Do team and task performance improve after training situation awareness? A randomized controlled study of interprofessional intensive care teams

Abstract

Background When working in complex environments with critically ill patients, team performance is influenced by situation awareness in teams. Moreover, improved situation awareness in the teams will probably improve team and task performance. The aim of this study is to evaluate an educational programme on situation awareness for interprofessional teams at the intensive care units using team and task performance as outcomes. Method Twenty interprofessional teams from the northern part of Sweden participated in this randomized controlled intervention study conducted in situ in two intensive care units. The study was based on three cases (cases 0, 1 and 2) with patients in a critical situation. The intervention group (n = 11) participated in a two-hour educational programme in situation awareness, including theory, practice, and reflection, while the control group (n = 9) performed the training without education in situation awareness. The outcomes were team performance (TEAM instrument), task performance (ABCDE checklist) and situation awareness (Situation Awareness Global Assessment Technique (SAGAT)). Generalized estimating equation were used to analyse the changes from case 0 to case 2, and from case 1 to case 2. Results Education in situation awareness in the intervention group improved TEAM leadership (p = 0.003), TEAM task management (p = 0.018) and TEAM total (p = 0.030) when comparing cases 1 and 2; these significant improvements were not found in the control group. No significant differences were observed in the SAGAT or the ABCDE checklist. Conclusions This intervention study shows that a 2-h education in situation awareness improved parts of team performance in an acute care situation. Team leadership and task management improved in the intervention group, which may indicate that the one or several of the components in situation awareness (perception, comprehension and projection) were improved. However, in the present study this potential increase in situation awareness was not detected with SAGAT. Further research is needed to evaluate how educational programs can be used to increase situation awareness in interprofessional ICU teams and to establish which components that are essential in these programs. Trial registration This randomized controlled trial was not registered as it does not report the results of health outcomes after a health care intervention on human participants.

The effectiveness of improving healthcare teams’ human factor skills using simulation-based training: a systematic review

“…Nevertheless, Emani et al [ 60 ] and Jafri et al [ 74 ] show a correlation between TS scores and HFS scores, which emphasises that the effect of SBT is evident when HFS is trained solely in combination with other competencies. Studies of multi-disciplinary training ( n = 47) [ 13 , 48 , 53 , 56 , 58 – 64 , 66 – 69 , 71 – 102 ] were generally associated with greater effectiveness than mono-disciplinary training, perhaps because multi-disciplinary training better reflects everyday clinical practice.…”

“…There are inherent challenges in using rating and self-assessments because assessors must be congruent and unbiased, and participants tend to overrate their performance and therefore, the method has been proven unreliable [ 123 , 124 ]. Some studies ( n = 21) used video recording and blinded assessors [ 47 , 48 , 54 , 58 , 60 , 61 , 63 , 66 , 70 , 71 , 74 , 76 , 89 , 91 , 98 , 99 , 103 , 106 , 108 , 111 , 114 ], which increased the validity of the ratings; because the assessors’ could rewind the video and review the situation multiple times. Other studies rated participants in real-time, which challenged the assessors’ ability to simultaneously watch, listen and rate [ 10 , 49 – 51 , 53 , 57 , 59 , 62 – 65 , 67 , 68 , 72 , 73 , 75 , 77 – 79 , 81 , 85 , 93 , 96 , 101 , 107 , 115 , 125 ].…”

“…Maybe because you know it when you experience it but not always when you see it. However, the studies that reflected on the use of high-level concepts and worked to specify these in behaviour markers achieved greater internal validity along with assessed facts, due to the increased transparency [ 10 , 13 , 47 , 48 , 50 , 52 – 55 , 65 – 67 , 69 – 72 , 74 , 75 , 77 , 78 , 96 – 98 , 100 , 101 , 103 , 107 , 114 , 116 ].…”

Shared Situational Awareness within the Hospital Emergency Context: A Scoping Review

“…Seven of these studies employed an observational design [ 11 , 12 , 13 , 14 , 15 , 16 , 17 ]. One was a randomized controlled intervention [ 18 ]. The results of this review showed that the term “shared situational awareness” in itself was not commonly used; instead “team situational awareness” was the most commonly used term [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 ].…”

“…Although, SSA is not globally used in the hospital emergency context [ 19 ], the review results revealed that Endsley’s frameworks [ 2 ] were the most used SA frameworks in the hospital emergency context. Four studies [ 11 , 12 , 15 , 18 ] employed the three-levels of Endsley’s framework [ 2 ], while one study has used one level of the framework [ 13 ]. According to Endsley’s framework [ 2 ], situational awareness components are Level 1: perception of the information present in the situation, Level 2: comprehension of what the information present in the situation means and, Level 3: projection of what might happen in the situation in the near future.…”