Source: Blike GT, Christoffensen K, Cravero JP, et al. A method for measuring system safety and latent errors associated with pediatric procedural sedation.
Anesth Analg.
2005
;
101
:
48
–58.

Authors from Dartmouth-Hitchcock Medical Center in Lebanon, NH, used a pediatric simulator (Medical Education Technologies Inc.) to test the ability of providers in 2 common in-hospital pediatric sedation care settings (the radiology and emergency departments) to administer rescue therapy. The simulator scenarios presented a realistic clinical situation that required interventions to prevent severe cardio-respiratory compromise. The scenarios centered on the management of sedation-related airway obstruction and apnea in a pediatric patient. The simulator airway management scenarios were set to challenge the novice (medical students) but to be within reach of individuals with some airway management skills (second-year anesthesia residents). The subsequent “field tests” were videotaped, and simulator physiologic data recorded at 5-second intervals. The field tests were compared to a gold standard of a similar scenario managed by an experienced pediatric anesthesiologist. The video and audio field-test data were reviewed for deviations from best practice for event detection, diagnosis, and management. Simulator physiologic data were analyzed for time out of range of critical variables, such as oxygen saturation and blood pressure. A qualitative and quantitative analysis of each field test was made, and many care management problems were identified. The authors conclude that these types of simulations are potentially effective for identifying pediatric sedation system vulnerabilities and may provide opportunities to enhance patient safety.

Dr. Valley has disclosed no financial relationships relevant to this commentary.

The benefit of critical event analysis is well supported,1 yet because some catastrophic events are rare, the opportunity to learn from them is also rare. True critical events, although educational, are an obvious source of potential harm to patients, psychological stress for health care providers, and medical-legal ramifications for all. Simulated critical events may be an excellent way to educate health care personnel and to identify potential system problems that could be corrected before a real crisis occurs. Simulation labs currently are used to help train health care providers in the management of common as well as rare critical events.2 Simulation in the “field” adds the benefit of observing clinical scenarios in real-life settings. This may allow for identification of problems unique to a real critical event but hard to reproduce in a simulation lab.3 

Just as in the aviation industry, the health care system can benefit from using advanced simulation technology.4,5 Taking the technology out of the lab and into the field may enhance that benefit. Pediatric procedural sedation seems an excellent target for this preventive quality assurance.

There is nothing like a real pediatric resuscitation to get one’s adrenaline going! Simulation is the next best thing to experiencing a stressful event and improving one’s response to such an event. This study was unique in that, instead of using a simulation center, it brought the simulation to an environment where the event actually occurs. While such simulation...

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