PMID- 35226626
OWN - NLM
STAT- MEDLINE
DCOM- 20220302
LR  - 20230930
IS  - 1535-1815 (Electronic)
IS  - 0749-5161 (Linking)
VI  - 38
IP  - 3
DP  - 2022 Mar 1
TI  - A Brief, Just-in-Time Sedation Training in the Pediatric Emergency Department 
      Improves Performance During Adverse Events Encountered in Simulated Procedural 
      Sedations.
PG  - e1030-e1035
LID - 10.1097/PEC.0000000000002657 [doi]
AB  - BACKGROUND: Procedural sedation (PS) is commonly performed in emergency 
      departments (EDs) by nonanesthesiologists. Although adverse events (AEs) are 
      rare, providers must possess the clinical skills to react in a timely manner. We 
      previously described residents' experience and confidence in PS as part of a 
      needs assessment. We found that their ability to perform important clinical tasks 
      as a result of the usual training experience demonstrates educational needs. We 
      developed an educational intervention to address the deficiencies uncovered 
      during our needs assessment. OBJECTIVE: To evaluate the effectiveness of an 
      educational intervention on pediatric residents' clinical performance and 
      confidence when faced with an AE during a simulated PS. METHODS: This was a 
      prospective observational cohort study of residents at a tertiary care children's 
      hospital. All ED attending physicians and fellows were trained in uniform 
      delivery of the educational intervention, which was delivered extemporaneously at 
      the bedside ("Just-in-Time" [JIT]) to all residents performing PS on actual 
      patients in the pediatric ED, over the course of 1 year. Subjects completed the 
      following both before and after the educational intervention: a survey pertaining 
      to confidence in PS, followed by a standardized, video-recorded simulated PS 
      complicated by apnea and desaturation. Clinical performance was evaluated and 
      assessed both in real time and by a video-rater blinded to participants' year of 
      training. We summarized baseline resident characteristics, confidence 
      questionnaire item rankings and success in both the preparation and AE tasks. We 
      compared successful task completion and time to task completion before and after 
      intervention. RESULTS: Forty residents completed both the PRE and POST phases of 
      the study. There was significant improvement in the proportion of residents who 
      completed both preparation and AE tasks after the JIT training. Specifically, 
      there was a significant improvement in the proportion of residents who performed 
      positive-pressure ventilation to treat an apneic event associated with 
      desaturation during the PS (P = 0.007). Residents' confidence scores also 
      significantly improved after the training. CONCLUSION: A brief JIT training in 
      the pediatric ED improves resident clinical performance and confidence when faced 
      with an AE during a simulated PS. Future direction includes correlating this 
      improved performance with patient outcomes in PS.
CI  - Copyright (c) 2022 Wolters Kluwer Health, Inc. All rights reserved.
FAU - Schinasi, Dana Aronson
AU  - Schinasi DA
AD  - From the Northwestern University Feinberg School of Medicine, Division of 
      Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, 
      Chicago, IL.
FAU - Colgan, Jennifer
AU  - Colgan J
AD  - From the Northwestern University Feinberg School of Medicine, Division of 
      Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, 
      Chicago, IL.
FAU - Nadel, Frances M
AU  - Nadel FM
AD  - Perelman School of Medicine at the University of Pennsylvania, Division of 
      Emergency Medicine.
FAU - Hales, Roberta L
AU  - Hales RL
AD  - Center for Simulation, Advanced Education, and Innovation, The Children's 
      Hospital of Philadelphia, Philadelphia, PA.
FAU - Lorenz, Douglas
AU  - Lorenz D
AD  - Department of Bioinformatics and Biostatistics, University of Louisville, KY.
FAU - Donoghue, Aaron J
AU  - Donoghue AJ
AD  - Perelman School of Medicine at the University of Pennsylvania, Divisions of 
      Critical Care and Emergency Medicine, The Children's Hospital of Philadelphia, 
      Philadelphia, PA.
LA  - eng
PT  - Journal Article
PT  - Observational Study
PL  - United States
TA  - Pediatr Emerg Care
JT  - Pediatric emergency care
JID - 8507560
SB  - IM
MH  - Child
MH  - Clinical Competence
MH  - Emergency Service, Hospital
MH  - Humans
MH  - *Internship and Residency
MH  - Prospective Studies
MH  - Surveys and Questionnaires
COIS- Disclosure: The authors declare no conflict of interest.
EDAT- 2022/03/01 06:00
MHDA- 2022/03/03 06:00
CRDT- 2022/02/28 17:10
PHST- 2022/02/28 17:10 [entrez]
PHST- 2022/03/01 06:00 [pubmed]
PHST- 2022/03/03 06:00 [medline]
AID - 00006565-202203000-00012 [pii]
AID - 10.1097/PEC.0000000000002657 [doi]
PST - ppublish
SO  - Pediatr Emerg Care. 2022 Mar 1;38(3):e1030-e1035. doi: 
      10.1097/PEC.0000000000002657.