Dr. Schnapp
Benjamin H. Schnapp, MD
BerBee Walsh Department of Emergency Medicine
Assistant Professor (CHS)
Assistant Emergency Medicine Residency Program Director
University of Wisconsin
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Medical errors harm thousands of patients per year. There’s already a lot we know about systems errors - the ways that care delivery can go wrong. We know less about cognitive errors, or the ways in which doctors think that can lead to bad outcomes. An Emergency Department can feel particularly vulnerable to this type of errors - it’s a chaotic environment with patients in various states of illness, many unaccompanied, without records, or too ill to communicate well.
An Emergency Department with trainee physicians can feel even more chaotic - even though they are supervised by staff physicians, resident physicians in their first few months to years of training have not yet accumulated the same level of knowledge and experience as longer-tenured doctors. Errors that get made on the hospital floor are errors of information processing - physicians have the right information, they just don’t always do the right thing with it. We wanted to know what kinds of errors get made in an Emergency Department with trainees. Are the errors related to the chaos and an inability to obtain reliable information from patients? Are they related to the trainees not having enough knowledge and experience? Or are they like the errors that get made on an inpatient floor?
Our study found that the most frequent type of errors were errors of information processing - just like on the hospital floors. The most common types of errors we saw were physicians settling on a diagnosis prematurely and weighing the importance of findings incorrectly. Patients with abdominal problems had the highest number of errors in our study. Patients with certain risk factors, such as psychiatric disease or substance abuse, seemed to be particularly prone to errors.
MedicalResearch.com: What should readers take away from your report?
Response: On some level, this is a reassuring result. The next time you are in a teaching Emergency Department, regardless of how busy it may seem, this study helps tell us that despite the chaos, your team of doctors is likely to have the right knowledge and information to be able to take care of you well. Putting together all of the information that physicians gather about a patient (blood work, imaging, medical history, medications and more) into a coherent diagnosis and treatment plan is really hard, and it makes sense that when errors are made, that this is where they occur.
On the other side of the coin, doctors need to do much better than we’re currently doing at looking into these errors and at ways to reduce them as much as possible. No one wants themselves or a loved one to suffer unnecessarily and we have an obligation as a profession to try to prevent all the harms that we possibly can.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: We need to know a lot more about cognitive errors in physicians in general. What factors predispose doctors to make thinking errors? Can we teach them methods for avoiding these errors? So far, things that have worked in other fields, like checklists for aviation, have been somewhat helpful but not a complete solution. For example, there are too many causes of abdominal pain for a doctor to use a complete “abdominal pain” checklist for every patient with pain in their stomach. How do we nudge doctors towards the right answers when their thinking is going off track?
Citation:
Cognitive error in an academic emergency department
Benjamin H. Schnapp, Jean E. Sun, Jeremy L. Kim, Reuben J. Strayer, Kaushal H. Shah
Published Online: 2018-07-17 |DOI:https://doi.org/10.1515/dx-2018-0011
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