Critical care clinics
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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.
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Critical care settings are unpredictable, dynamic environments where clinicians face high decision density in suboptimal conditions (stress, time constraints, competing priorities). Experts have described two systems of human decision making: one fast and intuitive; the other slow and methodical. ⋯ Heuristics are also prone to failures, or cognitive biases, which can lead to diagnostic errors. A variety of strategies have been proposed to mitigate biases; however, current understanding of such interventions to optimize diagnostic safety is still incomplete.
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Critical care clinics · Jan 2022
ReviewEnhancing Diagnosis Through Technology: Decision Support, Artificial Intelligence, and Beyond.
Patient care in intensive care environments is complex, time-sensitive, and data-rich, factors that make these settings particularly well-suited to clinical decision support (CDS). A wide range of CDS interventions have been used in intensive care unit environments. ⋯ Evolving artificial intelligence and machine learning models may reduce information-overload and enable teams to take better advantage of the large volume of patient data available to them. It is vital to effectively integrate new CDS into clinical workflows and to align closely with the cognitive processes of frontline clinicians.
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Epidemiologic studies of diagnostic error in the intensive care unit (ICU) consist mostly of descriptive autopsy series. In these studies, rates of diagnostic errors are approximately 5% to 10%. ⋯ These alternative measurement strategies have yielded similar estimates for the frequency of diagnostic error in the ICU. Although there is a fair understanding of the frequency of errors, further research is needed to better define the risk factors for diagnostic error in the ICU.
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Critical care clinics · Jan 2022
ReviewA Research Agenda for Diagnostic Excellence in Critical Care Medicine.
Diagnosing critically ill patients in the intensive care unit is difficult. As a result, diagnostic errors in the intensive care unit are common and have been shown to cause harm. ⋯ However, much work remains to fully elucidate the diagnostic process in critical care. To achieve diagnostic excellence, interdisciplinary research is needed, adopting a balanced strategy of continued biomedical discovery while addressing the complex care delivery systems underpinning the diagnosis of critical illness.