Cognitive bias refers to processing of information based on an individual’s existing believes. This results to results in ignoring critical information (Norman et al., 2017). The existing believes may include predictions and given situations about a certain outcome. People are inclined to process information in support in their own believes when the issue is self-relevant and highly important. Cognitive bias has been identified as one of the common causes of medical errors in the healthcare system. The increased awareness on biasness has led to increased research on the area. This study aims to investigate how cognitive bias influences medical errors in intensive care units.
Causes of cognitive Bias
Cognitive errors are common among healthcare professionals. According to O’Sullivan & Schofield, (2018), “Up to 75% of errors in internal medicine practice are thought to be cognitive in origin, and errors in cognition have been identified in all steps of the diagnostic process, including information gathering, association triggering, context formulation, processing and verification”. Medical errors occur in about 6% of all hospital admissions causing millions of injuries and avoidable deaths. Medical errors cost the United States about 20 billion in 2018. Medical errors associated with cognitive bias have also increased the length of stay in hospitals which also has significant cost implications.
Other studies suggest that cognitive errors occur in various levels in the healthcare system. According to Elston, 2019), “System errors happen when responsibilities are handed off between members of a team, during prescribing and dispensing of medications, entry and delivery of laboratory orders and results, and during documentation”. Almost all physicians have done some errors in the process of diagnosing their patients. This is particularly because most of medical conditions have similar symptoms that make it difficult for them to identify the condition the patient is suffering from (Norman et al., 2017). Errors are inevitable. It is therefore important to develop strategies to reducing cognitive errors among physicians.
Effects of Cognitive Errors
Apart from the financial implications, medical errors have significant adverse effects on the patients, their families and the healthcare facility. According to Saposnik et al., (2016), “The ultimate consequences of medical errors include avoidable hospitalizations, medication underuse and overuse, and wasted resources that may lead to patients’ harm”. Medical errors may occur in many ways. Most system errors occur when responsibilities are given to various healthcare professionals, during documentation, during prescription, during dispensation of medication and delivery of laboratory results. However, most cognitive errors occur during diagnosis. Diagnostic errors account for about a third of all medication errors in the hospitals.
Cognitive bias has significant impacts in decision making process in the healthcare system. “Cognitive biases, also known as heuristics, are cognitive short cuts used to aid our decision-making. A heuristic can be thought of as a cognitive ‘rule of thumb’ or cognitive guideline that one subconsciously applies to a complex situation to make decision-making easier and more efficient” (O’Sullivan & Schofield, 2018).This has been recognized for a long period of time but researchers have focused more on cognitive bias in other field including business, military and economics. However, it is becoming clear that cognitive errors can result in medical errors.
Strategies for reducing Cognitive Bias
Various approaches have been developed to reduce cognitive bias in healthcare systems. Bias specific teaching is one of the strategies that have been found to be effective in reducing cognitive bias. Other approaches that have been found effective in reducing cognitive bias include slowing down, checklists, meta-cognition and considering alternatives, novel methods and teaching statistical principles. “Lack of formal education in statistics and logic is often bemoaned by clinicians and researchers alike as an explanation for poor insight into underlying principles, thus leading to error” (O’Sullivan & Schofield, 2018).
Gap in Literature
While a lot of studies have been conducted to determine the impacts of cognitive bias on medication errors, few have focused on the intensive care unit. Most of the studies have focused on other departments in the healthcare systems that are not as delicate as the intensive care department. Intensive care is a very complex department which requires all procedures to be carried out effectively. This study aims to evaluate how cognitive bias among healthcare professionals working in the intensive care unit impact medication errors. The study will provide significant insights that can be used in developing strategies for reducing cognitive bias in intensive care units.
The hypothesis for this study is Cognitive bias among healthcare professionals result in medical errors in intensive care units. Qualitative methodology will be used to conduct this study and answer the research question. This methodology is the most appropriate for the study because it allows participants to expand on their responses providing depth and details of the phenomena being studies. Research instruments for the study will include questionnaires and interviews. The methodology and study instruments will be discussed in details in the following section.
Elston, D. M. (2019). Cognitive bias and medical errors. Journal of the American Academy of Dermatology, 81(6), 1249. Retrieved from https://www.jaad.org/article/S0190-9622(19)32283-2/pdf
Norman, G. R., Monteiro, S. D., Sherbino, J., Ilgen, J. S., Schmidt, H. G., & Mamede, S. (2017). The causes of errors in clinical reasoning: cognitive biases, knowledge deficits, and dual process thinking. Academic Medicine, 92(1), 23-30. Retrieved from https://www.researchgate.net/profile/Jonathan_Sherbino/publication/309465770_The_Causes_of
O’Sullivan, E. D., & Schofield, S. J. (2018). Cognitive bias in clinical medicine. JR Coll Physicians Edinb, 48(3), 225-32. Retrieved from https://www.rcpe.ac.uk/sites/default/files/jrcpe_48_3_osullivan.pdf
Saposnik, G., Redelmeier, D., Ruff, C. C., & Tobler, P. N. (2016). Cognitive biases associated with medical decisions: a systematic review. BMC medical informatics and decision making, 16(1), 138. Retrieved from https://link.springer.com/article/10.1186/s12911-016-0377-1