Situation Awareness: A New Model for Predicting and Preventing Patient Deterioration

P. W. Brady, D. S. Wheeler, S. E. Muething, U. R. Kotagal
2014 Hospital Pediatrics  
Health care systems, including acute care hospitals, have historically been designed to respond to, rather than predict and prevent, events. The move to a prevention-based health care system continues to mature in outpatient care, particularly around screening and chronic care management. The use of prediction and prevention is more limited in the acute care environment. This is the case despite growing evidence that failure to rescue from preventable deterioration and complications is
more » ... d with devastating outcomes. 1,2 Clinical antecedents occur before most in-hospital cardiorespiratory arrests but may not be fully recognized or acted on. 3 Interventions such as rapid response teams, early warning scores, and virtual monitoring target the quality of monitoring and the response taken when abnormalities are identifi ed. We believe that rapid response systems work to improve the situation awareness of the clinical teams and that situation awareness, with its focus on projection and prediction, provides a model for their further improvement. Situation awareness is achieved by (1) gathering information, (2) understanding that information in context, and (3) making short-term projections based on current state. A health care system that supports excellent clinician situation awareness would actively scan for risk across multiple domains (eg, proactively eliciting family concerns and using early warning scores to detect vital sign abnormalities). It would then couple these reliably with clear, expected actions. A system that reliably identifi es, mitigates, and escalates multiple categories of patient risk will likely result in safer and less costly care. We have begun to test a system to improve situation awareness and prevent unrecognized deterioration at our center. 4 Herein, we present 2 conceptual models of situation awareness in health care and discuss how proactive multimodal risk assessment might drive situation awareness. SITUATION AWARENESS More than a decade ago, the Institute of Medicine challenged health care to learn from other industries and academic disciplines that also face dynamic working conditions and constant safety threats. 5 The Institute of Medicine noted that "Medicine is not unique among high-risk, high-reliability industries because it too is concerned with learning how to prevent, detect, recover, and learn from mishaps and accidents." Indeed, organizational theory researchers have described High Reliability Organizations that face high risk with impressive safety records. 6 A core tenet of High Reliability Organizations is a sensitivity to operations on the front line. These organizations constantly seek to fi nd and correct vulnerabilities AUTHORS
doi:10.1542/hpeds.2013-0119 pmid:24785557 fatcat:nl2hgw66jjbo3dxxzmory3kpki