• Int. J. Clin. Pract. · Apr 2015

    Complex clinical reasoning in the critical care unit - difficulties, pitfalls and adaptive strategies.

    • M Shaw and S Singh.
    • Intensive Care Unit, Magill Department of Anaesthesia, Intensive Care and Pain Management, Chelsea and Westminster Hospital NHS Trust, Imperial College, London, UK.
    • Int. J. Clin. Pract. 2015 Apr 1; 69 (4): 396-400.

    AbstractDiagnostic error has implications for both clinical outcome and resource utilisation, and may often be traced to impaired data gathering, processing or synthesis because of the influence of cognitive bias. Factors inherent to the intensive/acute care environment afford multiple additional opportunities for such errors to occur. This article illustrates many of these with reference to a case encountered on our intensive care unit. Strategies to improve completeness of data gathering, processing and synthesis in the acute care environment are critically appraised in the context of early detection and amelioration of cognitive bias. These include reflection, targeted simulation training and the integration of social media and IT based aids in complex diagnostic processes. A framework which can be quickly and easily employed in a variety of clinical environments is then presented. © 2015 John Wiley & Sons Ltd.

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