Value of a cognitive simulation in medicine: towards optimizing decision making performance of healthcare personnel

Satish, Usha; Streufert, Siegfried

doi:10.1136/qhc.11.2.163

Cited by 70 publications

(40 citation statements)

References 18 publications

(26 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…28,29 Most efforts to quantify errors focus on downstream events, predominantly errors in diagnosis and treatment. Such mistakes, viewed in isolation from their causal origins, appear as clinical misjudgments 30,31 and inspire interventions designed around skill building, 32,33 yet the underlying issue may not be misjudgment but the quality of the data on which the judgments are based. The policy importance of overlooking proximal causes is great, because physicians, health care systems, and policy makers, operating from inadequate evidence and the misperceptions it creates may be inattentive to the errors and system defects that threaten patients the most.…”

Section: Cascade Analysis Of Medical Errorsmentioning

confidence: 99%

A String of Mistakes: The Importance of Cascade Analysis in Describing, Counting, and Preventing Medical Errors

Woolf¹

2004

The Annals of Family Medicine

192

136

View full text Add to dashboard Cite

BACKGROUND Notions about the most common errors in medicine currently rest on conjecture and weak epidemiologic evidence. We sought to determine whether cascade analysis is of value in clarifying the epidemiology and causes of errors and whether physician reports are sensitive to the impact of errors on patients. METHODSEighteen US family physicians participating in a 6-country international study fi led 75 anonymous error reports. The narratives were examined to identify the chain of events and the predominant proximal errors. We tabulated the consequences to patients, both reported by physicians and inferred by investigators.RESULTS A chain of errors was documented in 77% of incidents. Although 83% of the errors that ultimately occurred were mistakes in treatment or diagnosis, 2 of 3 were set in motion by errors in communication. Fully 80% of the errors that initiated cascades involved informational or personal miscommunication. Examples of informational miscommunication included communication breakdowns among colleagues and with patients (44%), misinformation in the medical record (21%), mishandling of patients' requests and messages (18%), inaccessible medical records (12%), and inadequate reminder systems (5%). When asked whether the patient was harmed, physicians answered affi rmatively in 43% of cases in which their narratives described harms. Psychological and emotional effects accounted for 17% of physician-reported consequences but 69% of investigator-inferred consequences.CONCLUSIONS Cascade analysis of physicians' error reports is helpful in understanding the precipitant chain of events, but physicians provide incomplete information about how patients are affected. Miscommunication appears to play an important role in propagating diagnostic and treatment mistakes. INTRODUCTIONT he early years of the patient safety movement focused on the lowhanging fruit-the medical errors that are easiest to recognize and remedy (eg, adverse drug events, surgical mishaps). It is unclear, however, whether these errors are the most common or most harmful to patients.1 Properly measuring the incidence and morbidity of errors requires sound epidemiologic research, and the results and validity of such research depend greatly on how precisely errors are defi ned and the settings where the research is conducted.Errors are diffi cult to measure, not only because of inadequate reporting and varied defi nitions, but also because most error incidents are not single acts but a chain of events.2 Prescribing the wrong dose of a drug may be counted as a single error and given a single name, such as a prescribing error, but the physician' s prescribing error may have occurred because the medical record contained an incorrect body weight or because a laboratory report was missing. 317 CASCADE ANALYSIS OF MEDICAL ERRORScan produce skewed statistics and propagate imprecise notions about the anatomy, causes, and consequences of errors. This imprecision affects patients, clinicians, and policy makers, because it misplaces blam...

show abstract

Section: Cascade Analysis Of Medical Errorsmentioning

confidence: 99%

A String of Mistakes: The Importance of Cascade Analysis in Describing, Counting, and Preventing Medical Errors

Woolf¹

2004

The Annals of Family Medicine

192

136

View full text Add to dashboard Cite

show abstract

“…The fraction of inspired oxygen (F IO 2 ) was set on 0.5. A catheter was inserted into the jugular vein 5 for monitoring of the CVP. Through the right femoral artery, a catheter tip manometer 6 was placed in the descending aorta for monitoring the aortic pressure.…”

Section: 1a Anesthesia and Preparationmentioning

confidence: 99%

Automation of a portable extracorporeal circulatory support system with adaptive fuzzy controllers

