Eyes wide open in the ICU: A scoping review of tools and strategies for situational awareness

IntroductionSituational awareness (SA) is the dynamic ability to perceive and analyse information from the environment and to use it to make predictions.1 In sport, SA enables players to perceive what is happening on the field, understand its implications and anticipate others’ actions, allowing them to make informed decisions and respond effectively to rapidly changing circumstances.2 A similar cognitive process is required in critical care, as critical care physicians are constantly exposed to a high volume of information and must manage multiple critical situations simultaneously. As the population ages and medical treatments advance, patients admitted to critical care are increasingly complex, often presenting with multiple advanced diseases. In such high-hazard clinical environments, SA is a crucial cognitive construct for enhancing patient safety.3,4According to Endsley's Cognitive Model, SA consists of three progressive levels: perceiving the key elements in a situation; understanding their significance and impact and projecting future developments based on the current context.3 Schulz et al. investigated in-hospital anaesthesia or ICU-related cases from the Critical Incident Reporting System (CIRS) in a German hospital. They reported that in 81.5% of cases, the problem was attributable to a lack of SA.5 Of these, 38.0% were perception errors, including missing data resulting from communication failures or overlooked monitoring issues; 31.5% were comprehension errors, mainly due to the use of incorrect mental models and over-reliance on default values.Although it is well established that SA is a key element of organisational safety, there are no comprehensive reports on the implementation of this feature in the training and clinical practice of ICU doctors.This scoping review aims to summarise available evidence from medical literature on evaluation and methods to improve the SA of doctors in the ICU. For descriptive purposes, we considered low-fidelity simulation as simple, low-tech training environments that emphasise cognitive and teamwork skills (e.g., hazard-detection rooms), whereas high-fidelity simulation uses immersive, technologically advanced setups that closely replicate real ICU conditions.MethodsStudy designThis scoping review followed the methodological framework proposed by Arksey and O’Malley,6 further refined by Levac et al.7, and the JBI guideline,8 and is reported according to PRISMA-ScR.9Eligibility criteriaThe full eligibility criteria, including inclusion and exclusion criteria across population, phenomenon of interest, study design and publication characteristics, are presented in Table 1. We included studies involving physicians working in adult ICUs. We made no distinction between ICU residents and residents from different specialities rotating through the ICU. We considered studies that investigated SA in the ICU context. SA was defined in accordance with commonly accepted frameworks (e.g. Endsley's model3) as the perception of environmental elements, the comprehension of their meaning, and the projection of future status. We included studies that examined SA directly, as well as those addressing closely related constructs in which SA was a central theme.Table Presented