Procedural sedation and its place in paediatric emergency medicine

Krauss, Baruch; Green, Steven M.

doi:10.1136/emermed-2016-205743

Cited by 5 publications

(2 citation statements)

References 9 publications

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“…Other countries report similar gaps between adult and paediatric PSA in the ED [ 13 , 14 ]. McCoy et al addressed the challenges of practice and provision of paediatric PSA in the UK and Ireland.…”

Section: Discussionmentioning

confidence: 68%

Procedural sedation and analgesia practices by emergency physicians in the Netherlands: a nationwide survey

et al. 2017

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BackgroundSeveral efforts have been made to assure and to improve the quality of procedural sedation and analgesia (PSA) performed by emergency physicians (EPs) in The Netherlands. This study investigated the current PSA practice and competences of EPs in both adult and paediatric patients. In particular, if residency and current training, awareness of guidelines is sufficient for registered EPs to adequately perform PSA and if the availability of both adult and paediatric PSA in the ED is adequate.MethodsA cross-sectional nationwide survey was performed amongst Dutch EPs (n = 463) in June 2016. We collected data on background, training, practice, and competencies of both adult and paediatric PSA. We investigated guideline adherence, reasons for not performing PSA, and desired improvements.ResultsThe respondents (n = 191) represented 84.6% hospitals with EPs and 41.3% of all EPs in The Netherlands. Nearly all EPs (97.8%) performed PSA in adult patients compared to only 59.1% who performed PSA in paediatric patients (p < 0.001). The major reason for not performing paediatric PSA was caused by a lack of exposure during the training-program (74.1%). PSA-guideline knowledge (98.3%) and PSA related adverse event registration (98.3%) were excellent. Lack of 24/7-availability of both adult and paediatric emergency department PSA was mainly caused by a shortage of EPs. Self-reflection indicated that EPs feel less competent in performing paediatric PSA when compared to adult PSA.ConclusionThis nationwide survey demonstrates that there is still a significant gap between the performance of adult and paediatric PSA even though guideline adherence and registration of PSA-related adverse events appear to be adequate. Enhancement of paediatric PSA training in combination with an increase of EP-staffing can help improve the availability of adult and paediatric PSA in the emergency department.Electronic supplementary materialThe online version of this article (10.1186/s12245-017-0159-2) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 68%

Procedural sedation and analgesia practices by emergency physicians in the Netherlands: a nationwide survey

et al. 2017

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“…In North America, PSA is commonplace, 15 and in Europe, it has been gaining more and more acceptance in the last few years. 16,17 However, in Italy, many obstacles remain, especially regarding moderate and deep sedation.…”

Section: Introductionmentioning

confidence: 99%

Quality Improvement Initiative Using Blended In Situ Simulation Training on Procedural Sedation and Analgesia in a Pediatric Emergency Department

et al. 2021

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IntroductionThere is evidence in the literature for high-fidelity in situ simulation training programs being an effective modality for physicians training. This quality initiative focused on implementation of the procedural sedation and analgesia (PSA) in our pediatric emergency department (PED). The primary outcomes of this study were to evaluate the impact of blended in situ simulation training (BST) program on PSA for closed forearm fracture reduction in the PED and to assess its cost-effectiveness. The secondary outcomes were to estimate this change on PSA's clinical efficacy and safety.MethodsBetween 2014 and 2018, a single-center, quasi-experimental, uncontrolled before and after study on forearm fracture reduction management was conducted. To assess the impact of our BST-PSA course, both historical control and prospective analyses were performed. Statistical significance was based on Fisher exact test or Pearson χ2 test.ResultsEight hundred eighty-five children met inclusion criteria. A significant difference in the number of PSAs performed in the PED, before and after BST, was found (37% vs. 85.3%, P < 0.001). Furthermore, a reduction in the number of hospitalizations for closed fracture reduction was measured (68.2% vs. 31.8%, P < 0.001). The overall cost savings from the BST-enabled increase in PSAs carried out in the PED was €370,714 ($440,838) with a return on investment of 64:1. No significant increase of PSA-related adverse events was found, and no serious adverse events occurred.ConclusionsFindings provide evidence of the benefits of implementing BST to enable PSA use in the PED, with an improved patient flow and significant cost savings from avoiding unnecessary hospitalizations.

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The effect of in situ simulation training on the performance of tasks related to patient safety during sedation

et al. 2018

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In many countries, procedural sedation outside of the operating room is performed by pediatricians. We examined if in situ sedation simulation training (SST) of pediatricians improves the performance of tasks related to patient safety during sedation in the Emergency Department (ED). We performed a single-center, quasi-experimental, study evaluating the performance of sedation, before-and-after SST. Sixteen pediatricians were evaluated during sedation as part of their usual practice, using the previously validated Sedation-Performance-Score (SPS). This tool evaluates physician behaviors during sedation that are conducive to safe patient outcomes. Following the sedation, providers completed SST, followed by a structured debriefing. They were then re-evaluated with the SPS during a subsequent patient sedation in the ED. Using multivariate regression, odds ratios were calculated for each SPS component, and were compared before and after the SST. Thirty-two sedations were performed, 16 before and 16 after SST. SPS scores improved from a median of 4 (IQR 2-5) to 6 (IQR 4-7) following SST (p < 0.0009, median difference 2, 95% CI 1-3). SST was associated with improved performance in four SPS components. The findings of this pilot study suggest that sedation simulation training of pediatricians improves several tasks related to patient safety during sedation.

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Procedural sedation and its place in paediatric emergency medicine

Cited by 5 publications

References 9 publications

Procedural sedation and analgesia practices by emergency physicians in the Netherlands: a nationwide survey

Procedural sedation and analgesia practices by emergency physicians in the Netherlands: a nationwide survey

Quality Improvement Initiative Using Blended In Situ Simulation Training on Procedural Sedation and Analgesia in a Pediatric Emergency Department

The effect of in situ simulation training on the performance of tasks related to patient safety during sedation

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