García

Krane

Baumgartner

et al. 2014

Medical Engineering & Physics

View full text Add to dashboard Cite

ZusammenfassungDie frühe Behandlung mit Extrakorporalen Kreislauf-Unterstützungssystemen bei Patienten mit kardiogenem Schock wirkt sich positiv auf den weiteren Verlauf aus und kann einem Multi-Organversagen entgegenwirken. Um eine frühe Behandlung zu ermöglichen, ist eine kontinuierlicheÜberwachung des Patienten durch geschulte Kardiotechniker notwendig. Unter Notfallbedingungen kann eine ungeteilte Aufmerksamkeit für den Patienten nicht garantiert werden womit es zu Behandlungsfehlern kommen kann.Durch AbstractPatients suffering from cardiogenic shock may benefit with an early application of a portable Extracorporeal Circulatory Support System (ECSS) preventing multi organ failure. This however requires the presence and constant supervision of the patient by trained personal at the emergency site. Under these circumstances full attention to the patient may not be guaranteed and operation errors may occur.With the automation of the portable ECSS optimal perfusion may be achieved with minimal workload for the human operator allowing the safe transportation of the patient to the hospital.The focus of this thesis is the development of an adaptive and robust control system that regulates perfusion based on online data of the patient. While the system needs to be highly dynamic, so that it is able to adapt to different situations, it must ensure maximal patient safety at all times.To develop such control system first an animal model was used to analyze the type of signals acquired during extracorporeal circulation. This information was used as a reference for the creation of a mathematical model. The model includes a cardiovascular system undergoing extracorporeal circulation, a gas exchange model and a medication model. This was integrated into a simulation system that could be used for the creation and evaluation of the designed controller.Fuzzy logic was considered as a control mechanism allowing the easy creation of rules based on the knowledge of trained perfusionists. Since patient pre-conditions and reactions will be different from one case to another an adaptive mechanism is proposed to modify the existing controller and adapt to the specific needs of the patient.A software framework was developed allowing a fast implementation of the control system. This framework was created not only focusing on the automation of the ECSS but also to serve as a basis for the development of control systems for other medical devices with similar requirements.Several simulations are presented showing the performance of the fuzzy controller with the proposed adaptive mechanism. Additional simulations show the response of the designed ECSS controller under different patient scenarios.vii Acknowledgments I want to give thanks to my advisor Prof. Dr. Alois Knoll for giving me the opportunity of working in this thesis, for his support and confidence. I would also like to thank Prof. Dr. Robert Bauernschmitt for taking the time to review my work and acting as a second advisor. From the department of Robotics and Embedded Systems ...

show abstract

“…This instrument is designed to determine how the participant thinks and makes decisions in these stressful or challenging situations. [23] The computerized simulation takes participants through a simulated scenario that includes a period of crisis. Participants can collect information, strategize and plan, and must make decisions based upon the resources available.…”

Section: Methodsmentioning

confidence: 99%

A method to improve the selection of nursing students

LaMartina

Zamierowski²,

Dewan³

2018

JNEP

View full text Add to dashboard Cite

Background: Current baseline measures-primarily cognitive-do not select the best nurses. We hypothesized that a validated test of thinking skills, Strategic Management Simulations (SMS), will predict the nurses the faculty deemed the best at graduation. Methods: A total of 37 RNs in the last semester of an Associate Degree program voluntarily took the SMS. At graduation, faculty ranked them on "who would best take care of your loved one?" Faculty rank was correlated with SMS scores, admission rank and graduation end points. Results: Faculty rank did not correlate with admission rank or cumulative grade but did with the final nursing module rank and with three SMS measures: crisis response, breadth of approach, and focused activity. Conclusions: Traditional selection methods, e.g., admission rank, do not predict outcomes of nursing graduates, e.g., final nursing module rank. Measures of thinking, e.g., SMS crisis response, correlate with desired outcomes and could be used during the selection process to improve outcomes.

show abstract

Value of a cognitive simulation in medicine: towards optimizing decision making performance of healthcare personnel

Cited by 70 publications

References 18 publications

A String of Mistakes: The Importance of Cascade Analysis in Describing, Counting, and Preventing Medical Errors

A String of Mistakes: The Importance of Cascade Analysis in Describing, Counting, and Preventing Medical Errors

Automation of a portable extracorporeal circulatory support system with adaptive fuzzy controllers

A method to improve the selection of nursing students

Contact Info

Product

Resources

About