Same patients, same critical events--different systems of care, different outcomes: description of a human factors approach aimed at improving the efficacy and safety of sedation/analgesia care.
The practice of sedating pediatric patients undergoing diagnostic and therapeutic procedures represents an ideal model for evaluating systems of health care delivery. We present detailed evidence of how different systems acting on the same patient under similar conditions result in very different outcomes. In contrast to epidemiological methods, our research follows a Human Factors approach of observing a small number of representative cases in great detail to characterize the critical components and processes of ideal sedation care. In this descriptive article we present a framework by which this work domain can be codified and evaluated. We conclude with a demonstration of how a patient simulator can be used to quantify responses to sedation emergencies. These data constitute the basis for innovating novel sedation care systems and strategies that will optimize safety and efficacy.
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Department of Anesthesiology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.
Cravero
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Nelson
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D000700:Analgesics / Q000008:administration & dosage* / Q000009:adverse effects; D001007:Anxiety / Q000517:prevention & control; D002648:Child; D002675:Child, Preschool; D016292:Procedural Sedation / Q000523:psychology; D006302:Health Services Research; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage* / Q000009:adverse effects; D007049:Iatrogenic Disease / Q000517:prevention & control*; D008508:Medication Errors / Q000517:prevention & control*; D017146:Models, Organizational; D017064:Process Assessment, Health Care; D017751:Safety Management / Q000379:methods*; D013597:Systems Analysis; D014481:United States; D014743:Videotape Recording
D000700:Analgesics; D006993:Hypnotics and Sedatives