Charles Spear, MD
Pediatric Critical Care Fellow
Cincinnati Childrens Hospital Medical Center, United States
Disclosure information not submitted.
Allison Parsons
Research Associate
Cincinnati Children's Hospital Medical Center, United States
Disclosure information not submitted.
Naveen Muthu, MD
Attending Physician, Instructor of Clinical Informatics
Children's Hospital of Philadelphia, United States
Disclosure information not submitted.
Heather Wolfe, MD,
Pediatric Critical Care Attending Physician
Children's Hospital of Philadelphia
Philadelphia, Pennsylvania, United States
Disclosure information not submitted.
Robert Sutton, MD, FCCM
Professor of Anesthesia, Critical Care, & Pediatrics
Children's Hospital of Philadelphia
Philadelphia, Pennsylvania, United States
Disclosure information not submitted.
Ken Tegtmeyer, MD, FAAP,FCCM
Professor of Pediatrics
Cincinnati Children's Hospital Medical Center
Portland, Oregon, United States
Disclosure information not submitted.
Matthew Zackoff, MD, MEd
Assistant Professor of Pediatrics
Cincinnati Children's Hospital Medical Center, United States
Disclosure information not submitted.
Maya Dewan, MD, MPH
Assistant Professor
Cincinnati Children's Hospital Medical Center
Cincinnati, Ohio
Disclosure information not submitted.
Title: Goal-Directed Task Analysis to Understand the Assessment of Shared Situational Awareness
Introduction: We hypothesize that purposive sampling of expert opinion via the use of goal-directed task analysis (GDTA) would elucidate differences in development of shared situational awareness for critically ill children by discipline. GDTA is a method that documents the information needed to perform tasks and how this information is integrated to address a particular decision.
Methods: We utilized a cross-sectional, qualitative, descriptive study via purposive sampling using a series of 30 semi-structured expert interviews (5 intensivists, 5 hospitalists, 10 RNs, and 10 RTs). Interviewees were questioned using GDTA with a sample case involving the presentation of critically ill pediatric patient. We used thematic content analysis to examine common themes that highlighted goals, decision-making, and information synthesis used in shaping shared situational awareness.
Results: In-depth interview analysis revealed themes surrounding the perception, comprehension, and projection of shared situational awareness. The most common theme for individual goals of care amongst physicians and RTs was illness severity establishment, while the majority of RNs highlighted a focus on goal-oriented interventions and family awareness of the situation. Physicians differed from RNs and RTs regarding decision-making, with an emphasis on independent vs. collaborative decision-making, whereas the latter two groups highlighted knowing when to ask for help. All groups demonstrated similar themes for information synthesis related to instinct and experience recall, understanding vital sign trends, and understanding of response to prior interventions. The most common themes surrounding shared situational awareness included establishment of a mental model, contingency planning, and designation of high risk patient status. Nearly all noted the importance of the timing and method with which to ensure a team understands individual thought processes. Physicians placed emphasis on clear role assignment and prioritization establishment, while RNs and RTs stressed importance of expression of level of concern.
Conclusions: Common themes exist surrounding the development and recognition of shared situational awareness amongst expert pediatric providers, although differences exists in importance of the timing and methods of decisions by discipline.