A collaborative educational intervention on procedural sedation and analgesia across the Pacific

Worldwide, health-care providers carry out procedural sedation and analgesia (PSA) in the emergency department. However, training opportunities are limited in many Asian countries, including Japan. We formed an educational group consisting of board-certified emergency physicians in the USA and Japanese physicians and developed a PSA training module. The aims of our study were to demonstrate the effectiveness of training and to describe PSA practice in Japan.

We undertook a pretest of PSA knowledge questions and a retest immediately after the training intervention. We also carried out a survey and asked about participants' PSA practice. The training module consisted of four didactic hours and three simulation and skills laboratory hours. Results of all pre- and post-intervention knowledge questions were analyzed with McNemar's test, and overall scores were analyzed with a paired t-test.

One hundred and forty-four health-care providers including 123 physicians, 16 nurses, two pharmacists, and three medical students participated in the training. A total of 119 (83%) completed both the pre- and post-intervention knowledge questions. Before the training, participants scored an average 66% (63%-69%) on the written knowledge test. After the intervention, participants showed significant improvement on the knowledge test (improvement 17%; 14%-20%). Among participants who answered the practice survey, 121 (88%) have undertaken PSA. Only 14 (12%) participants always or often use a continuous capnography for PSA. Only 32 (26.4%) participants undertook pre-PSA systematic evaluation.

Our educational intervention successfully increased participants' knowledge. Only the minority of health-care providers use capnography routinely for PSA, and pre-PSA evaluation is not commonly carried out.