1. S.A.F.E Situation Awareness For Everyone
Closing the Gap in Paediatric Safety

2. 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.

3. 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

4. Programme Overview
Redirecting the “clinical gaze” to reduce harm and drive cultural change through better communication in children’s wards

5. 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, World Health Organisation Regional Office for Europe. European Detailed Mortality Database.

6. 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

7. 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

8. 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

9. 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

10. 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.

11. 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?

12. 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

13. 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

14. Contact Details
Darren Cooper Programme Manager #SAFEQI