|
Dartmouth Pediatric Sedation Project Site |
||
|
Welcome to the Dartmouth Pediatric Sedation Project Site
Goal-- To eliminate the physical and emotional harm commonly associated with the diagnosis and treatment of illness in children. Background--Infants and children require sedation and pain control for procedures performed in a hospital to a much different degree than older patients. For example, it is impossible to simply ask an 18 month old to hold still for a 45 minute Magnetic Resonance Imaging scan. Hospitals across the country struggle with the logistical and medical difficulties associated with providing this service. There is often heavy demand for pediatric sedation services and these cases must be performed in a wide variety of locations involving many different services – radiology, pediatric inpatient floor, emergency department, nuclear medicine etc. Attempts to accommodate the need for pediatric sedation vary widely across the country and even within a given hospital. Some services require direct physician involvement while others rely on trained nursing personnel. Still others have unified around the concept of a “sedation room” or a “sedation team”. The result of this lack of consistency and control is a situation where children are sedated by under-trained personnel using out-of-date medications and without the most modern safety monitors. We firmly believe that pediatric sedation represents an area of pediatric care that exposes patients to the greatest risk of iatrogenic morbidity and mortality. Unfortunately, pediatric procedural sedation has undergone precious little organized or scientific analysis in spite of a dismal record for safety and efficacy. For the purposes of this project, we seek input from all providers who practice pediatric sedation in order to gain the widest understanding possible for the current state of this practice. We have sponsored a multispecialty conference on pediatric sedation which was used to further define the salient issues involved in pediatric sedation at this time. A summary of this conference and a transcription of its content will be available on this website in the coming months. We have also started a newsletter which will cover the latest developments in pediatric sedation - including all areas of specialty practice. The current and back issues of this newsletter can be accessed on this site as well. Your questions and comments are welcome - please contact us with any comments or input you may have concerning this website or pediatric sedation practice at Joseph.Cravero@Hitchcock.org. We propose to systematically study the nature of the way in which pediatric sedation is delivered by all providers and suggest improvements to the systems that are utilized to deliver this service. Our project will utilize a “human factors” approach to characterize pediatric sedation work. Human factors is a research discipline which has succeeded in leveraging human expertise and its interface with technology to achieve safest and most effective systems possible in both industry and medicine. Our project will use a multi-step paradigm that will proceed with several parallel and sequential tasks. We will first need to develop tools to measure the efficacy, risk exposure, and risk containment strategies used in individual sedation cases. We will accomplish this through the use of high quality video taping and expert analysis. We will then need to validate the reliability of our measures through statistical analysis and correlation with the processed video data. Validated video data can then be used to analyze sedation system performance and sedation work performance in a wide variety of settings. We will then model pediatric sedation work using accepted human factors methods. Finally, (and possibly most importantly) data from this analysis will allow us and others to design and prototype safer and more efficacious sedation systems. The new systems will be tested for safety and efficacy with in a pediatric simulator provided by Medical Education Technologies Inc (METI). The Dartmouth Medical Interface Laboratory has already initiated the process of developing tools for measuring the efficacy of sedation work as well as risk factors and risk containment during sedation cases - at the Children’s Hospital at Dartmouth. Our data indicates the clear need for a systematic evaluation of pediatric sedation. Only through a clear understanding of the human-technical interface involved in pediatric sedation as it exists today can we model new systems that will add to the efficacy and safety of this area of pediatric patient care
Funded in part by a grant from the National Patient Safety Foundation (NPSF)
|