Assessment of Emergency Medicine Residents' Situational Awareness and Perception of Patient Safety Culture in the Emergency Department.

Background: Situational awareness (SA) and positive safety climate are crucial to patient safety. Little is known about emergency medicine (EM) trainees' SA and perception of emergency department (ED) safety climate, and the interactions of those factors with safety-related behaviors. Objectives: Our objective was to evaluate EM residents' perceptions of ED safety climate, self-reported SA, and comfort with identifying, rectifying, and reporting safety hazards. Methods: In this cross-sectional study at two EM residencies, residents completed the Situational Awareness Rating Technique (SART) after ED-based or simulated resuscitations as well as a survey regarding safety climate and comfort with identifying, rectifying, and reporting ED hazards. Descriptive statistics were used for SART, safety climate, and comfort. A correlation coefficient was calculated between post graduate year (PGY) and SA, PGY and comfort, comfort and SA, and ED safety climate and comfort. Results: 51/91 residents completed the SART; the mean score was 13.4 (max 39). 64/91 completed the additional survey; 57.8% identified a positive safety climate. 46.0%, 41.3%, and 36.5% expressed comfort with identifying, rectifying, and reporting hazards, respectively. PGY correlated with comfort with identifying, rectifying, and reporting hazards and with the number of reported hazards; there was no correlation with PGY and SA. Residents' SA did not correlate with comfort with identifying, rectifying, or reporting hazards or with the number of reported hazards. Perception of a positive safety climate correlated with comfort with reporting hazards, but not with comfort with identifying or rectifying hazards or with the number of reported hazards. Conclusion: Perceiving a culture of safety may not translate to behaviors associated with addressing hazards, and SA itself does not necessarily mean that hazards will be addressed. Targeting departmental culture alone may be insufficient toward equipping residents to address patient safety; there is a need for longitudinal curricular interventions targeting patient safety and SA across all PGYs.