Stress For Healthcare Providers Research Articles

Quantitative EEG correlates of 'Kriya yoga' benefits for mental health among health care providers.

Health care workers (HCWs) experience abounding physical and mental exhaustion mandating a deliverable solution for their mental health care. Kriya yoga (KY) includes several relaxation techniques and offers a stress-alleviating experience. The objective signature of KY benefits needs to be investigated. To study the effects of KY practice on brain oscillations and perceived stress in health care providers. This prospective interventional study was conducted during coronavirus disease 2019 pandemic. HCWs were enrolled to the intervention group (IG) and control group (CG) after obtaining an informed consent. IG visited the yoga center for learning the KY technique. Electroencephalogram (EEG) was recorded in both the groups, at baseline, and at the end of 6 weeks in the EEG Laboratory. Perceived stress scale (PSS) scores and participants' subjective response to KY practice were also collected. Paired t-test and independent t-test were used for statistical comparison wherever applicable. Age and baseline EEG powers among the IG and CG (N = 25) were statistically comparable. Absolute power analysis revealed a statistically significant increase in alpha and delta powers after 6 weeks of KY practice. The PSS scores revealed a statistically significant decrease in perceived stress after KY practice. Furthermore, 83% of the participants reported the subjective calming effects of KY practice. KY practice ensues relaxing effects on the brain, as evident from the EEG absolute power analysis, PSS scores, and participants' subjective response. As KY is a brief technique, it may be encouraged during short break session among the HCWs for promotive health.

The Prevalence and Associated Factors of Occupational Stress in Healthcare Providers in Saudi Arabia.

Occupational stress is a negative physical and emotional response to job requirements, which might be caused by various factors that can harm the emotional and physical well-being of the employee. We aimed to investigate the factors and conditions associated with occupational stress. The study was cross-sectional, conducted with the Perceived Stress Scale ten item version. The majority of the participants reported moderate stress 223 (71%) and a small proportion (n=38, 12.2%) a high stress level. Several factors associated with higher risk of stress level for example being single were associated with higher risk of stress level in 135 (74.6%), moderate and high stress level was also reported in the group without enough income, 96 (75%) and 20 (15.6%), respectively. A group of sociodemographic factors were consistently associated with occupational stress, including gender, income, comorbidity and marital status. However, some factors remained complex and multifaceted. It is important to focus on reducing stress levels for all employees, regardless of their work experience or income. To prevent losing control of the healthcare worker's stress and to prevent an escalation to anxiety or depression, stress-management programs are necessary, specifically for those who are experiencing high stress levels.

Telehealth use and work stress among Chinese health care providers during the COVID-19 pandemic

Telehealth services in China rapidly expanded during the COVID-19 pandemic. The work stress of health care providers (HCPs) associated with providing telehealth care services in China has been less studied. Our study describes the telehealth services provided by hospitals in China and examines the relationships between telehealth use and work stress of HCPs in China during the COVID-19 pandemic. With a survey research design, HCPs aged 18 or older in China were electronically recruited from October 19 to November 10, 2021 (n=1,073). After preprocessing, data from 1,036 HCPs were used for further analyses, which included descriptive statistics and multiple linear regression models. Results showed that 64.29% of Chinese hospitals reported virtual physician-to-physician consultations, and 59.94% of Chinese HCPs conducted online physician consultations. Lower levels of HCP work stress was associated with live video conferencing (p=0.04), online physician consultations (p=0.00), and higher levels of team collaboration (p=0.00) and team trust (p=0.00). Work stress was also positively correlated with COVID-19 stress (p=0.00), working hours (p=0.00), and the interaction between live video conferencing and COVID-19 stress (p=0.04). HCPs’ work stress decreased by using live video conferencing and online patient care. However, the positive effects of live video conferencing may decrease with the increase in COVID-19 stress for HCPs. Our findings encourage efforts to develop extensive coverage of telehealth service systems in China to promote HCPs’ virtual communication and collaboration to relieve HCPs’ work stress and support their well-being.

A Systematic Review of Heart Rate Variability as a Measure of Stress in Medical Professionals.

