Startseite Mortality and morbidity rounds (MMR) in pathology: relative contribution of cognitive bias vs. systems failures to diagnostic error
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Mortality and morbidity rounds (MMR) in pathology: relative contribution of cognitive bias vs. systems failures to diagnostic error

  • Quentin Eichbaum EMAIL logo , Brian Adkins ORCID logo , Laura Craig-Owens , Donna Ferguson , Daniel Long , Aaron Shaver und Charles Stratton
Veröffentlicht/Copyright: 4. Dezember 2018
Diagnosis
Aus der Zeitschrift Diagnosis Band 6 Heft 3

Abstract

Background

Heuristics and cognitive biases are thought to play an important role in diagnostic medical error. How to systematically determine and capture these kinds of errors remains unclear. Morbidity and mortality rounds (MMRs) are generally focused on reducing medical error by identifying and correcting systems failures. However, they may also provide an educational platform for recognizing and raising awareness on cognitive errors.

Methods

A total of 49 MMR cases spanning the period 2008–2015 in our pathology department were examined for the presence of cognitive errors and/or systems failures by eight study participant raters who were trained on a subset of 16 of these MMR cases (excluded from the main study analysis) to identify such errors. The Delphi method was used to obtain group consensus on error classification on the remaining 33 study cases. Cases with <75% inter-rater agreement were subjected to subsequent rounds of Delphi analysis. Inter-rater agreement at each round was determined by Fleiss’ kappa values.

Results

Thirty-six percent of the cases presented at our pathology MMRs over an 8-year period were found to contain errors likely due to cognitive bias.

Conclusions

These data suggest that the errors identified in our pathology MMRs represent not only systems failures but may also be composed of a significant proportion of cognitive errors. Teaching trainees and health professionals to correctly identify different types of cognitive errors may present an opportunity for quality improvement interventions in the interests of patient safety.

Keywords: cognitive bias; cognitive error; diagnostic error; mortality and morbidity rounds (MMR); pathology; systems failure
Corresponding author: Quentin Eichbaum, MD PhD MPH MFA MMHC, Professor of Pathology, Microbiology and Immunology, Professor of Medical Education and Administration, Vanderbilt Pathology Education Research Group (VPERG), Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center (VUMC), TVC 4511C, 1301 Medical Center Drive, Nashville, TN 37232-5310, USA, Phone: +(615)-936-5124, 617-697-9556 (mobile), E-mail:

Acknowledgments

We thank Dr. Compton for her general assistance with this project.

  1. Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

  2. Research funding: None declared.

  3. Employment or leadership: None declared.

  4. Honorarium: None declared.

  5. Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.

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Received: 2018-09-09
Accepted: 2018-10-30
Published Online: 2018-12-04
Published in Print: 2019-08-27

©2019 Walter de Gruyter GmbH, Berlin/Boston

Artikel in diesem Heft

  1. Frontmatter
  2. Editorial
  3. The Model List of Essential In Vitro Diagnostics: nuisance or opportunity?
  4. Reviews
  5. Skeletal myopathies as a non-cardiac cause of elevations of cardiac troponin concentrations
  6. Histo-genomics: digital pathology at the forefront of precision medicine
  7. Opinion Papers
  8. Patients as diagnostic collaborators: sharing visit notes to promote accuracy and safety
  9. Understanding the “philosophy” of laboratory hemostasis
  10. Original Articles
  11. Serious misdiagnosis-related harms in malpractice claims: The “Big Three” – vascular events, infections, and cancers
  12. Electronic health records, communication, and data sharing: challenges and opportunities for improving the diagnostic process
  13. Mortality and morbidity rounds (MMR) in pathology: relative contribution of cognitive bias vs. systems failures to diagnostic error
  14. Experienced physician descriptions of intuition in clinical reasoning: a typology
  15. A randomized experimental study to assess the effect of language on medical students’ anxiety due to uncertainty
  16. Development and application of a PCR-HRM molecular diagnostic method of SNPs linked with TNF inhibitor efficacy
  17. Acute rejection in kidney transplantation and the evaluation of associated polymorphisms (SNPs): the importance of sample size
  18. Letter to the Editor
  19. Physically damaged second victims by diagnostic delay in pulmonary tuberculosis of hospitalized patients. Cognitive errors with urgent need for prevention
  20. The physical examination, including point of care technology, is an important part of the diagnostic process and should be included in educational interventions to improve clinical reasoning
  21. Case Reports
  22. Case reports of diagnostic error: liposarcoma mistaken for hematoma in an obese female with concurrent ipsilateral thrombosis on rivaroxaban
  23. Macro-CK type 2 in metastatic prostate cancer
https://doi.org/10.1515/dx-2018-0089
Schlagwörter für diesen Artikel
cognitive bias; cognitive error; diagnostic error; mortality and morbidity rounds (MMR); pathology; systems failure

Artikel in diesem Heft

  1. Frontmatter
  2. Editorial
  3. The Model List of Essential In Vitro Diagnostics: nuisance or opportunity?
  4. Reviews
  5. Skeletal myopathies as a non-cardiac cause of elevations of cardiac troponin concentrations
  6. Histo-genomics: digital pathology at the forefront of precision medicine
  7. Opinion Papers
  8. Patients as diagnostic collaborators: sharing visit notes to promote accuracy and safety
  9. Understanding the “philosophy” of laboratory hemostasis
  10. Original Articles
  11. Serious misdiagnosis-related harms in malpractice claims: The “Big Three” – vascular events, infections, and cancers
  12. Electronic health records, communication, and data sharing: challenges and opportunities for improving the diagnostic process
  13. Mortality and morbidity rounds (MMR) in pathology: relative contribution of cognitive bias vs. systems failures to diagnostic error
  14. Experienced physician descriptions of intuition in clinical reasoning: a typology
  15. A randomized experimental study to assess the effect of language on medical students’ anxiety due to uncertainty
  16. Development and application of a PCR-HRM molecular diagnostic method of SNPs linked with TNF inhibitor efficacy
  17. Acute rejection in kidney transplantation and the evaluation of associated polymorphisms (SNPs): the importance of sample size
  18. Letter to the Editor
  19. Physically damaged second victims by diagnostic delay in pulmonary tuberculosis of hospitalized patients. Cognitive errors with urgent need for prevention
  20. The physical examination, including point of care technology, is an important part of the diagnostic process and should be included in educational interventions to improve clinical reasoning
  21. Case Reports
  22. Case reports of diagnostic error: liposarcoma mistaken for hematoma in an obese female with concurrent ipsilateral thrombosis on rivaroxaban
  23. Macro-CK type 2 in metastatic prostate cancer
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