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BMJ Qual Saf. 2014 Feb;23(2):153-61. doi: 10.1136/bmjqs-2012-001747. Epub 2013 Sep 23.

A qualitative study examining the influences on situation awareness and the identification, mitigation and escalation of recognised patient risk.

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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.



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.


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.


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.


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.


Communication; Hospital Medicine; Patient Safety; Safety Culture; Teamwork

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