Journal of Anesthesia

, Volume 32, Issue 2, pp 300–304 | Cite as

The effect of in situ simulation training on the performance of tasks related to patient safety during sedation

  • Meital Ben-Ari
  • Gilad Chayen
  • Ivan P. Steiner
  • Dana Aronson Schinasi
  • Oren Feldman
  • Itai Shavit
Short Communication


In many countries, procedural sedation outside of the operating room is performed by pediatricians. We examined if in situ sedation simulation training (SST) of pediatricians improves the performance of tasks related to patient safety during sedation in the Emergency Department (ED). We performed a single-center, quasi-experimental, study evaluating the performance of sedation, before-and-after SST. Sixteen pediatricians were evaluated during sedation as part of their usual practice, using the previously validated Sedation-Performance-Score (SPS). This tool evaluates physician behaviors during sedation that are conducive to safe patient outcomes. Following the sedation, providers completed SST, followed by a structured debriefing. They were then re-evaluated with the SPS during a subsequent patient sedation in the ED. Using multivariate regression, odds ratios were calculated for each SPS component, and were compared before and after the SST. Thirty-two sedations were performed, 16 before and 16 after SST. SPS scores improved from a median of 4 (IQR 2–5) to 6 (IQR 4–7) following SST (p < 0.0009, median difference 2, 95% CI 1–3). SST was associated with improved performance in four SPS components. The findings of this pilot study suggest that sedation simulation training of pediatricians improves several tasks related to patient safety during sedation.


Sedation Emergency In situ simulation Children 



Emergency department


Sedation Performance Score


Author contributions

Dr. MB-A: Designed the study and the analysis plan; collected, analyzed and interpreted the data; and critically revised the manuscript for important intellectual content. Dr. GC: Facilitated simulations; collected, analyzed and interpreted the data; and critically revised the manuscript for important intellectual content. Prof. IPS: Analyzed and interpreted the data, and critically revised the manuscript for important intellectual content. Dr. DAS: Interpreted the data, and critically revised the manuscript for important intellectual content. Dr. OF: Interpreted the data, and critically revised the manuscript for important intellectual content. Prof. IS: Designed the study and the analysis plan, drafted the manuscript, and analyzed and interpreted the data. Professor IS has full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.


No honorarium, grant, or other form of payment was given to anyone to produce the manuscript. No funding received for this work from any organizations.

Compliance with ethical standards

Financial discloser

None declared for all authors.

Conflict of interest

For all authors, there are no potential conflicts of interest, real or perceived in the study design, the collection, analysis, and interpretation of data, the writing of the report, and the decision to submit the paper for publication.


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Copyright information

© Japanese Society of Anesthesiologists 2018

Authors and Affiliations

  • Meital Ben-Ari
    • 1
  • Gilad Chayen
    • 2
    • 3
  • Ivan P. Steiner
    • 4
  • Dana Aronson Schinasi
    • 5
  • Oren Feldman
    • 2
  • Itai Shavit
    • 2
  1. 1.Rappaport Faculty of MedicineTechnion-Institute of TechnologyHaifaIsrael
  2. 2.Pediatric Emergency DepartmentRambam Health Care CampusHaifaIsrael
  3. 3.Simulation Laboratory, Rappaport Faculty of MedicineTechnion-Institute of TechnologyHaifaIsrael
  4. 4.Faculty of MedicineUniversity of AlbertaEdmontonCanada
  5. 5.Division of Emergency MedicineLurie Children’s Hospital of ChicagoChicagoUSA

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