Yasser A Sowb, PhD*; George T Blike, MD⁺
* VAPAHCS and Stanford University School of Medicine
⁺ Dartmouth University School of Medicine

Introduction: Pediatric sedation (PS) is common for diagnostic and therapeutic procedures in both hospitals and office settings. Training requirements for PS providers and environmental safety factors vary among the different clinical settings. In 1999, the Dartmouth Summit on Pediatric Sedation (DSPS)¹ was organized to gather different practitioners, researchers, and policy developers and to discuss common PS procedures, techniques, and regulations. The goal of the summit was to identify the challenges facing PS practitioners and their influence on patient safety.

Methods: A round table discussion session was conducted which included a panel of 20 invited experts and 100 observers. The panel included experts from dentistry, pediatric anesthesiology, emergency medicine, and patient safety and health care policy. During the session, several sedation cases were presented and analyzed to elicit the challenges facing PS providers and the factors affecting patient safety. Goal-means analysis was utilized to build a representation of the organizational and clinical goals and factors pertaining to provision of PS.

Results: The figure below shows some of the goals and factors influencing provision of PS. The figure shows organizational goals of clinical settings such as "Quality Management" and "Economics or profit" and procedural or clinical goals of the PS task including minimizing 1) "Pain" and 2) "Stress and Anxiety", and 3) optimizing "Patient Condition" for diagnostic or therapeutic procedures. Patient safety is influenced by the balance between available resources and the demands of the PS task.² Demands of the PS task depend on the PS procedure and the patient’s health status.

A goal-means representation of the PS task. Arrows point from the goal to the means. Italicized text indicates competing goals. Thick arrows highlight pathways for competing goals.

Discussion: The representation illustrates how organizational, procedural and patient safety goals all compete with each other. While organizational goals influence availability of resources in clinical settings such as training requirements of PS providers, equipment, and PS medications, PS providers utilize available resources to optimize procedural goals and patient safety. Lack of available resources compromises patient safety and clinicians’ abilities to meet procedural goals, resulting in patient injury and costly delays of PS procedures. The long-term objective of this project is to develop sedation techniques and tools that optimize patient safety and clinicians’ abilities to meet procedural goals during PS.

1. Blike, G (2001). Report on the Dartmouth Summit on Pediatric Sedation.

2. Sowb, Y; Loeb, R (In Press). Cognition, Technology, and Work: Human Error in Medicine.