” Patel says. “It was tough, not because the staff weren’t amazing (they were), but because she just couldn’t tolerate it.” 

With IV sedation, the experience changed. Mila was able to undergo the full assessment, and the visit was less stressful for both Mila and her mom.  

“We were in the same clinic, with the same team we already knew,” Patel says. “It was smoother, faster, and she even got to take home a toy she fell in love with.” 

That toy is still her favourite. 

This past spring, the team behind the program received the 2025 SickKids Nursing Excellence Award for Innovation.  

“Our team is small but mighty,” said Jennifer. “We’re using more of our skills than ever before. We saw a better way, and we made it happen.” 

Meet the Ophthalmology Expanded IV Sedation Team