2003-2004 Grant Awards
James S. Todd Memorial Award
Improving the Safety and Efficacy of Pediatric Sedation Practice through the Creation of the Pediatric Sedation Research Consortium at Dartmouth-Hitchcock Medical Center in New Hampshire
Joseph P. Cravero MD, FAAP, (Principal Investigator), Michael L. Beach, MD, PhD, Kristen Chambers, MS, and Susan M. Gallager
This study was conceived as a method to help all pediatric sedation providers better understand the safety and efficacy issues associated with this practice—and to allow the participants to compare their practice to that of a large group of sedation systems. Pediatric sedation remains a fertile area for safety investigation as a variety of pediatric subspecialists, with different training and techniques, attempt to achieve the same end result through very different means.
Prior to this project there had been no large multi-specialty study of this area of practice. The Pediatric Sedation Research Consortium has brought together 26 institutions from around the United Sates and Canada to (prospectively) develop the only database of its kind. To date over 45,000 sedation encounters have been collected and archived by this consortium that consists of an eclectic group of anesthesiologists, emergency medicine physicians, intensivists, radiologists, general pediatricians, and various pediatric subspecialists. Each encounter includes demographic and medical diagnosis data on the child who was sedated, the procedure performed, and the provider who performed the sedation, as well as safety and effectiveness data.
The initial data analysis from the group has concentrated on defining the common safety concerns involved in the field of pediatric sedation—regardless of the specialty of the sedation provider. Other work is continuing on comparison studies of the effectiveness and safety of the different drugs used by members of the consortium. Still other investigators within the consortium are trying to use the database to answer questions on “hot-button” sedation issues such as the safety of propofol use by practitioners other than anesthesiologists.
The ultimate goal of the consortium is to use the power of this very large database to highlight and promote “best practice” that meets the highest standards of safety and effectiveness in the field of pediatric sedation. This project remains a unique example of the power of a collaborative effort among a wide array of specialists with the single goal—that of improving the safety and quality of care delivery in a particular field of practice.
Can Knowledge from a Clinical Decision Support System Developed at an Academic Medical Center Be Applied to Other Hospitals and Populations Throughout an Integrated Delivery Network?
Martha J. Radford, MD (Principal Investigator), Dianne Collins, RN, Lisa Stump, RPh, Richard Shiffman, MD, MCIS, Jennifer Travers, Catherine O’Neill, and Wei Teng, PhD
We strove to understand consequences of automated decision support for medication safety in one of our three system hospitals, in order to apply this knowledge at the other two hospitals, where different electronic health records were deployed. We analyzed both quantitatively and qualitatively all medication misadventures reported at one hospital, and communicated them with the other two hospitals. The following insights were generalizable and actionable across hospitals:
- Identification of general themes concerning medication safety: which medications were particularly problematic; where in the medication administration chain (preparation; distribution; dispensing; monitoring) were problems occurring.
- Workflow innovations that did not involve the specific electronic health record (responsibility for various steps in the medication administration chain; medication monitoring routines, etc.).
By contrast, issues that involved technical solutions, for example, specific programming for specific decision support modules, needed to be customized to each hospital’s electronic health record.
