Learning Objective: 1. Assess the baseline comfort for EM residents identifying and rectifying patient safety hazards 2. Assess the EM residents baseline ED safety climate.

Background: Situational awareness (SA) is crucial in emergency medicine (EM) and to patient safety. SA refers to perceptions and understanding of the environment. Little is known about EM trainees’ SA and perception of Emergency Department (ED) safety climate.

Objectives: Our objective was to evaluate EM residents’ perception of ED safety climate and their self-reported SA; we hypothesized that both would be low.

Methods: A cross-sectional observational study was conducted over 3 months at 2 university-affiliated 3-year EM programs. A convenience sample of residents completed the validated self-reported Situational Awareness Rating Technique (SART) measure after the resuscitation of an ED or simulated patient. The safety climate portion of the Safety Attitudes Questionnaire and a survey assessing comfort with identifying and rectifying hazards in the ED were completed Descriptive statistics were used for SART, safety climate, and comfort. A Spearman-Rho correlation coefficient was calculated to assess the correlation between PGY and SA, PGY and comfort, and the correlation between comfort and SA.

Results: 51/91 residents completed a SART for a total of 62 SARTs; 10 residents completed more than one SART. The mean SART score was 13.4 (max 21). 64/91 residents completed the safety climate scale; 57.8% of participants identified a positive safety climate. 46.0% and 41.3% reported being somewhat or very comfortable identifying and rectifying hazards, respectively. There was no correlation between PGY and SA (r=0.163,p=0.25). There was a correlation between PGY and comfort with identifying (r=0.252,p=0.046) and rectifying hazards (r=0.252,p=0.046).

Conclusions: Less than 50% of residents reported comfort with identifying and rectifying hazards and only a slight majority reported a positive ED safety climate. Comfort modestly improved throughout residency, while SA did not. This data suggests a need for longitudinal patient safety curriculum.

Learning Objective: 1. Assess EM residents satisfaction with a patient safety simulation and debriefing 2. Assess EM residents ability to identify hazards and solutions in a simulated patient safety room.

Background: Situational awareness (SA) is essential to patient safety in emergency medicine (EM). SA has 3 ascending levels and is impacted by environment and workload.(Fig.1) Little is known about how EM residents’ SA evolves during training, limiting development of curricula, though simulation may be a promising approach.

Objectives: Our objective was to evaluate EM residents’ SA of hazards in a simulation and assess satisfaction with the exercise and debriefing. We hypothesized senior residents would identify more hazards.

Methods: A cross-sectional observational study was conducted over 3 months with a convenience sample of residents at 2 university-affiliated 3-year EM programs. A simulation scenario was designed, incorporating common safety hazards.(Fig. 2) After reviewing a mock handoff and chart, participants spent 10 minutes in a simulated room documenting hazards and solutions. An interruption and new task were introduced midway to replicate the ED environment and workload. Hazards, solutions, and core SA concepts were discussed during the debriefing. Descriptive statistics were used for hazards and survey responses. A Spearman-Rho coefficient was calculated to assess the correlation between PGY and hazards identified.

Results: 46/91 residents participated in the simulation. Mean hazards identified were 6.12/13(47.1%): Level 1:3.8/6(63.3%), Level 2:1.84/4(46.0%), Level 3:1.13/3(37.7%). There was no correlation between PGY and hazards identified (all hazards: r=0.136,p=0.3655; Level 3: r=-.039,p=0.796). 97.8% and 96.7% reported satisfaction with the exercise and debriefing, respectively. 100% agreed the exercise improved knowledge of ED safety hazards.

Conclusions: Residents identified <50% of hazards; higher level hazards were less frequently identified for all PGYs. This suggests a need for longitudinal SA and patient safety education. Educators should consider incorporating elements of workplace complexity for patient safety education.