Decision making under uncertainty in the emergency department

Abstract

Sepsis, a sever reaction to infection, has a diverse array of causes and manifestations that makes screening and diagnosis extremely difficult. In the face of this uncertainty, several attempts have been made to formalize the definition of sepsis with the intention that well-defined criteria could be used to design screens for identifying septic patients and unify the way sepsis is diagnosed. But these alerts tend to not be very specific and as such they produce many false alarms. The aim of this study was to determine how these alerts effect the decision making of physicians in the emergency department in regard sepsis diagnosis. More specifically, the goal was to determine if any of a number of well-known cognitive biases could be detected in relation to sepsis diagnosis. By looking at the records of patients for which sepsis alerts were triggered, a set of behavioral criteria was used to determine the physicians' diagnoses of those patients. The distribution of these diagnoses and the correlation between past alerts on diagnoses rates was found as evidence of certain cognitive biases. Additionally, there was found to be correlation between past alerts and the amount of information physicians use to make diagnoses. These results could be used to help design better alerts in the future or to improve the way medical information is presented to physicians to prevent biases from occurring in sepsis diagnosis.