Developing situational awareness (‘helicopter view’)

M R C O G PA R T 2 · S O S P O C K E T C A R D · K N O W L E D G E A R E A 1 – C L I N I C A L S K I L L S

Developing Situational Awareness (‘Helicopter View’) Yoong W et al. Developing situational awareness (‘helicopter view’). TOG 2021;23:60–66. doi:10.1111/tog.12709

≥50% 97% >80% SERIOUS INCIDENTS WITH SA LOSS BILE DUCT INJURY ERRORS = POOR SA GERMAN ANAESTHETIC INCIDENTS (SA)

DO N' T-M IS S FA C TS

1. SA loss implicated in ≥50% of serious safety events (HIE, maternal deaths)

2. NUPA: Notice → Understand → Project Ahead

3. NOTSS SA rated 1–4: Poor / Marginal / Acceptable / Good

4. Cognitive capacity ≈ 3–5 items at once — overload → task shedding → SA lost

5. Red flags: ambiguity, target fixation, confusion, failure to meet targets/adhere to SOPs/resolve discrepancies/communicate — most errors show ≥4 cues

6. ‘Sterile cockpit’: avoid non-essential tasks during critical phases

7. Delegate a team member to hold the ‘helicopter view’ when you must fixate during a critical step

8. HEMS: BASTE / STACS called every 10 minutes to update team SA

SA LOSS — KEY MECHANISMS

Target fixation Task saturation / workload Distractions No shared mental model Fatigue Complacency

GOOD SA BEHAVIOURS

Briefing / mini-brief Shared mental model Shallow authority gradient Speak up Delegate 'helicopter view'

ABBREVIATION KEY

SA — situational awareness DIC — disseminated intravascular coagulation

NUPA — Notice, Understand, Project Ahead — the 3-level SA MBTI — Myers-Briggs Type Indicator framework HEMS — Helicopter Emergency Medical Service NOTSS — Non-Technical Skills for Surgeons CTG — cardiotocograph ANTS — Anaesthetists' Non-Technical Skills GTIRT — Grenfell Tower Investigation and Review Team RCOG — Royal College of Obstetricians and Gynaecologists BASTE — blood, arterial blood gases, surgery, temperature, GMC — General Medical Council equipment

SOP — standard operating procedure STACS — systolic, temperature, acidosis, coagulation, surgery

PPH — postpartum haemorrhage

Source: The Obstetrician & Gynaecologist (TOG), RCOG journal — Yoong W et al. Developing situational awareness (‘helicopter view’). TOG 2021;23:60–66. doi:10.1111/tog.12709

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