Introduction: Pediatric sedation performed by non-anesthesiologists has become common practice in recent years. Patient safety during these procedures remains a principle concern due to the varying skillsets of the physicians who perform these sedations, as well as lack of uniformity in training. The objective of this study was to examine whether in-situ simulation training has an impact on the practice of safe sedation.
Methods: We performed a prospective study evaluating the performance of sedation providers pre and post in-situ simulation training. Providers were observed and evaluated during a pediatric sedation as part of their usual practice, using the previously validated Sedation Safety Tool (SST). Following the sedation, providers completed an in-situ sedation simulation followed by a structured debriefing; they were re-evaluated with the SST during a subsequent sedation in the pediatric ED. Odds ratios and confidence intervals were calculated for each of the 8 SST components, and compared pre- and post- our in-situ simulation training.
Results: Sixteen providers (10 residents, 6 attending physicians) completed a total of 32 pediatric sedations, 16 before and 16 after the in-situ simulation training session, during the study period. SST scores improved from a median of 4 [IQR, 2-5] to 6 [IQR, 4-7] following our in-situ simulation (p<0.0009, median difference 2, 95% CI 1 to 3). In-situ simulation training had the greatest effect on the performance of four key tasks related to patient safety.
Discussion: The findings of this study suggest that in-situ simulation training results in a safer practice of sedation by non-anesthesiologists.
