Reflections on the 2014 Society for Pediatric Sedation Annual Conference
By Sally Webb, MD and Benjamin Jackson, MD
2014 SPS Conference Program Co-Chairs
The 2014 Society for Pediatric Sedation (SPS) Annual Conference convened in Charleston, South Carolina, May 19-21, with the Medical University of South Carolina (MUSC) Children’s Hospital honored to serve as the host institution. We were privileged to lead a very dedicated local program committee and would like to thank the SPS Conference Planning Committee, the SPS Board of Directors, SPS headquarters, and the staff of the Francis Marion Hotel for their collaboration in putting on a wonderful annual meeting. We are especially grateful to the staff of the MUSC Simulation Center and the faculty who participated in the SPS Sedation Provider Course© on May 18, and to all the plenary, panel, and breakout session faculty whose knowledge, experience, and insight formed the foundation for this successful conference and the substance of pediatric sedation-based conversation and research ideas for years to come.
This year’s Annual Conference again actualized the Society’s commitment to multidisciplinary collaboration as pediatric sedation providers from anesthesiology, critical care medicine, emergency medicine, hospital medicine, advanced practice and registered nursing, dentistry, child life, and other allied health fields, came together in the spirit of safe, high-quality care, innovative research, and quality professional education. Almost 190 attendees hailed from 33 states, as well as Puerto Rico and Canada, to gather for the first ever three-day SPS Annual Conference. This schedule allowed for increased committee meeting attendance and afforded attendees freedom to explore the host city of Charleston.
Inspired by the white paper by SPS leadership defining quality in pediatric sedation recently published in the Journal of Healthcare Quality, this year’s conference theme was “Great Expectations: Forging a Culture of Safety and Quality in Sedation Practice.” MUSC Children’s Hospital Director of Quality and Safety, David Bundy, MD, gave a rousing opening plenary presentation Monday morning entitled “Advise We Don’t Have Fuel: Lessons from Avianca Flight 52 – Communication and Safety.” Dr. Bundy shared compelling examples from the airline industry of tragedy and tragedy averted, and applied these to pediatric sedation practice.
Frances Lee, DBA, Director of Instructional Operations for Healthcare Simulation of South Carolina, presented the MUSC experience with a simulation module for training and privileging faculty in airway management and moderate sedation. Defining this as a “high stakes, low risk” course, because stakes are never higher when patient safety is involved, but high-fidelity mannequins in a simulated environment offer low risk patient surrogates on which to train and practice, Dr. Lee highlighted the role for simulation in the future of sedation safety.
Myron Yaster, MD, the Richard J. Traystman Professor of Anesthesiology and Critical Care Medicine at The Johns Hopkins University School of Medicine, kept the audience interested in opioid pharmacogenomics by sharing a brilliant overview of how understanding an individual’s “sips” (CYP’s = cytochrome P450 enzyme systems) and “snips” (SNP’s = single nucleotide polymorphisms) can lead to better quality and personalized opioid treatment regimens.
David McSwain, MD, MUSC Pediatric Intensivist and Medical Director of Inpatient Telemedicine, gave the first SPS presentation via teleconferencing as he talked to us ‘live from Baltimore’ during the annual American Telemedicine Association conference. By watching his demonstration of available telemedicine carts and tools, the audience saw how this innovative technology could be used remotely for pre-screening, physical examinations, meeting patients and families in advance, and sedation consultations.
Kevin Couloures, DO, moderated the four excellent oral abstract presentations by Daniel Tsze, MD, Jennifer Biber, MD, Michael Mallory, MD, and Tamika Rozema, MD. Dr. Tamika Rozema, a second year pediatric resident from Kentucky Children’s Hospital, won the Physician-In-Training award for her abstract, “Apnea/Bradycardia Events in Preterm and Term Infants after Deep Sedation”. Shelly Marino, RN, Manager, Children’s Sedation and Procedure Unit from Kentucky Children’s Hospital, received the Non-Physician Abstract Award for her poster, “You Need How Many Nurses...? Developing a Staffing Model for a Pediatric Sedation and Procedure Unit”.
Keeping with SPS tradition, attendees then sampled culinary treats and beverages at the afternoon reception while joining Poster Session Professor Rounds with Drs. Lia Lowrie and Michael Mallory. Monday concluded with the annual Pediatric Sedation Research Consortium (PSRC) Meeting led by Joseph Cravero, MD.
Tuesday morning began early with a well received optional session proctored by Patricia Scherrer, MD, and John Berkenbosch, entitled “Safe Sedation of the Obese Child.” Drs. Scherrer and Berkenbosch discussed the challenges involved in sedating this patient population and presented PSRC data demonstrating the risks, primarily airway/respiratory events, that providers should anticipate and prepare for when called upon to sedate obese children.
Tuesday’s opening plenary was given by Morton Rosenberg, DMD, of Tufts University Schools of Medicine and Dental Medicine, who offered a very engaging, informative, and entertaining review of sedation and anesthesia in dentistry from its earliest history through the present and a glimpse into what the future may hold with respect to dental sedation and anesthesia. As the SPS continues to explore more effective means of attracting dental members and learning from pediatric sedation providers in the dental community, we are grateful for leaders like Dr. Rosenberg who shed light on the practice of these providers whose work occurs in the line of the airway of children who frequently require sedation to tolerate necessary dental care.
