Olson Adriana S, Olson Nathan, Hartman Nicholas D, Morrone Casey, Battaglia Morgan, Balhara Kamna S
Section of Emergency Medicine, Department of Medicine University of Chicago Chicago Illinois USA.
Department of Emergency Medicine Wake Forest University School of Medicine Winston-Salem North Carolina USA.
AEM Educ Train. 2025 Jun 12;9(3):e70060. doi: 10.1002/aet2.70060. eCollection 2025 Jun.
Situational awareness (SA) and positive safety climate are crucial to patient safety. Little is known about emergency medicine (EM) trainees' SA and perception of emergency department (ED) safety climate, and the interactions of those factors with safety-related behaviors.
Our objective was to evaluate EM residents' perceptions of ED safety climate, self-reported SA, and comfort with identifying, rectifying, and reporting safety hazards.
In this cross-sectional study at two EM residencies, residents completed the Situational Awareness Rating Technique (SART) after ED-based or simulated resuscitations as well as a survey regarding safety climate and comfort with identifying, rectifying, and reporting ED hazards. Descriptive statistics were used for SART, safety climate, and comfort. A correlation coefficient was calculated between post graduate year (PGY) and SA, PGY and comfort, comfort and SA, and ED safety climate and comfort.
51/91 residents completed the SART; the mean score was 13.4 (max 39). 64/91 completed the additional survey; 57.8% identified a positive safety climate. 46.0%, 41.3%, and 36.5% expressed comfort with identifying, rectifying, and reporting hazards, respectively. PGY correlated with comfort with identifying, rectifying, and reporting hazards and with the number of reported hazards; there was no correlation with PGY and SA. Residents' SA did not correlate with comfort with identifying, rectifying, or reporting hazards or with the number of reported hazards. Perception of a positive safety climate correlated with comfort with reporting hazards, but not with comfort with identifying or rectifying hazards or with the number of reported hazards.
Perceiving a culture of safety may not translate to behaviors associated with addressing hazards, and SA itself does not necessarily mean that hazards will be addressed. Targeting departmental culture alone may be insufficient toward equipping residents to address patient safety; there is a need for longitudinal curricular interventions targeting patient safety and SA across all PGYs.
态势感知（SA）和积极的安全氛围对患者安全至关重要。关于急诊医学（EM）实习生的态势感知以及对急诊科（ED）安全氛围的认知，以及这些因素与安全相关行为之间的相互作用，我们所知甚少。
我们的目的是评估急诊医学住院医师对急诊科安全氛围的认知、自我报告的态势感知，以及识别、纠正和报告安全隐患的舒适度。
在两项急诊医学住院医师培训项目的横断面研究中，住院医师在基于急诊科的或模拟复苏后完成态势感知评分技术（SART），以及一项关于安全氛围和识别、纠正及报告急诊科隐患舒适度的调查。描述性统计用于SART、安全氛围和舒适度。计算研究生年级（PGY）与态势感知、PGY与舒适度、舒适度与态势感知以及急诊科安全氛围与舒适度之间的相关系数。
91名住院医师中有51名完成了SART；平均得分为13.4（满分39分）。91名中有64名完成了额外的调查；57.8%的人认为安全氛围积极。分别有46.0%、41.3%和36.5%的人表示在识别、纠正和报告隐患方面感到舒适。PGY与识别、纠正和报告隐患的舒适度以及报告的隐患数量相关；PGY与态势感知无相关性。住院医师的态势感知与识别、纠正或报告隐患的舒适度或报告的隐患数量无相关性。对积极安全氛围的认知与报告隐患的舒适度相关，但与识别或纠正隐患的舒适度或报告的隐患数量无关。
感知到安全文化不一定会转化为与解决隐患相关的行为，而且态势感知本身并不一定意味着会解决隐患。仅针对部门文化可能不足以让住院医师具备解决患者安全问题的能力；需要针对所有PGY阶段的患者安全和态势感知进行纵向课程干预。
