Format

Send to

Choose Destination
Simul Healthc. 2012 Apr;7(2):81-94. doi: 10.1097/SIH.0b013e31823b9923.

Pilot-phase findings from high-fidelity In Situ medical simulation investigation of emergency department procedural sedation.

Author information

1
Department of Emergency Medicine, Brown University; and Medical Simulation Center, Rhode Island Hospital, Suite 106, Coro West Bldg, 1 Hoppin St, Providence, RI 02903, USA. LKobayashi@lifespan.org

Abstract

INTRODUCTION:

Emergency department procedural sedation (EDPS) is becoming widespread. Simulation may enhance patient safety through evidence-based training, effective assessment, and research of EDPS operators in pertinent knowledge, skills, processes, and teamwork.

METHODS:

Investigators developed a 2-scenario in situ simulation-based methodology and research tool kit for objective examination of EDPS practice. The emphasis was on protocol-driven presedation preparation, intrasedation vigilance and readiness for adverse events, and postsedation reassessment. Pilot sessions were conducted to test the methodology at an academic 719-bed hospital, with Institutional Review Board approval.

RESULTS:

Five interns and 5 attending emergency physicians completed pilot sessions resulting in protocol revisions to optimize simulation consistency, research tool sets, data acquisition, and operational conditions. Pilot data sets demonstrated interscenario consistency and intersubject reproducibility for timing, progression, and duration of critical EDPS events; high levels of perceived realism and relevance; and utility and suggested validity of the study methodology as an EDPS research mechanism. Small sample sizes limited the study methodology's ability to distinguish between the subject groups' clinical performances (critical action completion, probe detection, and situational awareness) except with composite scoring of presedation and postsedation assessments. Key EDPS preparation, adverse event management, and reassessment actions were selected to derive a Simulation EDPS Safety Composite Score that differentiated inexperienced [4.60 ± 0.8 on a 10-point score (n = 3)] and experienced EDPS operators [8.95 ± 1.03 (n = 5); P = 0.0007].

CONCLUSIONS:

In situ simulation is a useful and relevant means to investigate EDPS patient safety. Pilot sessions have cleared the way for further experimental safety intervention research and development with the simulation-based methodology.

PMID:
22286554
DOI:
10.1097/SIH.0b013e31823b9923
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Wolters Kluwer
Loading ...
Support Center