emergency and critical care
Situation awareness
during crisis in the OR
The operating room is a complex environment and knowledge
and improvement of situation awareness can increase the performance
in this domain, leading to better patient outcomes
Diana Zamudio Penko
PhD
Daniel Arnal Velasco
MD
Department of
Anaesthesia and Critical
Care, The Alcorcon
Foundation University
Hospital, Spain
Situation awareness (SA) can be defined as ‘the
perception of elements of the environment within a
volume of time and space, the comprehension of
their meaning and the projection of their status in
the near future’. 1 In simple terms, it is knowing what
is going on around you by extracting information
from the environment and then integrating that
information to create a notion of the situation and
anticipate future events. Therefore, SA is important
for effective decision-making, performance and
teamwork. 2 Understanding the meaning of SA and
how to improve it in a complex work environment,
such as the operating room (OR), is essential for
patient safety.
Individual SA
According to the definition, SA is subdivided into
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HHE 2018 | hospitalhealthcare.com
three levels: perception (level I), comprehension
(level II) and projection (level III). 2 The first level
comprises the identification of the key elements
that assess the ongoing situation; in the OR, the
perception of the patient’s state is provided by
the patient (for example, through verbal
communication or appearance), monitors,
patient charts, communication within the team,
anaesthesia machines, respirators, and the
surgical field. 3 The second level comprises the
comprehension and integration of multiple pieces
of information and the determination of their
relevance to the situation to form a coherent
mental picture. Finally, the highest level entails
the ability to forecast the future development
of the patient’s state and determine the best way
to proceed.