- clinical deterioration
- medical emergency teams
- patient safety
- rapid response systems
- situation awareness
Health care systems, including acute care hospitals, have historically been designed to respond to, rather than predict and prevent, events. The move to a prevention-based health care system continues to mature in outpatient care, particularly around screening and chronic care management. The use of prediction and prevention is more limited in the acute care environment. This is the case despite growing evidence that failure to rescue from preventable deterioration and complications is associated with devastating outcomes.1,2 Clinical antecedents occur before most in-hospital cardiorespiratory arrests but may not be fully recognized or acted on.3 Interventions such as rapid response teams, early warning scores, and virtual monitoring target the quality of monitoring and the response taken when abnormalities are identified.
We believe that rapid response systems work to improve the situation awareness of the clinical teams and that situation awareness, with its focus on projection and prediction, provides a model for their further improvement. Situation awareness is achieved by (1) gathering information, (2) understanding that information in context, and (3) making short-term projections based on current state. A health care system that supports excellent clinician situation awareness would actively scan for risk across multiple domains (eg, proactively eliciting family concerns and using early warning scores to detect vital sign abnormalities). It would then couple these reliably with clear, expected actions.
A system that reliably identifies, mitigates, and escalates multiple categories of patient risk will likely result in safer and less costly care. We have begun to test a system to improve situation awareness and prevent unrecognized deterioration at our center.4 Herein, we present 2 conceptual models of situation awareness in health care and discuss how proactive multimodal risk assessment might drive situation awareness.
More than a decade ago, the Institute of Medicine challenged health care to learn …