title: Pilot-phase findings from high-fidelity In Situ medical simulation investigation of emergency department procedural sedation.
abstract: BACKGROUND
  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.
authors.affiliation: 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
authors.forename: Leo
authors.initials: L
authors.lastname: Kobayashi
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Dunbar-Viveiros
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Devine
authors.forename: Mark S
authors.initials: MS
authors.lastname: Jones
authors.forename: Frank L
authors.initials: FL
authors.lastname: Overly
authors.forename: John W
authors.initials: JW
authors.lastname: Gosbee
authors.forename: Gregory D
authors.initials: GD
authors.lastname: Jay
mesh_terms: D000328:Adult; D054810:Deep Sedation / Q000379:methods*; D004503:Education, Medical, Graduate / Q000379:methods*; D004635:Emergency Medicine / Q000193:education*; D004636:Emergency Service, Hospital; D005260:Female; D006305:Health Status Indicators; D006784:Hospitals, Teaching; D006801:Humans; D007858:Learning; D008297:Male; D016544:Patient Simulation; D010865:Pilot Projects; D011787:Quality of Health Care; D012237:Rhode Island; D017751:Safety Management / Q000379:methods; D013223:Statistics as Topic; D013663:Teaching / Q000379:methods*; D013997:Time Factors