Understanding the physiological effects of responding to crises is a critical component in understanding how to manage and prepare medical professionals to be crisis responders. Heart rate variability (HRV) is the variation in rate between a succession of R-R intervals. This variation is not only affected by physiological processes such as respiration or metabolic rate but is also directly controlledby the autonomic nervous system. As such, heart rate variability has been proposed as a noninvasive tool to measure the physiological stress response. The aim of this systematic review is to consolidate heart rate variability literature in the context of medical emergencies to determine if heart rate variability changes predictably from baseline when responding to medical crises. This may demonstrate utility as an objective, noninvasive measure of stress response. A systematic literature review of six databases yielded 413 articles, 17 of which met our inclusion criteria of being written in English, measuring HRV in healthcare providers, and measuring HRV in real or simulated medical resuscitations or procedures. Articles were then analyzed using the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) scoring system. Out of the 17 articles reviewed, 11 demonstrated statistically significant results showing heart rate variability responding in a predictable manner to stress. Three articles utilized a medical simulation as the stressor, six used medical procedures, and eight used medical emergencies encountered during clinical work. Overall, a predictable trend in heart rate variability metrics of standard deviation from the mean value of normal-to-normal(N-N) intervals (SDNN), root mean square of the successive differences (RMSSD),mean number of times per time interval in which the change in successive normal sinus (N-N) intervals exceeds 50 ms (PNN50), low frequency % (LF%), and low-frequency-to-high-frequency ratio (LF/HF) was observed when responding to stress. This systematic literature review showed that heart rate variability among healthcare providers responding to stressful scenarios follows a predictable pattern of change and expands our understanding of the physiology of stress in healthcare providers. This review supports the use of HRV to monitor stress during high-fidelity simulation to ensure that appropriate physiological arousal is achieved during the training of medical personnel.

Prevalence of occupational stress among Iranian physicians and dentist: a systematic and meta-analysis study.

Occupational stress in health care providers is an undesirable factor that can lead to dissatisfaction and burnout and affect the quality of care and treatment of patients. This study estimated the prevalence of occupational stress among Iranian physicians and dentists. The articles were searched using the keywords: "job stress", "job-related stress", "occupational stress", "work-related stress", "workplace stress", "physician", "dentist", and "Iran", and all possible combinations of these terms in domestic databases of Scientific Information Database (SID) and MagIran and international databases of Web of Science, PubMed, and Scopus with no time limit. Heterogeneity among the studies was assessed using the Cochran's Q test. Data analysis was performed in Stata version 11 based on the heterogeneity state using a random-effects model. The sample size in selected articles on physicians and dentists varied from 71 to 516 and 90 to 200, respectively. The prevalence of occupational stress in physicians was 70.10% (95% CI: 55.43-84.78), and among dentists was 50.87% (95% CI: 33.93-67.81). According to the results, there was no significant association between the prevalence of occupational stress, sample size, and year of publication in physicians and dentists. The results showed that publication bias was (p=0.029) for physicians and (p=0.630) for dentists. Occupational stress among Iranian physicians and dentists is high, which can adverselyaffect therapists and patients. Therefore, it is necessary to focus on this problem to manage and control it.

Feasibility of a brief mindfulness-based program for burnout in pain healthcare professionals.

Stress inherent to health care, which is characterized by work overload and shortage of specialized staff, is associated with decreased quality of life and suboptimal patient care. Mindfulness-based programs have proved to be effective in reducing stress in healthcare providers. This study aims to assess the feasibility of an 8-week mindfulness program to reduce the burnout levels of the staff of a pain clinic in a tertiary public hospital. A longitudinal study with a within subject pre/post-intervention design, consisting of daily face-to-face 10-min sessions and the creation of a virtual group using a social media platform. Variables measured: burnout, mindfulness, empathy, self-compassion, and demographic characteristics. Program feasibility (i.e., reach, adherence, acceptability, and preliminary effectiveness) was evaluated in 10 participants (6 physicians, 2 nurse practitioners, 1 nursing assistant, and 1 administrative). The results revealed a high reach (i.e., participation rate of 90%), excellent adherence to the program (daily practice 95% of times), and very good acceptability of the group format and satisfaction with most treatment components. Regarding potential effectiveness, we report the results of the Wilcoxon signed-rank tests and its associated effect size (r). We observed improvements in mindfulness and all its subscales (-2.077 ≤ Z ≤ -2.703, 0.69 ≤ r ≤ 0.90, all p < 0.05) except for non-reactivity and all subcomponents of self-compassion (-2.501 ≤ Z ≤ -2.611, 0.83 ≤ r ≤ 0.87, all p < 0.05) but not on its global self-compassion score. Empathy and burnout did not change. In an exploratory manner, however, we found significant reductions in the burnout component of emotional exhaustion, but only in physicians (Z = -2.201, p = 0.028, r = 0.73). We believe that the 8-week mindfulness-based program described in the present investigation might be a feasible and potentially effective method that can be easily implemented to reduce burnout and promote mindfulness in specialized pain clinics.

