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Open Access Publications from the University of California

Assessment of Emergency Medicine Residents’ Situational Awareness and Perception of Patient Safety Culture in the Emergency Department

Creative Commons 'BY' version 4.0 license

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.

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