Decision making mistakes in anesthesiology

黄建宏

Decision making mistakes in anesthesiology

Anesthesia decision making mistakes usually related to thought process. What kinds of thought process can lead to decision making mistakes?

1.       Feedback remote or absent: anesthesiologists often were not informed complications which happened postoperatively. Therefore they have false impression of complications. They did not have data in their memories that can prevent the complications in their future practice.

2.       Bad outcomes: bad outcomes permanently implant into their memories, which cause overestimation of current situation. Anesthesiologists judge quality of decision based on outcome.

3.       Delay in action: Anesthesiologists have tendency toward inaction rather than action. Preservation may result in injury to or death of patient.

How can anesthesiologists do to reduce decision making mistakes?

1.       Do not jump into the conclusion. Remember “ Rule of 3”: for any diagnosis or therapy, never make final decision without considering and excluding >3 alternatives.

2.       Always consider other options or potential causes of events. Always consider factors that would lead to different decision or diagnosis

3.       Practicing “worst-case medicine”: during event, entertain hypothesis that bad outcome will happen,  and attempt to find helpful data in real time that can prevent poor outcome.

Reference:

Marjorie Podraza Stiegler: Errors in decision making: bias and heuristics in anesthesiology. Audio-digest Anesthesiology, 2013; 55:36

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