Psychological and mental wellbeing of healthcare workers in Saudi Arabia during the COVID-19 pandemic

Background: The COVID-19 pandemic has induced a substantial burden on healthcare organizations, with increased workload and stress for healthcare providers. Healthcare professionals working on the frontline are vulnerable to stress, putting their psychological and mental wellbeing in considerable jeopardy. Methods: This is a cross-sectional study using data collected from a self-administered questionnaire that was distributed electronically to healthcare workers. The validated Kessler Psychological Distress Scale (K10) and the General Self-Efficacy Scale (GSE) were used to measure the level of stress of the healthcare professionals and the psychological impact of the pandemic on them. Results: Two hundred and thirteen participants were included. A third of the responders (34.3%) were previously infected with COVID-19, while 72.3% had to self-isolate during the pandemic. The average score for the K10 questionnaire was 24.8 ± 9 out of 50, where almost a third of the responders (33.3%) had very high psychological stress levels. The average score for the GSE was 30.2 ± 5.3 points out of 40. Nurses and physicians (p = 0.033) showed significantly higher scores on the K10 survey. Furthermore, nurses between ages 20 and 29 (p = 0.025) and nurses of any age (p = 0.009) had significantly high levels of psychological stress. Conclusion: Healthcare professionals are at significant risk of psychological and mental adverse effects, particularly nurses on the frontline. Such findings should drive initiatives to prepare task forces that can put forward and implement strategies to minimize the risk imposed on the psychological and mental wellbeing of frontline health workers.

Stress among pediatric oncology staff. A systematic review

Cancer is considered one of the dominant life-threatening diseases in children. Working in the field of pediatric oncology, although rewarding, can be a source of stress and emotional burden for health care providers. The aim of this systematic review was to summarise the evidence regarding the occupational stress of health care providers working with pediatric cancer patients. Extensive search of the Pubmed and Scopus databases was performed to identify studies relevant to the topic. Initial search retrieved 657 studies. The reviewing investigators, after applying the inclusion/exclusion criteria, extracted data to critically appraise the quality of evidence. The final step of search concluded in 23 studies of heterogeneous design. Results revealed two main domains of which occupational stress derived from i) the interaction of the health care provider with the patient and the family, and ii) several organisational factors, such as hierarchical structures, experience, workload, and low organisational support. Literature on the stress of pediatric oncology staff is limited. The rather small sample sizes of the studies, the heterogeneity of methodological design, the lack of assessment from a sociological point of view, as well as the limited psychometric instruments adapted to pediatric oncology staff, make the validity of the results questionable. Further research is warranted to obtain a more accurate view of the field, to identify a cause-effect relation between work-related stress and pediatric oncology staff, and, more importantly, to guide future recommendations on support systems and stress management training within pediatric oncology settings.

Flash Technique in a Scalable Low-Intensity Group Intervention for COVID-19-Related Stress in Healthcare Providers

