Critical care clinics
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Critical care clinics · Jan 2022
ReviewDiagnostic Stewardship: Appropriate Testing and Judicious Treatments.
Diagnostic stewardship encompasses the entire diagnosis-to-treatment paradigm in the intensive care unit (ICU). Initially born of the antimicrobial stewardship movement, contemporary diagnostic stewardship aims to promote timely and appropriate diagnostic testing that directly links to management decisions. ⋯ Though the evidence basis for diagnostic stewardship initiatives in the ICU is nascent and largely limited to retrospective analyses, available literature generally suggests that these initiatives are safe, feasible, and associated with similar patient outcomes. As diagnostic testing of critically ill patients becomes increasingly sophisticated in the ensuing decade, a stewardship mindset will aid bedside clinicians in interpreting and incorporating new diagnostic strategies in the ICU.
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Critical care clinics · Jan 2022
ReviewIntensive Care Unit Decision-Making in Uncertain and Stressful Conditions Part 2: Cognitive Errors, Debiasing Strategies, and Enhancing Critical Thinking.
Diagnostic errors are considered a blind spot of health care delivery and occur in up to 15% of patient cases. Cognitive failures are a leading cause of diagnostic error and often occur as a result of overreliance on system 1 thinking. This narrative review describes why diagnostic errors occur by shedding additional light on systems 1 and 2 forms of thinking, reviews literature on debiasing strategies in medicine, and provides a framework for teaching critical thinking in the intensive care unit as a strategy to promote learner development and minimize cognitive failures.
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Critical care clinics · Jan 2022
ReviewLearning from Missed Opportunities Through Reflective Practice.
Identification of diagnostic errors is difficult but is not alone sufficient for performance improvement. Instead, cases must be reflected on to identify ways to improve decision-making in the future. ⋯ Reflection in action-in which diagnostic decisions are considered in real-time-may also improve medical decision-making especially through strategies such as structured reflection. Ongoing regular feedback can normalize the discussion about improving decision-making, enable reflective practice, and improve decision making.
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Critical care clinics · Jan 2022
ReviewPromoting Critical Thinking in Your Intensive Care Unit Team.
Effective and efficient critical thinking skills are necessary to engage in accurate clinical reasoning and to make appropriate clinical decisions. Teaching and promoting critical thinking skills in the intensive care unit is challenging because of the volume of data and the constant distractions of competing obligations. Understanding and acknowledging cognitive biases and their impact on clinical reasoning are necessary to promote and support critical thinking in the ICU. Active educational strategies such as concept or mechanism mapping can help to diagnose disorganized thinking and reinforce key connections and important clinical and pathophysiologic concepts, which are critical for inductive reasoning.
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Critical care clinics · Jan 2022
ReviewDual Process Theory and Cognitive Load: How Intensivists Make Diagnoses.
Improving clinical reasoning in order to reduce frequency of diagnostic errors is an important area of study. The authors discuss dual process theory as a model of clinical reasoning and explore the role that cognitive load plays in clinical reasoning in the intensive care unit environment.