Article Text

This article has a correction. Please see:

Download PDFPDF

Realistic evaluation of Situation Awareness for Everyone (SAFE) on paediatric wards: study protocol
  1. J Deighton1,
  2. J Edbrooke-Childs1,
  3. E Stapley1,
  4. N Sevdalis2,
  5. J Hayes3,
  6. D Gondek1,
  7. E Sharples1,
  8. P Lachman4
  1. 1Evidence Based Practice Unit, University College London and the Anna Freud National Centre for Children and families, London, UK
  2. 2Health Service and Population Research Department, Centre for Implementation Science, Kings College London, London, UK
  3. 3Department of Psychology, University of Roehampton, London, UK
  4. 4International Society for Quality in Health Care, Dublin, Ireland
  1. Correspondence to Dr Jessica Deighton; Jessica.Deighton{at}


Introduction Evidence suggests that health outcomes for hospitalised children in the UK are worse than other countries in Europe, with an estimated 1500 preventable deaths in hospital each year. It is presumed that some of these deaths are due to unanticipated deterioration, which could have been prevented by earlier intervention, for example, sepsis. The Situation Awareness For Everyone (SAFE) intervention aims to redirect the ‘clinical gaze’ to encompass a range of prospective indicators of risk or deterioration, including clinical indicators and staff concerns, so that professionals can review relevant information for any given situation. Implementing the routine use of huddles is central to increasing situation awareness in SAFE.

Methods and analysis In this article, we describe the realistic evaluation framework within which we are evaluating the SAFE programme. Multiple methods and data sources are used to help provide a comprehensive understanding of what mechanisms for change are triggered by an intervention and how they have an impact on the existing social processes sustaining the behaviour or circumstances that are being targeted for change.

Ethics and dissemination Ethics approval was obtained from London—Dulwich Research Ethics Committee (14/LO/0875). It is anticipated that the findings will enable us to understand what the important elements of SAFE and the huddle are, the processes by which they might be effective and—given the short timeframes of the project—initial effects of the intervention on outcomes. The present research will add to the extant literature by providing the first evidence of implementation of SAFE and huddles in paediatric wards in the UK.


This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Contributors JD is principal investigator for the evaluation and takes main responsibility for the research design and delivery. She drafted the paper in full and coordinated input from coauthors. JE-C is a research advisor to the project and made substantial revisions to all aspects of the current paper. ES is qualitative research lead for the project, shaping the qualitative research design in detail and drafting this section of the current paper, as well as contributing to drafting of the introduction. NS is a research advisor on the project and provided significant guidance and redrafting of the paper. JH led the qualitative design for the initial stages of the project and was also involved in the design of the huddle tool. DG manages the research project and provided particular input on drafting of procedure and methods sections. ES is a research assistant supporting qualitative data collection and provided input on these aspects of the paper. PL is the clinical lead on the implementation team for the project and provided input to drafting of introduction and discussion sections.

  • Funding Situation Awareness For Everyone (SAFE) is a Health Foundation funded Programme; the implementation of SAFE and the evaluation were funded by the Health Foundation. This work was also supported by funding from WellChild, the funding was specifically to support evaluation work around perspectives of parents and young people and to support patient and parent involvement in the research. NS’ research is supported by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South London at King’s College Hospital NHS Foundation Trust. NS is a member of King's Improvement Science, which is part of the NIHR CLAHRC South London and comprises a specialist team of improvement scientists and senior researchers based at King's College London. Its work is funded by King's Health Partners (Guy's and St Thomas’ NHS Foundation Trust, King's College Hospital NHS Foundation Trust, King's College London and South London and Maudsley NHS Foundation Trust), Guy's and St Thomas’ Charity, the Maudsley Charity and the Health Foundation. JD was partly supported by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) North Thames at Bart's Health NHS Trust.

  • Disclaimer The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.

  • Competing interests None declared.

  • Ethics approval Dulwich Research Ethics Committee (14/LO/0875).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data collection for the project is on-going so not currently available to those external to the research team. Any requests for access to prospective data should be sent to

Linked Articles

  • Correction
    British Medical Journal Publishing Group