title: Measuring situation awareness in emergency settings: a systematic review of tools and outcomes.
abstract: BACKGROUND
  Nontechnical skills have an impact on health care outcomes and improve patient safety. Situation awareness is core with the view that an understanding of the environment will influence decision-making and performance. This paper reviews and describes indirect and direct measures of situation awareness applicable for emergency settings.
  
  
  METHODS
  Electronic databases and search engines were searched from 1980 to 2010, including CINAHL, Ovid Medline, Pro-Quest, Cochrane, and the search engine, Google Scholar. Access strategies included keyword, author, and journal searches. Publications identified were assessed for relevance, and analyzed and synthesized using Oxford evidence levels and the Critical Appraisal Skills Programme guidelines in order to assess their quality and rigor.
  
  
  RESULTS
  One hundred and thirteen papers were initially identified, and reduced to 55 following title and abstract review. The final selection included 14 papers drawn from the fields of emergency medicine, intensive care, anesthetics, and surgery. Ten of these discussed four general nontechnical skill measures (including situation awareness) and four incorporated the Situation Awareness Global Assessment Technique.
  
  
  CONCLUSIONS
  A range of direct and indirect techniques for measuring situation awareness is available. In the medical literature, indirect approaches are the most common, with situation awareness measured as part of a nontechnical skills assessment. In simulation-based studies, situation awareness in emergencies tends to be suboptimal, indicating the need for improved training techniques to enhance awareness and improve decision-making.
authors.affiliation: School of Nursing and Midwifery, Monash University, Berwick, Victoria, Australia; School of Nursing and Midwifery, University of Brighton, Brighton, UK.
authors.forename: Simon
authors.initials: S
authors.lastname: Cooper
authors.affiliation: School of Nursing and Midwifery Monash University, Gippsland, VIC, Australia.
authors.forename: Joanne
authors.initials: J
authors.lastname: Porter
authors.affiliation: School of Nursing and Midwifery, Monash University, Melbourne, VIC, Australia.
authors.forename: Linda
authors.initials: L
authors.lastname: Peach
keywords: acute care; emergency; nontechnical skills; situation awareness; teamwork