The flash technique (FT) is a low-intensity individual or group intervention that appears to rapidly lessen the distress of disturbing and traumatic memories. This paper reports on the safety and effectiveness of group FT with 77 healthcare providers and 98 psychotherapists impacted by working with COVID-19 patients. One-hour webinars included 30 minutes of psychoeducation and two guided 15-minute FT interventions, focused on participants' most distressing pandemic-related memory. Before and after each 15-minute FT intervention, they rated that memory using the 11-point 0-to-10 subjective units of disturbance (SUD) scale. Results from both interventions were highly significant with large effect sizes (p &lt; .001, Hedges' g = 2.01, Hedges' g = 2.39). No adverse reactions were reported. For 35 participants who processed the same memory in both interventions, the pre–post SUD scores from the beginning of intervention #1 to the end of intervention #2 showed a significant reduction with a large effect size (p &lt; .001, Hedges' g = 3.80). For this group, both intervention #1 and intervention #2 showed significant reductions with large effect sizes (p &lt; .001, Hedges' g = 2.00) (p &lt; .001, Hedges' g = 1.18). Follow-up SUD scores were obtained from 58 participants, with the mean disturbance level showing a significant further decrease. These findings provide preliminary evidence that group FT appears to safely provide rapid relief from disturbing memories. FT merits further research.

Association of hospital pharmacy–related knowledge and skills with occupational stress of clinical pharmacists in tertiary hospitals of China

ObjectiveOccupational stress of health care providers may lower the quality of care. Person-environment fit theory and practical evidence have indicated that various types of knowledge and skills of health care providers are differentially associated with occupational stress. Clinical pharmacists are an indispensable part of medical teams. Clinical pharmacists in China are generally under high occupational stress, but what kind of knowledge and skills can relieve their occupational stress remains unclear. This study aimed to assess the association between the specific knowledge and skills of clinical pharmacists and their occupational stress in China. This study aimed to assess the association between the specific knowledge and skills of clinical pharmacists and their occupational stress in China. MethodsA field questionnaire survey using a stratified sampling was conducted to gather data on occupational stress, knowledge and skills related to hospital pharmacy, and other factors of occupational stress using the Brief Job Stress Questionnaire and a self-developed instrument. Ordinary least squares regression was used to evaluate the association of the participants’ knowledge, skills, and other factors with their occupational stress. ResultsA total of 625 clinical pharmacists from 311 tertiary hospitals in China (response rate = 84%) participated. Knowledge of or skills related to pharmaceutical care service provision (P = 0.02), the use of computers and the Internet in pharmacy practice (P = 0.02), interpersonal communication (P = 0.10), or pharmacoepidemiology (P = 0.08) was associated with reduced occupational stress of the participants. Participants who had credentials of nation-level specialized (P = 0.09) and general training (P = 0.04) for clinical pharmacist had lower degrees of occupational stress than those without these credentials. The participants’ clinical professions, routine tasks, technical titles, and type of hospital they work in were also associated with their occupational stress. ConclusionEnhancing several aspects of knowledge or skills among clinical pharmacists in tertiary hospitals in China may help reduce their occupational stress. Efforts are needed to improve the education and training system of clinical pharmacists in China.

A Survey on IoT based Wearable Sensor for Covid-19 Pandemic

The COVID-19 pandemics have highlighted the importance of leveraging and harnessing our digital infrastructure enabling remote health monitoring. We foresee the need for more powerful diseases diagnosis and monitoring of personal and group health, which might be supported by wearable sensors, since conventional virus testing and vaccinations are delayed. Also, Internet of Things (IoT) has gained traction in a variety of research sectors, including academic and industrial settings, particularly in healthcare. By merging economic, social, and technological perspectives, IoT revolution reshapes today's healthcare systems. It evolves from traditional medical services to far more individualised programs that allow patient monitoring, diagnosis &amp; treatment more convenient. IoT with wearable has recognized as a dominant component of healthcare transformation. When commonly diagnosed, wearable devices are linked to the internet, it may acquire vital information that might save lives. Also, models designed regulates and continuously monitors the condition of the patient by employing an network infrastructure during pandemics, reducing stress of health care providers, minimising medical errors, decrease the amount of work and medical staff productivity, lowering on-going medical cost and improving patient experience. Developing a convenient and accurate wearable device for earlier detection, assessment during social distance, as well as recovery is important during the COVID-19 outbreak. As a result, numerous researchers devised wearable models; this study looks at the effect of wearable body sensors based on IoT technology in fighting COVID-19. In addition, the advantages of wearable devices are contrasted to those of traditional approaches.

Psychological outcomes of debriefing healthcare providers who experience expected and unexpected patient death in clinical or simulation experiences: A scoping review.

