A qualitative study examining the influences on situation awareness and the identification, mitigation and escalation of recognised patient risk.
BACKGROUND
Situation awareness (SA)-the perception of data elements, comprehension of their meaning and projection of their status in the near future-has been associated with human performance in high-risk environments, including aviation and the operating room. The influences on SA in inpatient medicine are unknown.


METHODS
We conducted seven focus groups with nurses, respiratory therapists and resident physicians using a standardised semistructured focus group guide to promote discussion. Recordings of the focus groups were transcribed verbatim, and transcripts were qualitatively analysed by two independent reviewers to identify convergent and divergent themes.


RESULTS
Three themes emerged: (1) team-based care, (2) availability of standardised data and (3) standardised processes and procedures. We categorised these into social, technological and organisational influences on SA. Subthemes that emerged from each focus group were shared language to describe at-risk patients, provider experience in critical care/deterioration and interdisciplinary huddles to identify and plan for at-risk patients. An objective early warning score, proactive assessment and planning, adequate clinician staffing and tools for entering, displaying and monitoring data trends were identified by six of seven groups. Our data better reflected the concepts of team SA and shared SA than individual SA.


CONCLUSIONS
Team-based care and standardisation support SA and the identification and treatment of patient risk in the complex environment of inpatient care. These findings can be used to guide the development and implementation of targeted interventions such as huddles to proactively scan for risk and electronic health record displays of data trends.
Division of Hospital Medicine, Department of Pediatrics, The James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, , Cincinnati, Ohio, USA.
Patrick W
PW
Brady
Linda M
LM
Goldenhar
D001364:Awareness; D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D009741:Nursing Staff, Hospital / Q000523:psychology*; D010348:Patient Care Team; D061214:Patient Safety; D036301:Qualitative Research; D018570:Risk Assessment; D012931:Social Environment; D013647:Task Performance and Analysis
Communication; Hospital Medicine; Patient Safety; Safety Culture; Teamwork