Betsy McMillan and Melissa Hale, Certified Child Life Specialists at MUSC, taught us how important it is to use developmentally appropriate, non-pharmacologic skills to optimize a quality sedation experience for our patients. Several entertaining video examples of child life intervention during actual sedations helped the audience see firsthand the benefit of a collaborative team approach for sedation.
Following Tuesday’s morning sessions, the annual SPS Awards Luncheon was held. Instead of a single keynote speaker, SPS leaders J. Michael Connors, MD, Lia Lowrie, MD, Susanne Kost, MD, Deborah LaViolette, RN, CPN, Joseph Cravero, MD, and Patricia Scherrer, MD, discussed the white paper entitled “Great Expectations: Defining Quality in Pediatric Sedation.” Each respectively presented one of six aims by which quality in pediatric sedation will be defined and measured: safety, effectiveness, patient/family-centered care, timeliness, efficiency, and equitable service. These represent the Institute of Medicine’s defining quality aims.
After recognizing Dr. Lia Lowrie for her contributions during her presidential term, Patricia “Trish” Scherrer, MD was installed as the fourth SPS President. The 2014 Joseph P. Cravero, MD Award was given to Jason Reynolds, MD. In addition to serving as Program Committee Chair for the 2013 Annual Conference in Houston, Dr. Reynolds has been active in the Pediatric Sedation Research Consortium (PSRC), has previously served in a novel capacity as a General Pediatrics trained sedation provider in a division of pediatric anesthesia at Texas Children’s, and currently leads a Pediatric Hospital Medicine-based sedation service at Children’s Hospital of San Antonio. Elise Van der Jagt, MD, from University of Rochester, and Michelle Rhoads, APRN, from Nemours/A.I. duPont Hospital for Children, were installed as new members to the SPS Board of Directors.
While many conference attendees took advantage of an open Tuesday afternoon to enjoy Charleston, 20 dedicated attendees participated in a very positively reviewed optional ultrasound-guided vascular access workshop led by MUSC Emergency Medicine faculty Geoffrey Hayden, MD, Brad Pressley, MD, and Nicole Malouf, MD, assisted by the Pediatric Emergency Medicine fellows. Others toured the MUSC Children’s Hospital’s sedation care areas and simulation center with the MUSC Pediatric Sedation Team. SPS committee meetings were also held Tuesday afternoon.
The final morning of the conference began early once again with an optional session in which Ben Jackson, MD, Chair of the MUSC Children’s Hospital Sedation Committee, addressed the matter of sedation depth and privileging, emphasizing competency and a dedication to quality and safety over dogmatic restrictions of sedation privileges by disparate disciplines.
Founding member and Past President of the SPS and current leader of the PSRC, Joseph Cravero, MD, offered an inspiring presentation entitled “Evolution of Pediatric Sedation and the Dawn of the Sedation Specialist.” Engaging our core commitment to children, so many of whom are subjected to painful and anxiety producing procedures in the course of treatment of severe illness and injury, Dr. Cravero offered anecdotes and cited literature to substantiate the assertion that pediatric sedation has emerged as a legitimate de facto specialty among physicians and nurses. He made the compelling case that the time has come to move toward an effort to standardize the pediatric sedation specialty. The care provided by dedicated pediatric sedation providers is demonstrably better than its alternative.
Dr. Cravero’s presentation led into a multidisciplinary panel discussion by David Banks, MD, Judson Barber, MD, Deborah LaViolette, RN, CPN, Lia Lowrie, MD, and Jason Reynolds, MD. From distinct clinical backgrounds that converged in similar career work, this panel of experts drew from their experiences to offer obstacles and victories in their paths to becoming pediatric sedationists.
Gregg Hollman, MD, Director for the SPS Simulation-based SPS Sedation Provider Course© gave the final plenary session of the conference. Dr. Hollman expounded upon sedation credentialing and privileging. In so doing, Dr. Hollman spoke of a fund of knowledge and skill set necessary for sedation competency and proficiency, and gave a glimpse of what may define requisite content for a dedicated pediatric sedation training program.
In addition to the plenary sessions presented, there were also 30 breakout sessions offering 18 distinct topics over Monday and Tuesday. These breakout sessions drew on the expertise of many faculty but were also enriched by the interaction of attendees. To summarize, the 2014 SPS Annual Conference offered participants a trove of “quality” sedation content to reflect on and ponder.
This year’s conference program reflected much of the evaluation content and requests from prior years, so we encourage everyone who attended to complete the conference evaluation online (you will only be able to access this form if you attended the conference). Initial feedback has been positive, but more input will not only help us understand what we could have done better, it will also contribute to the success of future SPS Annual Conferences.
It was indeed our pleasure to serve as 2014 Program Committee Co-Chairs. We are so thankful for the opportunity to share Charleston and our passion for quality and safety in pediatric sedation with everyone. We really look forward to travelling west to St. Louis and to more exciting, state of the art sedation topics during the 2015 SPS Annual Conference!