Walsh BM, et al. – The clinicians undertook this study to test the hypothesis that general emergency departments (GEDs) would have higher rates of deviations from best practices (errors) compared to pediatric emergency departments (PEDs) when managing an infant with hypoglycemic seizures. Compared to PEDs, errors were more frequent in GEDs during the simulated care of an infant with hypoglycemic seizures. The best predictor of errors on regression analysis was decreasing annual pediatric patient volume.

• The clinicians conducted this multicenter simulation-based prospective cohort study in GEDs and PEDs.
• They used in situ simulation to measure deviations from best practices during management of an infant with hypoglycemic seizures by inter-professional teams.
• They measured 7 variables: 5 nonpharmacologic (i.e., delays in airway assessment, checking dextrose, starting infusion, verbalizing disposition) and 2 pharmacologic (incorrect dextrose dose and incorrect dextrose concentration).
• To describe and compare the frequency and types of errors between GEDs and PEDs was the primary aim.

• The clinicians enrolled 58 teams from 30 hospitals (22 GEDs, 8 PEDs).
• Compared to PEDs, pharmacologic errors occurred more often in GEDs (p = 0.043), whereas nonpharmacologic errors were uncommon in both groups.
• As per the outcomes, errors were more frequent in GEDs associated with incorrect dextrose concentration (60% vs. 88%; p = 0.025), incorrect dose (20% vs. 56%; p = 0.033), and failure to start maintenance dextrose (33% vs. 65%; p = 0.040).