UMPIRES AND HIERARCHIES: EXPLORING THE REALITY OF UNCHECKED BIAS AND INTERVENTION STRENGTHS TO IMPROVE EVIDENCE TRANSFER FOR DIAGNOSTIC DECISION MAKING

Monday, October 24, 2011
Poster Board # 23
(Innovations in Practice Management should describe programmatic improvements in the delivery of healthcare that are related to diagnostic error in medicine and should include information that allows session attendees to evaluate the replicability of such programs at their institutions. Each abstract should be 400 words or less, have a descriptive title, and the following 4 sections: statement of problem, description of the intervention or program, findings to date, and lessons learned; may include 1 table or figure. ) Innovations in Practice Management

Lorri A. Zipperer, MA, Zipperer Project Management, Albuquerque, NM and Linda Williams, RN., MSI., Veterans Healthcare Administration, Ann Arbor, MI

Statement of problem:

Diagnostic error is understudied although efforts are emerging to understand it and make improvements in a variety of disciplines. (1,2) Increased awareness of the role reliable information plays in safe patient care came about after the death of an asthma study volunteer at Johns Hopkins University, a tragedy that occurred in part because of a lack of complete literature review by the research team (3).  Recently, weaknesses in the evidence obtained are being recognized as latent failures that could impact the safety of care and the decision making that supports it. (4,5) These latent failures obligate health care to embrace a professional approach to evidence delivery and the processes of identifying the risks involved that go beyond evidence-based medicine practice and protocols. (6,7).

Description of the intervention or program: The co-submitters apply human factors and cognitive bias exploration mechanisms to the information evidence gathering process.  This poster illustrates the viability of two recognized constructs from which to explore potential cognitive failures present in secondary information and evidence identification activity: rapid-fire decision making (8); and an established hierarchy of improvement mechanisms with varied potential for impact and sustainability (9).

Findings to date: These tools reveal the vulnerabilities created by bias and human error in information and evidence identification work.  Because this work is in support of diagnostic decision making, reliability is key.  Establishing a dialogue to map the research avenues needed to fully understand how the intersection of evidence access, cognitive bias, and reasoning is the next step in providing reliable support for diagnostic accuracy.

Lessons learned: To achieve the dialogue efficiently and routinely, individuals with expertise in the identification and acquisition of evidence and information need to be part of the clinical team. (7)  Mitigation of bias becomes possible through improved evidence access and in participation in dialogue to consider alternatives and ensure vetting of relevant information takes place (10).  Health care teams and organizations need to embrace disciplined decision making processes and build awareness that highly competent, experienced individuals are fallible (11). These and other concepts as applied to the broader role of improved evidence use in patient safety will be explored in a future publication (12). REFERENCES available upon request