Situational awareness

Situational awareness can be simply explained as 'knowing what is going on around you'. It is a cognitive skill in which we are continuously monitoring our environment, noticing what is going on around us and detecting any changes that have occurred. It is maintaining the ‘bigger picture’ view, and being able to think ahead to potential possibilities.

Situational awareness can be defined as "the perception of elements in the environment within a volume of time and space, the comprehension of their meaning and the projection of their status in the near future" (Endsley, 1995).

When working within obstetrics and gynaecology we often work in high-risk environments, most commonly on the delivery suite or operating theatre. Transitions between low- and high-risk care can be quick, and adverse outcomes can occur seemingly without warning. It is therefore important that as healthcare professionals working within such environments, we understand and develop cognitive skills including situational awareness, which are essential for safe patient care. It is the development of these non-technical skills including decision-making, communication, situational awareness, teamwork and leadership which when combined with technical skills improve overall safety.

In 2015, 921 eligible babies were reported to the RCOG's 'Each Baby Counts' programme, of which 13% were intrapartum stillbirths, 16% early neonatal deaths and 71% severe brain injuries. It was found that in 44% of these tragedies, a lack of situational awareness was a contributory factor.

By taking the ‘helicopter view’, an oversight of activity can be maintained. This is usually performed by a senior member of the team, with an aim to prevent important information being overlooked, ensure new information is being acknowledged and allowing anticipation of future problems. It is important that this individual is not engaged in a complex technical task, and if they become so, that they hand over situational awareness to another team member.

The first part of situational awareness is perception. During our everyday practice we encounter multiple forms of information and communication: written, electronic, verbal and non-verbal. Situational awareness can be augmented by improving the quality of information we supply to decision makers – by keeping clear, quality records and using structured handover tools for communication. An effective handover should be multidisciplinary, ensuring that introductions are performed everyday, as teams are not fixed as a rule. Using structured handover tools such as the delivery suite board, we develop a shared mental model as a team. The board should always be legible, accurate, up-to-date and concise. The information on the board supports our perception, which after discussion with the multidisciplinary team, helps our comprehension – taking the information we have received from communication, and putting this into the context of our environment. We can therefore document our projections (plans) on the board, for the awareness of all team members. 

Once we have gathered our information about situational awareness, it is vital we communicate this to the rest of our team – this is key to a shared mental model.

Our working memory store, also known as short term memory, has a limited working capacity – being able to hold about five to seven pieces of information. If we do not pay devoted mental attention to the information we are trying to remember, the trace of this information decays. If we are stressed, distracted, interrupted, hungry or need to go to the bathroom, these distractions can knock key information from your working memory. That piece of information may have been the difference between making a mistake or otherwise, between patient harm or patient safety.

Watch the video about situational awareness and use it to reflect on how you could improve your situational awareness in everyday practice.