To synthesise and map the literature on the psychological outcomes reported following debriefing of healthcare providers who experience expected and unexpected patient death in either clinical practice or simulation setting. Patient death occurs in both the clinical and simulation environments and can result in psychological stress in healthcare providers and students. While debriefing following patient death has demonstrated the ability to promote positive psychological outcomes, addressing the psychological or emotional stress of the event is inconsistently addressed. A scoping review was conducted using the Arksey and O'Malley framework. The Cochrane Library, MEDLINE, CINAHL, PsycINFO, JBI and Scopus databases were searched with English language constraints and no limit on publication date. The Scoping Reviews (PRISMA-ScR) Checklist was used (Annals of Internal Medicine, 2018, 169, 467) (see Appendix S1). Eighteen articles (16 research papers and 2 review papers) met the inclusion criteria. Of the 16 research papers, 9 reported on debriefing models in the simulation environment and 7 in the clinical setting. The types of debriefing models found in the simulation setting tended to focus on healthcare providers' learning, while those in the clinical setting typically focused on healthcare providers' emotional reactions and resulted in positive psychological effects. Debriefing has the potential to positively affect psychological outcomes of healthcare providers who experience patient death. The type of debriefing that is selected is a key component to achieving these positive outcomes. This scoping review identified the debriefing frameworks used in both simulation and clinical environments following patient death events, and any associated psychological outcomes. There is a need for debriefing to occur after each death in either environment; however, there is a lack of evidence-based debriefing frameworks that can be used in both the clinical and simulation environments to promote positive psychological outcomes.

Mindfulness for Healthcare Providers: The Role of Non-Reactivity in Reducing Stress

There is strong evidence in the literature that the cultivation of mindfulness through programs such as Mindfulness-Based Stress Reduction (MBSR) has a profound impact on perceived stress for healthcare providers. The mechanism of the latter association is still being studied. However, it has been hypothesized that in particular, the cultivation of non-reactivity as a mindfulness skill may be particularly associated with the salutary effect of MBSR to reduce stress in health care providers even if adjusted for the benefit on quality of life gained after MBSR. The latter may represent important mechanistic information to build customized mindfulness interventions for health care providers. Determine whether the change in non-reactivity to inner experience after MBSR is associated with the adjusted changes in perceived stress after MBSR. a Cross-sectional study. A large, Midwestern teaching hospital. 100 health care providers. 8-week standard MBSR course. Perceived Stress Scale-10, Linear Analog Scale Assessment to measure Quality of life, and the mindfulness domain non-reactivity to inner experience was assessed by the non-reactivity subscale of the Five Facet Mindfulness Questionnaire. All measures were administered at baseline and completion of the intervention. The change from baseline to completion of MBSR was significant for all variables, with moderate-to-robust effect sizes. There was a significant negative correlation between non-reactivity and perceived stress both at baseline (p<0.0001) and when comparing changes in scores from baseline to post-intervention (p<0.0001). Change in non-reactivity to inner experience was robustly associated with the change in perceived stress (p<0.0001) after MBSR (97% in 5000 bootstrapped models). Non-reactivity to inner experience is a key aspect of MBSR that is independently associated with a change in perceived stress in health care providers.

Promoting the Self-Regulation of Stress in Health Care Providers: An Internet-Based Intervention.

The aim of our internet-based intervention study was to find out whether healthcare professionals can autonomously down-regulate the stress they experience at their workplace, using an established self-regulation tool called Mental Contrasting with Implementation Intentions (MCII). Applying MCII to reduce stress implied for our participants to repeatedly engage in a mental exercise that (1) required specifying a wish related to reducing stress, (2) identifying and imagining its most desired positive outcome, (3) detecting and imagining the obstacle that holds them back, and (4) coming up with an if-then plan on how to overcome it. We recruited on-line nurses employed at various health institutions all over Germany, and randomly assigned participants to one of three groups. In the MCII group (n = 33), participants were taught how to use this exercise via email and the participants were asked to engage in the exercise on a daily basis for a period of 3 weeks. As compared to two control groups, one being a no-treatment control group (n = 35) and the other a modified MCII group (n = 32), our experimental MCII group showed a reduced stress level and an enhanced work engagement. We discuss the strengths and weaknesses of the present study as well as ways to intensify MCII effects on stress reduction.

