Situational Awareness (SA) in medical simulation provides opportunities for learners to identify, practice, and evaluate environmental and potential hazard awareness during various clinical events. Healthcare Simulation is particularly useful when those events are rarely encountered during training or routine clinical practice. Medical errors associated with a lack of attention, inappropriate interpretation of data, and lack of follow-up to surrounding activities and equipment are not uncommon. While time-to-task, error identification, and other methods have been used to measure clinical performance, many of these methods are costly, depending on the experience of the raters, and do not directly consider SA. This HealthySimulation.com article by Founder/CEO Lance Baily focuses on how to incorporate situational awareness into clinical simulation.
What is Situational Awareness?
Situation awareness can be thought of as an internal mental model of the current state of an individualโs environment. According to the Healthcare Simulation Dictionary (2024, p 64):, the definition of situational awareness includes:
The โperception of environmental elements within time and space, and a perception of their meaning; it involves being aware of what is happening around you to understand how information, events, and your own actions impact the outcomes and objectivesโ (Endsley, 1995, p. 32). A field of study concerned with understanding of the environment critical to decision makers in complex, dynamic areas; situational awareness refers to the degree to which oneโs perception of a situation matches reality. The awareness of fatigue and stress among team members (including oneself), environmental threats to safety, immediate goals, information sharing, and the deteriorating status of the crisis or patient. Most commonly used in the context of crisis resource management training (Hancock et al., 2008).
There are three conceptually distinct levels of Situation Awareness:
- Perception of the elements in the environment,
- Comprehension of the current situation, and
- Projection of the future status of the situation (Endsley, 2015).
Increasing situation awareness in healthcare through real-time simulation by Harper, Mustafee, and Pitt (2023) provides a literature review, a framework for real-time simulations, a situational awareness framework, and a framework to support real-time simulation of sociotechnical systems.
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Assess Your Situational Awareness
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Klein suggests that SA is important in the study of human work for four reasons:
- SA is linked to performance.
- Limitations in SA may result in errors.
- SA may be related to expertise, so that previous experience affects actions.
- SA is the basis for decision-making in most cases.
Measurement of Situational Awareness
Although Situational Awareness was initially used in aviation, an adaptation of the Situation Awareness Global Assessment Technique (SAGAT) is available for use in the healthcare setting. SAGAT uses the query technique, where individuals participate in a simulated event, and a facilitator randomly โfreezesโ the simulation to query participants regarding their perception, comprehension, and projection of the situation.
Relevance of Situational Awareness to Clinical Practice.
- SA includes careful perception, understanding, and prediction of events in a specific environment.
- Cultures that focus on efficiency and the removal of staff from the bedside contribute to โinattentional blindnessโ to potential hazards currently existing in a given environment.
- Potential hazards to patient safety, such as medication errors or catheter-related infections, make ideal simulation scenarios to improve situational awareness.
- Experiential and other learner-centered activities that focus on situational awareness have been shown to increase the recognition and reporting of errors.
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Suggestions for Building Situational Awareness Into Clinical Simulation Scenarios:
Learners should assess the entire room. Questions for learners to consider:
Gathering Information:
- What do I see/hear?
- Am I aware of all possible cues coming from this environment?
- Have I scanned the entire room and identified all pieces of equipment?
- Is the equipment on, what is its role?
- Who is in the room, what is their role and what are they doing?
- What patient data is available?
- Vital signs/O2 saturation?
- Known medications?
- Patient assessment?
- Test results?
- Are there monitors or other pieces of equipment out of my line of vision?
Comprehension of the Current Status:
- Overall, what do I understand about the patientโs condition from my observations?
- Do I see anything that represents a potential patient hazard or be a cause for concern?
- Are all tubes/IV fluids/medications as expected, connected appropriately, and have dressings/ tubes that are not expired?
- Is there anything I can see that is not following institutional standards/protocols?
- Are there trip hazards? Are common patient items and call light within reach?
- Is there an identified team leader (if appropriate).
- Do I need any other information to make a decision?
- What does the monitor data tell me about the patientโs condition and likely progress?
- Do I have enough information to accurately reflect the situation?
- What is the patient telling me?
- Is there anything I do not understand?
- What is the likely cause of potential problems?
Projection of Future Status
- What are the most likely actions (effects) of all elements in the environment?
- Based on: The current status and possible future changes of all the elements in the environment
- Comprehension of the situation.
- What actions do I need to take based on my analysis of the situation?
- What will be the most likely outcomes of these decisions?
- What other outcomes could there be?
- What are the risks/benefits of my chosen course of action?
Freezing Scenarios
Freeze scenarios at certain points allows learners to review the situation, state their existing planned interventions, and make changes to their plans in light of a revised situational assessment.
