Situation awareness in emergency medicine

Abstract

The objective of this study is to determine the effects of environmental factors on physician situation awareness (SA) in an emergency department (ED) setting. An objective method of level 1 (i.e., perception) SA measurement and evaluation was developed and applied. Resident physician level 1 SA was measured using the Situational Awareness Global Assessment Technique (SAGAT). SAGAT question probes (i.e., sets of 10 questions) were generated randomly from a pool of questions and administered hourly. Questions were answered at a 7.4% false response rate. Environmental measures (i.e., patient information, physician information, temporal information, and workload) were collected concurrently. Mixed-effects modeling was used to determine the relationship between physician SA and environmental factors adjusting for potential correlation within physician observed, patients managed, and questions asked. Significant factors associated with decreases in SA include: patient hand-offs (Odds Ratio (OR): 1.67), resident physician in final year of training (OR: 0.49), and number of patients managed (OR: 1.17). Significant correlation within question was observed and adjusted for. Overall, this study demonstrates a novel approach toward diagnosing factors contributing to physician SA during patient care. SA studies in healthcare may provide evidence for interventions aimed at improving healthcare work environments and patient safety.