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August 2007

Enhancing Patient Safety During Pediatric Sedation: The Impact of Simulation-Based Training of Nonanesthesiologists

Author Affiliations

Author Affiliations: Emergency Department, Meyer Children's Hospital, Rambam Medical Center, Haifa (Drs Shavit and Hoffmann), Division of Anesthesiology and Intensive Care (Drs Keidan and Mishuk) and Israel Center for Medical Simulation (Dr Ziv), Sheba Medical Center, Tel Hashomer, and National Institute for Testing and Evaluation, Jerusalem (Dr Rubin), Israel; and Departments of Family Medicine and Emergency Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada (Dr Steiner).

Arch Pediatr Adolesc Med. 2007;161(8):740-743. doi:10.1001/archpedi.161.8.740

Objective  To evaluate the impact of simulation-based education on patient safety during pediatric procedural sedation.

Design  A prospective, observational, single-blind, controlled study of pediatric procedural sedation outside the operating room.

Setting  Two university teaching hospitals in Israel.

Participants  Nonanesthesiologists, with or without training in simulation-based education on patient safety, who routinely perform procedural sedation outside the operating room. These comprise full-time pediatricians practicing emergency medicine and a cohort of pediatric gastroenterologists.

Intervention  The study investigators used the internally developed, 9-criteria Sedation Safety Tool to observe and evaluate nonanesthesiologists who were trained in sedation safety and compared their performance with that of colleagues who did not receive similar training.

Outcome Measure  For each of the 9 criteria on the evaluation form, odds ratios and 95% confidence intervals were calculated to compare the actions of the individuals in the 2 study groups.

Results  Thirty-two clinicians were evaluated. Half of the physicians were graduates of the simulation-based sedation safety course. Significant differences in performance pertaining to patient safety were found between those physicians who did and those who did not complete simulation-based training.

Conclusions  Pediatric procedural sedations conducted by simulator-trained nonanesthesiologists were safer. The simulation-based sedation safety course enhanced physician performance during pediatric procedural sedation.