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Diagnosis

Official Journal of the Society to Improve Diagnosis in Medicine (SIDM)

Editor-in-Chief: Graber, Mark L. / Plebani, Mario

Ed. by Argy, Nicolas / Epner, Paul L. / Lippi, Giuseppe / Singhal, Geeta / McDonald, Kathryn / Singh, Hardeep / Newman-Toker, David

Editorial Board: Basso , Daniela / Crock, Carmel / Croskerry, Pat / Dhaliwal, Gurpreet / Ely, John / Giannitsis, Evangelos / Katus, Hugo A. / Laposata, Michael / Lyratzopoulos, Yoryos / Maude, Jason / Sittig, Dean F. / Sonntag, Oswald / Zwaan, Laura


CiteScore 2018: 0.69

SCImago Journal Rank (SJR) 2018: 0.359
Source Normalized Impact per Paper (SNIP) 2018: 0.424

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2194-802X
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Mortality and morbidity rounds (MMR) in pathology: relative contribution of cognitive bias vs. systems failures to diagnostic error

Quentin Eichbaum
  • Corresponding author
  • Vanderbilt Pathology Education Research Group (VPERG), Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center (VUMC), Nashville, TN, USA
  • Email
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Brian AdkinsORCID iD: https://orcid.org/0000-0002-9480-2762 / Laura Craig-Owens
  • Vanderbilt Pathology Education Research Group (VPERG), Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center (VUMC), Nashville, TN, USA
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Donna Ferguson
  • Vanderbilt Pathology Education Research Group (VPERG), Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center (VUMC), Nashville, TN, USA
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Daniel Long / Aaron Shaver
  • Vanderbilt Pathology Education Research Group (VPERG), Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center (VUMC), Nashville, TN, USA
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Charles Stratton
  • Vanderbilt Pathology Education Research Group (VPERG), Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center (VUMC), Nashville, TN, USA
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
Published Online: 2018-12-04 | DOI: https://doi.org/10.1515/dx-2018-0089

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

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About the article

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: qeichbaum@gmail.com


Received: 2018-09-09

Accepted: 2018-10-30

Published Online: 2018-12-04

Published in Print: 2019-08-27


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

Research funding: None declared.

Employment or leadership: None declared.

Honorarium: None declared.

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.


Citation Information: Diagnosis, Volume 6, Issue 3, Pages 249–257, ISSN (Online) 2194-802X, ISSN (Print) 2194-8011, DOI: https://doi.org/10.1515/dx-2018-0089.

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