S.A.F.ESituation Awareness For Everyone

Closing the Gap in Paediatric Safety

S.A.F.E. Partnership

This programme is part of the Health Foundation’s Closing the Gap in Patient Safety programme.The Health Foundation is an independent charity working to continuously improve the quality of healthcare in the UK.

The S.A.F.E Partnership brings together four UK organisations that have a shared goal to improve outcomes for children and young people.

Participating Sites

Specialist Children’s Hospitals

• Alder Hey• Birmingham Children’s• Evelina Children’s• Great Ormond Street• Royal Manchester Children’s• Sheffield Children’s

District & General Hospitals

• Barts and the London• Luton and Dunstable• North Middlesex• Royal Free• Watford General• Whittington

Programme Overview

Redirecting the “clinical gaze” to reduce harm and drive cultural change through better communication in

children’s wards

Programme Background

Children in the UK experience higher morbidity and mortality than those in comparable health systems.

Figure: Comparison of five year average mortality in childhood in European countries and excess deaths in UK (relative to comparator countries) according to method of first access to medical care, 2003-7 World Health Organisation Regional Office for Europe. European Detailed Mortality Database. www.euro.who.int/en/what-we-do/data-and-evidence/databases/european-detailed-mortality-database-dmdb2.

Closing the Gap

The programme aims to improve outcomes for children in acute healthcare:

• Introduce situation awareness in paediatric wards– Introduce tools to improve communication– Develop concepts of anticipation and containment to

promote high reliability– Drive the development of a culture based on safety– Adjust the Cincinnati ‘huddle’ model to UK care provision

• Develop a single framework for improving outcomes

Programme Deliverables

Paper published in BMJ Quality evaluating the impact of improved situation awareness in paediatric units on

outcomes for paediatric patients

Single, marketable intervention framework, using validated tools, for improving situation awareness in

paediatric units

The Collaborative Model

The programme will use IHI’s Breakthrough Series improvement methodology, using the spread and adaptation of existing knowledge to multiple settings to accomplish a common aim.

• Centrally delivered learning programme• Regular site visits with training for additional support• Additional mechanisms for sharing knowledge and

experience between sites

The ‘Huddle’ Suite

EscalateLeaders Daily Safety Brief

Overview of events of harm and risk

IdentifyWard Bedside huddles

Nurse and Doctor

Mitigate Ward Safety Huddle

Nurses, Doctors, Allied professionalsPEWS, Watchers, family or communication

concern

Developing a Single Intervention Model

Key domains in improving situation awareness will be identified (e.g. communication; safety attitudes; PEWS).

The collaborative teams will jointly agree which tools are most appropriate in these domains and the model will be built around that.

It is important, however, that the model includes flexibility.

Evaluating the Programme

The Anna Freud Centre are evaluating the impact of improved situation awareness. The specific evaluation question is:

Under what circumstances, by what means and in what ways does increasing situation awareness lead to improved safety, experience and other elements of

quality for children under inpatient care?

Quantitative Design

Will draw on :

1. Routinely collected harm data from sites2. PREMS/PROMS3. Staff reports safety culture4. Contextual information about sites5. Other implementation data being recorded

Qualitative Design

Site Observations– Researchers observe Huddles in practice– At different times of day and different intervals throughout

the project to ascertain who joins, what is discussed etc.– Observations and audio recording agreed with site lead

Semi-structured interviews or focus groups– With ward staff (experience of managing safety issues,

implementing situation awareness, and the huddle)– With parents and patients (perceptions and management

of safety

Contact Details

Darren CooperProgramme Manager

Darren.Cooper@rcpch.ac.uk

Twitter@SAFE_QI

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