Hindsight bias, outcome knowledge and adaptive learning

Henriksen, K

doi:10.1136/qhc.12.suppl_2.ii46

Cited by 136 publications

(119 citation statements)

References 17 publications

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“…The study also has weaknesses as the data required some interpretation. Interpretation of retrospective data may be problematic; reviewers often differ in their interpretation of the same data [36] and there is evidence that the outcome of an event influences peer reviewers' opinion [37][38][39]. All our primary reviewers were blinded to others' opinion and all were ................................................................................................................................................................................................................... …”

Section: Discussionmentioning

confidence: 99%

Litigation related to anaesthesia: an analysis of claims against the NHS in England 1995–2007

et al. 2009

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SummaryThe distribution of medico-legal claims in English anaesthetic practice is unreported. We studied National Health Service Litigation Authority claims related to anaesthesia since 1995. All claims were reviewed by three clinicians and variously categorised, including by type of incident, claimed outcome and cost. Anaesthesia-related claims account for 2.5% of all claims and 2.4% of the value of all claims. Of 841 relevant claims 366 (44%) were related to regional anaesthesia, 245 (29%) obstetric anaesthesia, 164 (20%) inadequate anaesthesia, 95 (11%) dental damage, 71 (8%) airway (excluding dental damage), 63 (7%) drug related (excluding allergy), 31 (4%) drug allergy related, 31 (4%) positioning, 29 (3%) respiratory, 26 (3%) consent, 21 (2%) central venous cannulation and 18 (2%) peripheral venous cannulation. Defining which cases are, from a medico-legal viewpoint, 'high risk' is uncertain, but the clinical categories with the largest number of claims were regional anaesthesia, obstetric anaesthesia, inadequate anaesthesia, dental damage and airway, those with the highest overall cost were regional anaesthesia, obstetric anaesthesia, and airway and those with the highest mean cost per closed claim were respiratory, central venous cannulation and drug error excluding allergy. The data currently available have limitations but offer useful information. A closed claims analysis similar to that in the USA would improve the clinical usefulness of analysis.

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Section: Discussionmentioning

confidence: 99%

Litigation related to anaesthesia: an analysis of claims against the NHS in England 1995–2007

et al. 2009

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“…The Fourth National Audit Project probably represents the largest ever UK study of complications of anaesthesia and its findings reflect current practice across the breadth of the UK; both the project design and data collection were meticulous as was the review process, conducted by a broad pool of clinical anaesthetists and others. This minimised issues such as hindsight and outcome bias and 'group-thinking' [5,[24][25][26]. Similar methods have been applied in other safety-conscious industries as well as in medicine to identify and correct deficiencies of care [13,27].…”

Section: New Report Same Old Findings?mentioning

confidence: 99%

Can we make airway management (even) safer? – lessons from national audit

2011

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SummaryThe Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society (NAP4) has published an extensive report examining both current practices in the United Kingdom regarding airway management during anaesthesia and the complications of airway management during anaesthesia and in intensive care units and emergency departments. The report makes more than 160 recommendations designed to improve care of patients. These recommendations have implications for individuals, departments, organisations and potentially for national policy in terms of training, standards of practice and the need for guidelines. The report also indicates several specific areas where future research might be directed. This article focuses on the implementation phase of NAP4, emphasising the importance of taking the lessons derived from NAP4 and turning them into actions to improve the safety of airway care delivered to patients, wherever in hospital this takes place.

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“…But there are pitfalls with focusing on the end-point error label so much. Given the advantage of a known outcome, it is easy for investigators, after the fact, to connect the dots, wonder "why they couldn't see it" and issue proclamations about diagnostic error [2]. Diagnostic work-ups occur from the vantage point of the unknown and foresight, not from the known and hindsight.…”

Section: Is the Focus On Error Serving Us Well?mentioning

confidence: 99%

“…At the same time, there is a need be careful about what we ask for. Yes, the need for feedback mechanisms and recalibration still stands, but the perils of being unduly influenced by feedback also need to be recognized [2,6]. To what extent should a readily available memory of a missed rare diagnosis (e.g., missing pinpoint aortic stenosis in favor of more common chronic obstructive pulmonary disease as portrayed in an otherwise instructive Annals of Internal Medicine cartoon [8]) influence subsequent diagnostic effort?…”

Section: The Double-edge Nature Of Feedbackmentioning

confidence: 99%

Improving diagnostic performance: some unrecognized obstacles

Henriksen

2014

Diagnosis

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Abstract:The growing interest and activity focused on improving diagnostic performance is a needed and welcomed change to which the new journal, Diagnosis, nicely attests. While the importance of raising awareness and building the evidence-base needs to be underscored, these efforts by themselves do not translate directly into improvements for patients. The complex and multifaceted nature of diagnostic work is becoming better understood, yet many of the obstacles seem to operate beneath the surface where the press of daily practice allows many of the untoward issues to be tacitly ignored. The purpose of the paper is to shine a light on some of these less reco gnized issues or obstacles. Among the issues addressed is whether use of the error term as in diagnostic error or medical error is serving us well in gaining of better understanding of diagnostic work, the lack of sensible feedback mechanisms that deny diagnosticians and their organizations the opportunity to learn something about their diagnostic performances, the double-edge nature of feedback, the obstacle of frame blindness, and the need for innovative empirical testing of promising ideas for improving diagnostic performance such as taking advantage of diagnostic simulation techniques that are inexpensive to generate and do not put patients at risk.

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Hindsight bias, outcome knowledge and adaptive learning

Cited by 136 publications

References 17 publications

Litigation related to anaesthesia: an analysis of claims against the NHS in England 1995–2007

Litigation related to anaesthesia: an analysis of claims against the NHS in England 1995–2007

Can we make airway management (even) safer? – lessons from national audit

Improving diagnostic performance: some unrecognized obstacles

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