Realistic evaluation of Situation Awareness for Everyone (SAFE) on paediatric wards: study protocol

Abstract

IntroductionEvidence suggests that health outcomes for hospitalised children in the UK are worse than other countries in Europe, with an estimated 1500 preventable deaths in hospital each year. It is presumed that some of these deaths are due to unanticipated deterioration, which could have been prevented by earlier intervention, for example, sepsis. The Situation Awareness For Everyone (SAFE) intervention aims to redirect the ‘clinical gaze’ to encompass a range of prospective indicators of risk or deterioration, including clinical indicators and staff concerns, so that professionals can review relevant information for any given situation. Implementing the routine use of huddles is central to increasing situation awareness in SAFE.Methods and analysisIn this article, we describe the realistic evaluation framework within which we are evaluating the SAFE programme. Multiple methods and data sources are used to help provide a comprehensive understanding of what mechanisms for change are triggered by an intervention and how they have an impact on the existing social processes sustaining the behaviour or circumstances that are being targeted for change.Ethics and disseminationEthics approval was obtained from London—Dulwich Research Ethics Committee (14/LO/0875). It is anticipated that the findings will enable us to understand what the important elements of SAFE and the huddle are, the processes by which they might be effective and—given the short timeframes of the project—initial effects of the intervention on outcomes. The present research will add to the extant literature by providing the first evidence of implementation of SAFE and huddles in paediatric wards in the UK.

Implementation of Situational Awareness in the Pediatric Oncology Setting. Does a ‘huddle’ Work and Is it Sustainable?

“…The concept of situational awareness is not new to healthcare settings, it relates to the state of knowing what is happening around you (Brady et al, 2013;Cohen, 2013;Endsely & Jones, 2004) and is based upon the model that High Reliability Organisations (HRO) use, by constantly seeking out situations that are susceptible to errors occurring and developing a situational awareness to help facilitate its prevention (Brady, Wheeler, Muething, & Kotagal, 2014;Deighton et al, 2016., Dutka, 2016Singh, Giardina, Peterson, Smith, et al, 2012). It is a concept that sustains reliability and functioning in organisations (Fore & Sculli, 2013) by creating an environment that leads to safer delivery of patient care, by decreasing incidents and errors Deighton et al, 2016). Loss of situational awareness, in high-risk areas such as healthcare is one of the most frequent causes of inferior clinical consequences (Australian Commission on Safety and Quality in Health Care, 2015-2016; Brock et al, 2013;Fore & Sculli, 2013).…”

“…High-risk medications are administered on a daily basis and treatment protocols can be complex, resulting in undesired side effects, rendering the child acutely unwell. Huddles enable these children to be identified as 'Watchers', this situational awareness can lead to better recognition of early deterioration and lead to proactively identifying sick children prior to them deteriorating further (Brady et al, 2013;Deighton et al, 2016). Medication load is also often high as a consequence of the child's intense treatment and errors that involve high-risk medications, such as cytotoxic drugs, cellular therapies and opioids can have fatal consequences, making prevention of errors imperative (Fyhr & Akselsson, 2012).…”

Do safety briefings improve patient safety in the acute hospital setting? A systematic review

“…These include a multi‐method study of briefings associated with the S.A.F.E. campaign (Deighton et al., ), a quasi‐experimental pilot study aiming to reduce the risk of alarm fatigue (Bonafide, ) and an ongoing randomized trial studying the impact of a monitor alarm reduction strategy through briefings (Bonafide, ).…”

Assessing risks to paediatric patients: conversation analysis of situation awareness in huddle meetings in England

“…A mixed methods approach was taken to the evaluation of the SAFE programme 17. Quantitative data were collected from the 12 hospital sites participating in Wave 1 of the SAFE programme and qualitative data (including observations of huddles and interviews with hospital staff about their experiences of implementing SAFE) were collected from four of these sites.…”

“…The data for this study were taken from a wider evaluation of the Situation Awareness for Everyone (SAFE) safety improvement collaborative 17. As part of SAFE, paediatric staff at an initial 12 (Wave 1) then a further 16 (Wave 2) National Health Service hospitals across England trialled several techniques, including huddles, to improve patient care and the anticipation of risks to patients.…”