Dr. Dave Johnson, our department's Medical Director, gives regular lectures on patient experience and satisfaction, evidence-based clinical practice, and updates on departmental policies and procedures. Recently, he gave a lecture about medical errors and ways to overcome them. How do you prevent medical errors in your emergency department?
We need to get better at avoiding:
o Delayed or inaccurate diagnoses
o Delayed or inappropriate treatments
Causes of bias:
o Fatigue
o Chaos
o Incomplete data/information
o Interruptions
Why is it hard to de-bias?
o Unaware of bias occurring
o Overconfident
o Unappealing
o Bias against bias
Some examples of bias in the ED:
– Premature closure
Tendency to accept the diagnosis before it has been fully verified, stopping the decision-making process.
– Anchoring
Tendency to perceptually lock onto salient features in the patient’s initial presentation too early in the diagnostic process and failing to adjust initial impression in the light of later information
– Diagnostic momentum
Through intermediaries (patients, paramedics, nurses, physicians), what might have started as a possibility gathers increasing momentum until it becomes definite, and all other possibilities are excluded
Take a step back and think objectively about the patient
– Confirmation bias
Tendency to look for confirming evidence to support a diagnosis rather than look for disconfirming evidence to refute it
Disconfirming evidence is often more persuasive and definitive
– Availability bias
Disposition to judge things as being more likely, or frequently occurring, if they readily come to mind
Recent experience with a disease may inflate the likelihood of its being diagnosed; conversely, not seeing a disease for a long time, may cause it to be diagnosed less frequently
– Framing effect
How diagnosticians see things may be strongly influenced by the way in which the problem is framed
Ex. Framing patient complaints in fast track (“Because they’re in fast track, there must not be anything serious going on with their back pain”)
Reducing cognitive errors:
– Be AWARE
Acknowledge we make mistakes
Wisdom – education, learning
Ambiance – ED design, less interruption
Rules – forcing functions (sit down, consider opposites)
ED team empowerment
