Avoiding anchoring bias by moving beyond ‘mechanical falls’ in geriatric emergency medicine

Nagaraj, Guruprasad; Hullick, Carolyn; Arendts, Glenn; Burkett, Ellen; Carpenter, Christopher R.

doi:10.1111/1742-6723.13129

Cited by 13 publications

(5 citation statements)

References 58 publications

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“…Musculoskeletal weakness, poor balance and slower response times to protect vital areas lead to more direct impacts to the hip or head [ 11 ]. Other frequent significant injuries include rib fractures, which are associated with increased mortality in older people [ 17 ]. Patients who have already had a fall may fear another, and therefore reduce their activities, leading to a downward spiral of rapid physiological decline [ 18 ].…”

Section: Resultsmentioning

confidence: 99%

Challenges in the PREHOSPITAL emergency management of geriatric trauma patients – a scoping review

Eichinger

Robb

Scurr

et al. 2021

Scand J Trauma Resusc Emerg Med

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Background Despite a widely acknowledged increase in older people presenting with traumatic injury in western populations there remains a lack of research into the optimal prehospital management of this vulnerable patient group. Research into this cohort faces many uniqu1e challenges, such as inconsistent definitions, variable physiology, non-linear presentation and multi-morbidity. This scoping review sought to summarise the main challenges in providing prehospital care to older trauma patients to improve the care for this vulnerable group. Methods and findings A scoping review was performed searching Google Scholar, PubMed and Medline from 2000 until 2020 for literature in English addressing the management of older trauma patients in both the prehospital arena and Emergency Department. A thematic analysis and narrative synthesis was conducted on the included 131 studies. Age-threshold was confirmed by a descriptive analysis from all included studies. The majority of the studies assessed triage and found that recognition and undertriage presented a significant challenge, with adverse effects on mortality. We identified six key challenges in the prehospital field that were summarised in this review. Conclusions Trauma in older people is common and challenges prehospital care providers in numerous ways that are difficult to address. Undertriage and the potential for age bias remain prevalent. In this Scoping Review, we identified and discussed six major challenges that are unique to the prehospital environment. More high-quality evidence is needed to investigate this issue further.

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Section: Resultsmentioning

confidence: 99%

Challenges in the PREHOSPITAL emergency management of geriatric trauma patients – a scoping review

Eichinger

Robb

Scurr

et al. 2021

Scand J Trauma Resusc Emerg Med

View full text Add to dashboard Cite

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“…The decision-maker makes the decision taking into consideration some initial reference data without adjusting its estimates according to the new information gained (Nagaraj et al 2018;Augestad et al 2016) SD, SP, SH…”

Section: Anchoringmentioning

confidence: 99%

Enhancing Healthcare Decision-Making Process: Findings from Orthopaedic Field

Schettini

Palozzi

Chirico

2020

Administrative Sciences

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In the healthcare field, the decision-making process is part of the broad spectrum of “clinical reasoning”, which is recognised as the whole process by which a physician decides about patients’ treatments and cares. Several clinicians’ intrinsic variables lead to this decisional path. Little is known about the inference of these variables in triggering biases in decisions about the post-discharge period in the surgical field. Accordingly, this research aims to understand if and how cognitive biases can affect orthopaedists in decision-making regarding the follow-up after knee and hip arthroplasty. To achieve this goal, an interview-based explorative case study was run. Three key-decisional orthopaedic surgeons were interviewed through a quality control tool aimed at monitoring the causes and effects of cognitive distortions. Coherently with the literature, eight biases come to light. All the interviewees agree on the presence of four common biases in orthopaedic surgery (Affect heuristic, Anchoring, Halo effect, Saliency). The other biases (Groupthink, Availability, Overconfidence, Confirmation), instead, depending on specific physicians’ intrinsic variables; namely: (i) working experience; (ii) working context. This finding contributes to the debate about the application of cognitive tools as leverage for improving the quality of clinical decision-making process and, indirectly, enhancing better healthcare outcomes.

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“…It may be that a tiered response is useful with early screening using one of these tools and then progressing to more complex evaluations, similarly to fall risk evaluations. Although there is no perfect fall risk tool (see the articles on falls and postural hypotension in this series 31,32 ), using a tool can give you and the patient objective evidence of their need for further fall risk evaluation.…”

Section: Screening Instrumentsmentioning

confidence: 99%