In this episode Dr. Doug Sinclair and Dr. Chris Hicks show us that, while the ED physician’s knowledge base may play a small part in predicting medical error, more important might be how we understand and reflect upon our decision-making processes, how we communicate with our staff and patients, and how we cope with the ED environment and shift work. Medical error is the 6th leading cause of death in North America, and despite huge advances in imaging technology and lab testing as well as an explosion of EM literature in recent years, the misdiagnosis rate detected through autopsy studies has not changed significantly over the past century.

Studies on diagnostic error in emergency medicine have shown error rates between 1 and 12%, and it’s been suggested that cognitive error, or some flaw in the decision making process (as apposed to a lack of knowledge), is present in about 95% of these cases. Dr. Sinclair and Dr. Hicks elucidate for us how to identify and understand cognitive error, and how we can improve our decision making, reduce medical error and optimize the care of our patients.

They answer questions like: What is heuristics training and how does it allow us to develop insight and awareness into our own thinking so that we minimize error? How does one’s affective state effect how we make decisions in the ED? How can we counter our natural tendency toward confirmation bias and premature closure in the ED? How can authourity gradients effect patient outcomes? What tools can we use to help us recognize high risk situations? How can we best minimize medical error related to handover or transfer of care? How does our decicision making ability change over the course of a typical shift and how can we prepare for this? How does shift work and sleep deprivation effect us in terms of our health and cognitive abilities, and what can do to minimize the negative effects of shift work? What can we do to help facilitate feedback for emergency physicians in order to improve quality of care and learn from our triumphs and our mistakes? What are some easy ways that we can minimize errors when communicating with our nurses, housestaff and patients? When you have made an error, what is the best way to disclose that error? and many more……