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

backgroundSituational awareness (SA) is a critical nontechnical skill for intensive care unit (ICU) physicians, underpinning safe decision-making and patient safety. Despite its importance, evidence regarding how SA is assessed and improved in ICU practice remains fragmented.

objectivesTo map the existing evidence on interventions and assessment methods for SA among physicians in adult ICUs, and to evaluate their reported effectiveness.

designScoping review of randomised controlled trials, quasi-experimental studies, cross-sectional studies, and qualitative studies, conducted in accordance with PRISMA-Scr guidelines. DATA SOURCES: MEDLINE, Web of Science, Scopus, and PsycINFO were searched from inception to July 2024. Reference lists and supplementary searches were performed. ELIGIBILITY CRITERIA: We included studies involving ICU physicians, residents and medical students working in adult ICUs that assessed or intervened on SA. Exclusions included studies limited to paediatric/neonatal ICUs, non-ICU staff, inter-unit handovers, reviews, opinion pieces and nonpeer-reviewed literature.

resultsFrom 991 records, 11 studies were included. Simulation-based training consistently improved SA and team co-ordination, while lecture-based training alone was largely ineffective. Crew resource management (CRM) courses increased self-reported awareness but had mixed effects on outcomes. Technological tools (e.g. dashboards, 3D visualisations) showed promise in enhancing early recognition of clinical deterioration and supporting decision-making. SA assessment was most frequently performed using the Situation Awareness Global Assessment Technique (SAGAT), though this remains impractical for real-time ICU use. Methodological quality was generally moderate, with small sample sizes and heterogeneity limiting quantitative synthesis.

conclusionsSimulation-based interventions and novel technological tools appear most effective in enhancing SA among ICU physicians, whereas CRM and didactic methods yield mixed results. The lack of validated, ICU-specific SA assessment tools represents a critical gap. Future research should focus on scalable, team-based training models, context-appropriate assessment instruments, and integration of technological decision-support to strengthen SA and improve patient safety.