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

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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.

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Abbreviations

ED:

Emergency department

SPS:

Sedation Performance Score

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Funding

No honorarium, grant, or other form of payment was given to anyone to produce the manuscript. No funding received for this work from any organizations.

Author information

Authors and Affiliations

  1. Rappaport Faculty of Medicine, Technion-Institute of Technology, Haifa, Israel

    Meital Ben-Ari

  2. Pediatric Emergency Department, Rambam Health Care Campus, Haifa, Israel

    Gilad Chayen, Oren Feldman & Itai Shavit

  3. Simulation Laboratory, Rappaport Faculty of Medicine, Technion-Institute of Technology, Haifa, Israel

    Gilad Chayen

  4. Faculty of Medicine, University of Alberta, Edmonton, Canada

    Ivan P. Steiner

  5. Division of Emergency Medicine, Lurie Children’s Hospital of Chicago, Chicago, IL, USA

    Dana Aronson Schinasi

Authors
  1. Meital Ben-Ari
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  2. Gilad Chayen
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  3. Ivan P. Steiner
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  4. Dana Aronson Schinasi
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  5. Oren Feldman
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  6. Itai Shavit
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Contributions

Dr. MB-A: Designed the study and the analysis plan; collected, analyzed and interpreted the data; and critically revised the manuscript for important intellectual content. Dr. GC: Facilitated simulations; collected, analyzed and interpreted the data; and critically revised the manuscript for important intellectual content. Prof. IPS: Analyzed and interpreted the data, and critically revised the manuscript for important intellectual content. Dr. DAS: Interpreted the data, and critically revised the manuscript for important intellectual content. Dr. OF: Interpreted the data, and critically revised the manuscript for important intellectual content. Prof. IS: Designed the study and the analysis plan, drafted the manuscript, and analyzed and interpreted the data. Professor IS has full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Corresponding author

Correspondence to Itai Shavit.

Ethics declarations

Financial discloser

None declared for all authors.

Conflict of interest

For all authors, there are no potential conflicts of interest, real or perceived in the study design, the collection, analysis, and interpretation of data, the writing of the report, and the decision to submit the paper for publication.

Appendix

Appendix

Sedation Performance Score.

Pre-sedation evaluation

Done/not done

 Prior history of anesthesia or procedural sedation

 

 Time of last meal

 

 History of known side effect to medication

 

 Verifying nurse measurements of vital signs prior drug administrationa

 

 Verifying equipmentb

 

Performance during sedation

 

 Maintaining eye contact with patient throughout the procedure

 

 Titration of sedation medication per department protocolc

 

 Ensuring correct monitoringd

 
  1. aBlood pressure, heart rate, and oxygen saturation
  2. bBag and mask (proper sizes for patient’s age) connected to an oxygen supply valve, feed tube connected to a vacuum pump
  3. cKetamine in a loading dose of 1 mg/kg in combination with propofol in a loading dose of 1 mg/kg. Followed by propofol boluses of 1 mg/kg every 0.5–2 min as needed
  4. dPatient is connected to oxygen saturation and non-invasive end-tidal carbon dioxide monitoring (via nasal cannula)

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Ben-Ari, M., Chayen, G., Steiner, I.P. et al. The effect of in situ simulation training on the performance of tasks related to patient safety during sedation. J Anesth 32, 300–304 (2018). https://doi.org/10.1007/s00540-018-2460-5

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  • DOI: https://doi.org/10.1007/s00540-018-2460-5

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