Developing situational awareness

Accreditation Insider, December 1, 2015

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In healthcare, situational awareness (SA) is defined as the perception of the elements within a volume of time and space, the comprehension of their meaning, and the projection of their status in the near future. To further explain, SA is divided into three levels:

Level 1: Perception of elements. A clinician is aware of things, meaning certain elements have reached his or her attention. For example, an Emergency Room (ER) physician assesses a patient and learns that the patient is 66 years old, lives with his daughter who is gone most of the day, has a history of congestive heart failure (CHF), recently had the flu, has not been in the hospital recently but was treated as an outpatient for “walking pneumonia” a few months ago, and has a productive cough, decreased breath sounds in the left chest, a temperature of 99° F, respiratory rate of 22/min, mild pleuritic chest pain, decreased appetite, and occasional confusion but is presently quite lucid. The patient’s lab work is unremarkable. A chest X-ray taken immediately after triage shows a “left lower lobe infiltrate.” These are simply elements or facts of which the physician is aware. By themselves, these pieces of information mean nothing. Again, level 1 is simply the perception of specific elements in the environment, meaning that these items have captured one’s attention. That’s all.

Level 2: Comprehension of meaning. The ER physician will now put all of these disjointed elements together, find relationships between them, and assign meaning to the scenario. It’s like taking individual trees and putting them together to create a patch of forest. One can say it’s an ability to see the “big picture.” Using the elements so far, the physician’s big-picture view suggests community-acquired pneumonia with a marginal Pneumonia Severity Index (a tool used to numerically calculate the chance of mortality and the need for admission as an inpatient).

Level 3: Projection. Now the physician will project into the very near or immediate future. From this projection, he or she knows that if interventions and therapies are not promptly initi¬ated, the patient may very well continue to deteriorate and develop a profound pneumonia with continued failure to thrive. Serious illness and mortality can occur, especially if the patient is sent home with minimal monitoring and assistance from family throughout the day.

Moving through these levels, the physician can then make decisions and take actions. In this case, sputum cultures, pulse oximetry, oxygen, and prompt antibiotic therapy are ordered, and a plan to admit as an inpatient is formulated.

This is an excerpt from the HCPro book Building a High-Reliability Organization: A Toolkit for Success. Visit HCPro Marketplace for more information and to order.

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