Associations of the Quality of Work Life and Depression, Anxiety, and Stress in the Employees of Healthcare Systems

Introduction: Human resources are an important asset to any organization, and it is essential to preserve their health in order to achieve organizational goals. The present study aimed to investigate the associations between the quality of work life (QWL) and depression, anxiety, and stress in the employees in the healthcare system of Islamabad-e-Gharb Health Care Network, Iran. Materials and Methods: This cross-sectional, descriptive-analytical study was conducted on 158 healthcare network employees using the census method. Data were collected using Walton’s quality of work life evaluation and depression, anxiety, and stress scale (DASS). Data analysis was performed using descriptive statistics, Spearman’s correlation-coefficient, Mann-Whitney U test, and Kruskal-Wallis test. Results:Mean and standard deviation of QWL, depression, stress, and anxiety were 80.45±17.70, 4.9±4.1, 6.34±4.2, and 3.7±3, respectively. Significant negative correlations were observed between QWL and depression (r=-0.255; P=0.001), anxiety (r=-0.260; P=0.001), and stress (r=-0.242; P=0.002). Each of depression, stress, and anxiety had individually no significant correlation with age, work experience, number of child, gender, work pattern, second job and level of education (P> 0.05). However, the relationship between depression and marital status was significant such that depression is found higher among single persons (P= 0.026). As was the correlation between residential status and stress (P=0.03) in which the stress was higher in tenants compared with residence owners. It also appeared that having a refractory patient at home has significantly associated with stress (P=0.027) and anxiety (P=0.045). Conclusion: According to the results, improving the QWL is essential to mitigating the rates of depression, anxiety, and stress in healthcare providers.

The Ethical Environment and Nurse Emotional Exhaustion: A Longitudinal Study

Although there has been a fair amount of research into the stress of health care providers, particularly nurses, most of this research has not considered that health care includes frequent ethical ...

An innovative approach to post-treatment cancer care: The After Cancer Treatment Transition Clinic (ACTT).

e19522 Background: Improvements in early detection and cancer therapy have led to better survival rates. Integration of cancer survivorship initiatives as part of cancer care is gaining momentum. However, post cancer treatment follow up care may not be best met in acute cancer clinics. Visits to a large urban cancer centre in Canada have increased by 30% in the past 5 years. These increased volumes have lead to prolongation of patient wait times and increased stress for health care providers. This cancer centre is undergoing a transformative change that focuses on improving the patient cancer care experience. Methods: The development of the ACTT clinic has been a partnered initiative between two academic healthcare centres: an urban cancer centre and a community ambulatory hospital with a focus in chronic disease management. It is being managed by an advanced practice nurse and a GP Oncologist. The ACTT clinic delivers high quality, safe specialized physician and advanced nursing patient care, with engagement of patients/families, oncologists and primary care. The target population is patients who have completed cancer therapy, are well and are at moderate to low risk for cancer recurrence. The initial phase of the project involved transitioning patients with Testes, Melanoma, Breast and Colorectal cancers. Each cancer site group identifies the appropriate processes for clinic functioning at the ACTT, and if required, for appropriate linkages back to acute cancer care and primary care. Results: Over 1,000 patients have been transitioned to ACTT since April 2010 with 10-20 additional patients referred weekly. Essential components of the model include: standard surveillance protocols for recurrence or secondary cancers, management of long term and late effects of cancer treatment, monitoring for distress and health promotion. Standard reporting includes patient assessment and a defined plan of care communicated to their oncologist and primary care. Patient experience evaluation of the program is ongoing. Conclusions: The ACTT clinic initiative has been successful in developing a novel clinic model and has successfully transitioned over 1,000 patients from an acute care cancer clinic.

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Measuring Pediatric Sedation Safety

Anesthesiology| November 01 2005 Measuring Pediatric Sedation Safety AAP Grand Rounds (2005) 14 (5): 53–54. https://doi.org/10.1542/gr.14-5-53 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Measuring Pediatric Sedation Safety. AAP Grand Rounds November 2005; 14 (5): 53–54. https://doi.org/10.1542/gr.14-5-53 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: sedation procedure 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... You do not currently have access to this content.