A26 Using the Situation Awareness Global Assessment Tool (SAGAT) and the Situation Awareness Rating Technique (SART) during Simulation Training for Intensive Care Teams
HIGHAM H., Greig P., YOUNG J., VINCENT C.
INTRODUCTION Situation Awareness (SA) is an essential cognitive skill for the safe management of patients in rapidly changing environments such as the Intensive Care Unit (ICU). The Situation Awareness Global Assessment Tool (SAGAT) was designed for the objective measurement of SA in military pilots1 and requires a Goal Directed Task Analysis (GDTA) to define expected responses from participants in simulated scenarios. Scenarios are paused and pre-determined questions relevant to SA answered by participants on a SAGAT questionnaire. The Situation Awareness Rating Technique (SART)2 is a subjective SA rating tool. Participants rate their SA over three domains – attentional demand, attentional supply and understanding. SAGAT and SART have been used extensively in military aviation but not in ICU. OBJECTIVES To determine the validity and usability of SAGAT and SART and the prevalence of SA error in ICU teams during simulation training. METHODS • We designed two standardised scenarios covering ICU emergencies for multidisciplinary teams of two nurses and one specialist trainee (ST3-7). Participants took part in both scenarios during training (only one incorporated the SAGAT questions because this takes substantially longer and training was time limited). • SA questions were generated from GDTAs and incorporated into a SAGAT questionnaire. • Candidates answered the SAGAT questions independently during pauses at pre-determined points- and the SART questionnaire immediately after the scenario ended. RESULTS • 19 teams (57 staff: 19 doctors, 38 nurses) attended the training. • Qualitative feedback was extremely positive. • 54% (31/57) recorded increased confidence in recognising changes in a patient’s condition; (42% [24/57] recorded no change and 4% [2/57] recorded a decrease). • 100% of candidates (55 responses) would recommend the training to colleagues. • Average pause lengths for the SAGAT scenarios varied between 4.0 and 9.9 minutes. • 86% (49/57) of candidates found the SAGAT pauses not at all or mildly disruptive to learning, 14% (8/57) of candidates found them extremely disruptive to learning. • Completion of the SAGAT and SART tools was straightforward (1,103 SART data points complete from a possible 1,110). • Analysis of the SAGAT and SART questionnaires is ongoing. CONCLUSIONS SAGAT and SART are valid and usable tools for the measurement of SA in simulation training for multidisciplinary teams in ICU. SAGAT pauses added richness to the discussion of situation awareness in the debriefing and highlighted discrepancies in SA between team members that were used to direct learning. The SAGAT and SART tools could be used to design and quality assure training to improve SA in ICU. REFERENCES 1. Endsley MR. Direct measurement of situation awareness: Validity and use of SAGAT. Situation Awareness Analysis and Measurement. Mahwah, NJ, US: Lawrence Erlbaum Associates Publishers; 2000. p. 147–73 2. Taylor RM. Situational Awareness Rating Technique (SART): The development of a tool for aircrew systems design. AGARD Conf Proc No 478, Situational Aware Aerosp Oper Neuilly sur Seine: NATO-AGARD; 1990. p. 1-17