S.A.F.E Situation 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

Leaders Daily Safety Brief The ‘Huddle’ Suite Escalate Leaders Daily Safety Brief Overview of events of harm and risk Mitigate Ward Safety Huddle Nurses, Doctors, Allied professionals PEWS, Watchers, family or communication concern Identify Ward Bedside huddles Nurse and Doctor

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 : Routinely collected harm data from sites PREMS/PROMS Staff reports safety culture Contextual information about sites 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 Cooper Programme Manager Darren.Cooper@rcpch.ac.uk Twitter @SAFE_QI #SAFEQI