HEARTBEATS, WHY DO I MISS WHAT YOU TRY TO SAY TO ME? PATTERN RECOGNITION AND DECISION PROCESSES IN FOETAL MONITORING

Monday, October 24, 2011
Poster Board # 5
(Scientific Abstracts should report the results of original research related to diagnostic error in medicine and must contain quantitative or qualitative data. Each abstract should be 400 words or less, have a descriptive title, and the following 4 sections: background, methods, results, and conclusion; may include 1 table or figure. ) Scientific Abstract

Sharon C. Davis, MSc, University of Gloucestershire, Cardiff, United Kingdom, Graham Edgar, MSc, PhD, University of Gloucestershire, GL50 4AZ, United Kingdom and Di Catherwood, PhD, University of Gloucestershire, Cheltenham, United Kingdom
Background:  Clinical reviews of foetal deaths and babies born in poor condition, found that in 75 percent of cases, cardiotocographs (CTG) were implicated (CESDI 1997 – 2008). Poor skills in CTG interpretation was identified as a key feature. This research is looking at how the brain works with regard to interpreting and acting on CTGs and the potential error pathways and adequate interpretation of CTGs is seen as crucial to quality improvement and the reduction of medico-legal risk. Research has been carried out looking at Communication (Patel, 1999); STAN, looking at the S and TAnalysis (Westerhuis et al 2009, Vayssuere et al 2009, Noren, 2008);shift working and fatigue (Durso, 1999); Team work and the effects on decisions (Prince &Salas, 2000); Simulations (Flin, 2008) and training (Patrick, 1992).  The human brain and how this affects decision and diagnostic outcomes (Groopman, 2007, Croskerry 2002, 2003) needs to be considered.

Methods:  In order to identify whether the brain finds certain CTG patterns more difficult to interpret, thus influencing information bias and level of confidence (Davis, Edgar & Catherwood, in press) and result from flipping from rule based decision-making to the heuristic style (De Neys, W., Vartanian, O. & Goel, V. 2008) two experiments were developed using e-prime and CTG trace patterns produced during labour (NICE, 2008). Two experiments have been run: Experiment 1FHR as the only datum line; Experiment 2 FHR and maternal contractions datum lines.  Key features, such as FHR variability and decelerations, were extracted and placed on slides. A short training session was built into the front end of the programme. A fixation slide was followed by slides showing different features. The participants, general population, were asked whether, for example, accelerations were present (true/false) followed by a slide asking for a confidence scale of one to four how certain they were that the statement was true/false. Experiment 1 (n = 81) had 20 slides randomly presented for 60 cycles, experiment 2 (n = 38) had 18 slides randomly presented for 38 cycles.

Results:  Most errors were made when identifying accelerations and decelerations in experiment 1 - deceleration error (true 2.79%, false 25.1%) (figure 1)  experiment 2- deceleration errors (true 9.23%, false 3.49%).  Eye scanning patterns might be selective based on information bias and there is a suggestion that as the error rate increases, situation awareness decreases, information bias remains high and the level of confidence also remains high. Further analysis is ongoing. A third experiment with health care professionals using SmartEyePro and EEG is in process in order see if the same patterns are difficult to identify, their eye scan patterns and decision strategies. This will inform training and operational procedures when using the CTG for foetal monitoring.