Introduction to the S.A.F.E Resource Pack

Situation Awareness for Everyone (S.A.F.E) was a two-year programme led by the RCPCH to trial and develop quality improvement tools and techniques which aim to reduce preventable deaths and error in paediatric hospital departments in the UK. 

This resource pack can help health professionals working in paediatric units implement S.A.F.E locally.


It is estimated that 2,000 preventable deaths occur each year compared to the best performing countries in Western Europe. If hospital staff have access to the correct tools and techniques, the lives of children who unnecessarily deteriorate could be saved.

Our short video introduces the key concepts

With Dr Peter Lachman, S.A.F.E National Clinical Lead, and other colleagues at Great Ormond Street Hospital.

By using the concepts in S.A.F.E, we anticipate that paediatric units can do the following

  • Reduce avoidable error and harm to acutely sick children
  • Improve communication between all healthcare professionals involved in a child’s care - as well as families - to ensure treatment is consistent and of the same high standard regardless of postcode or class
  • Help to close the disparity in health outcomes for children in UK vs other countries as well as between children’s care and adult care
  • involve parents, children and young people to be better involved in their children’s/own care

How the resource pack was developed

The S.A.F.E programme brought together paediatric units from 28 hospitals across England into three collaborative learning groups.

Each ran a local quality improvement project aimed at improving outcomes for paediatric patients. Participating units share their knowledge and experience with other collaborative partners, demonstrating both their successes and failures.

This resource pack has been co-designed with the participating units. We will continue to update it as materials evolve further and new tools are shared from participating sites, with major updates communicated through the RCPCH e-bulletins and social media channels.

It is funded by the Health Foundation, and supported by UCLPartners and WellChild.

How it is being evaluated

The Anna Freud Centre has quantitatively and qualitatively evaluated the impact of improved situation awareness, aiming to answer the question:

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?

Read more about the background to the S.A.F.E programme.

How to use this resource pack

Situation awareness requires shared understanding of what is happening and this needs non-hierarchical information and communication. There is no single intervention that can implement situation awareness in a single go. However, there are many different tools and techniques that together can deliver situation awareness in a paediatric or other healthcare setting. 

This resource pack provides many, but not all, of the tools you might consider using and is organised into six main themes, which reflect how S.A.F.E has been implemented elsewhere.

You can identify which chapter you wish to start from, depending on the experience of your organisation.

About Quality Improvement   

Every setting is different, and so an understanding of quality improvement methodology is essential. This will allow you to take ideas, new or existing, and implement them in such a way that they can be modified until they work for you.

Patient Safety Culture  

A key foundation for situation awareness is a safety-based culture, engaging all staff, as well as the patients and their families. This means breaking down hierarchies, a new mental model or way of thinking and accepting that everyone has a different view, all of which need to be considered.

Structured Communication  

Knowing exactly what information is needed when talking about a patient means communication is much smoother and the right information is available for decision-making. This will allow the platform for everyone to have a chance to express their view.

Recognising Deterioration  

A factor in the rate of preventable deaths is the failure to recognise and respond to deterioration. Ensuring that we recognise deterioration means we can respond in a timely and effective way, while reviewing cases of unrecognised deterioration allow us to identify new ways to improve.


A specific intervention that brings together the key elements of situation awareness, huddling provides a mechanism for ensuring that all information about a patient is shared effectively.

Evaluation and Spread  

Once you’ve found what works for you, you can evaluate the impact of introducing situation awareness locally. If you have a demonstrably positive impact, it’s time to start to spread your work to other sites locally, and further afield.

How to contact us if you are using the resourc pack

The materials available in this resource pack are free to use. We would like to track where and how the pack is being implemented - do let us know by emailing us at

You can also email with questions, which the team will try to answer, or pass on to one of our existing participants.

What happens next

The S.A.F.E Partnership, through the RCPCH, will continue to look for further opportunities to support the introduction of situation awareness across paediatric settings, with the aim of improving outcomes.

Situation awareness and S.A.F.E are a key theme for Making it Safer Together (MiST), a national paediatric patient safety collaborative of hospitals that share a vision of achieving harm-free paediatric healthcare. Sites using the resource pack are encouraged to engage with MiST and share their experiences and improvements on introducing situation awareness.

Section 1: Introducing quality improvement