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

Abstract

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.

Short and long arm cast and pain after discharge in children who underwent reduction of distal forearm fracture in the Emergency Department: A study protocol for a randomized comparative effectiveness study

“…Ketamine will be provided in a loading dose of 1 mg/kg, followed by propofol in a loading dose of 1 mg/kg. Additional boluses of 1 mg/kg of propofol and/or ketamine every 1–2 min will be administered as necessary [ 20 ].…”

<p>The Use of in situ Simulation in Healthcare Education: Current Perspectives</p>

“…Simulation in anesthetic skills was directed at both anesthetists but also non-anesthetists. 19,32 In situ simulation for anesthetists was carried out in the operating room to practice tracheal intubation. 19 Non-anesthetists practiced sedation skills in pediatric emergency settings.…”

“…19 Non-anesthetists practiced sedation skills in pediatric emergency settings. 32 A study in a mental health triage ward focused on medically deteriorating patients in a mental health setting, choosing priority training needs for the staff with scenarios such as respiratory distress, diabetic • Paediatric ED 1,12,13,16,22,23,27,28,32 • Adult ED 11,18,24,25,29, • Neonatal resuscitation 39 • Obstetrics and gynaecology 20,21,26,30,31 • Mental health 33 • Neurology 37 • ICU 35 • Anaesthetics 17,32 • Primary care 34 • General 14,36 Aim • Low-fidelity 11,27 • Medium fidelity 13 • High-fidelity 15,33,39 • Multi-centre design 12,22,23,25,34,36,39 Scheduling…”

“…• No evaluation 27,28 • Instructors during simulation watching 11,15,[24][25][26] • video recorded and assessed 16,29,39 • pre-post simulation survey 12,13,18,[21][22][23]30,34,35,37 • interviews or focus groups 31,33 • measured quality improvement 11,33 • assessed technique 17,19,32 • post simulation knowledge or confidence test 21,38 • comparing two methods of simulation…”

Training in pediatric anesthesia in Japan: how should we come along?

“…Subsequently, there are rising trends of minimally invasive surgeries including robotic surgery [18] and sedation or anesthesia outside the operating room [19][20][21]. Although these practices are not different in pediatric and adult patients, they may offer unique challenges, requiring the anesthesiologists' scrupulous knowledge and comprehension on the associated anatomical and physiological considerations in pediatric patients [22].…”