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Situation awareness errors in anesthesia and critical care in 200 cases of a critical incident reporting system.

ABSTRACT: A loss of adequate Situation Awareness (SA) may play a major role in the genesis of critical incidents in anesthesia and critical care. This observational study aimed to determine the frequency of SA errors in cases of a critical incident reporting system (CIRS).Two experts independently reviewed 200 cases from the German Anesthesia CIRS. For inclusion, reports had to be related to anesthesia or critical care for an individual patient and take place in an in-hospital setting. Based on the SA framework, the frequency of SA errors was determined. Representative cases were analyzed qualitatively to illustrate the role of SA for decision-making.SA errors were identified in 81.5%. Predominantly, errors occurred on the levels of perception (38.0%) and comprehension (31.5%). Errors on the level of projection played a minor role (12.0%). The qualitative analysis of selected cases illustrates the crucial role of SA for decision-making and performance.SA errors are very frequent in critical incidents reported in a CIRS. The SA taxonomy was suitable to provide mechanistic insights into the central role of SA for decision-making and thus, patient safety.

SUBMITTER: Schulz CM

PROVIDER: S-EPMC4715310 | biostudies-other | 2016 Jan

REPOSITORIES: biostudies-other

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Project description:ObjectivesTo summarize the literature on prevalence, impact, and contributing factors related to diagnostic error in the PICU.Data sourcesSearch of PubMed, EMBASE, and the Cochrane Library up to December 2019.Study selectionStudies on diagnostic error and the diagnostic process in pediatric critical care were included. Non-English studies with no translation, case reports/series, studies providing no information on diagnostic error, studies focused on non-PICU populations, and studies focused on a single condition/disease or a single diagnostic test/tool were excluded.Data extractionData on research design, objectives, study sample, and results pertaining to the prevalence, impact, and factors associated with diagnostic error were abstracted from each study.Data synthesisUsing independent tiered review, 396 abstracts were screened, and 17 studies (14 full-text, 3 abstracts) were ultimately included. Fifteen of 17 studies (88%) had an observational research design. Autopsy studies (autopsy rates were 20-47%) showed a 10-23% rate of missed major diagnoses; 5-16% of autopsy-discovered diagnostic errors had a potential adverse impact on survival and would have changed management. Retrospective record reviews reported varying rates of diagnostic error from 8% in a general PICU population to 12% among unexpected critical admissions and 21-25% of patients discussed at PICU morbidity and mortality conferences. Cardiovascular, infectious, congenital, and neurologic conditions were most commonly misdiagnosed. Systems factors (40-67%), cognitive factors (20-3%), and both systems and cognitive factors (40%) were associated with diagnostic error. Limited information was available on the impact of misdiagnosis.ConclusionsKnowledge of diagnostic errors in the PICU is limited. Future work to understand diagnostic errors should involve a balanced focus between studying the diagnosis of individual diseases and uncovering common system- and process-related determinants of diagnostic error.

Project description:BackgroundSituation awareness (SA) is a key factor in accountability and ensuring patient safety in health care. SA is an essential element to research on human factors in healthcare. It is essential to identify valid instruments for measuring this concept and assessing how it is affected by interventions and educational methods.MethodsThis systematic review aimed to assess the measurement properties of situation awareness instruments in health care providers' (HCPS) using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methodology. Four databases (Medline (through PubMed), Embase, Scopus, and Web of Science) were systematically searched. A manual search was also conducted on Google Scholar and the reference list of the included primary studies to supplement the electronic search. Studies aiming to determine the measurement properties of SA instruments or non-technical skills in HCPS were included. The overall results for each measurement property were reported as sufficient, insufficient, inconsistent, or indeterminate, and the quality of evidence was reported as high, moderate, low, or very low.ResultsA total of 25 studies and 15 instruments were included in the study. More than one measurement property was reported in some of the studies, and none of the studies presented all measurement properties. The most common measurement properties were content validity (12/25) and internal consistency (12/25). Cross-cultural validity and responsiveness were not investigated in any study. Evidence quality for the measurement properties was not high in any of the 15 instruments.ConclusionsNone of the instruments can be recommended as the most suitable instrument, and all instruments were classified as promising instruments in need of further psychometric assessment. This systematic review proves the dire need for the development and psychometric evaluation of instruments to measure SA in HCPs in clinical settings.Systematic review registrationPROSPERO CRD42020147349.

Project description:BACKGROUND:There is no globally accepted definition for dosing error in adult or pediatric practice. The definition of pediatric dosing error varies greatly in the literature. The objective of this study was to develop a framework, informed by a set of principles, for a clinician-based definition of drug dosing errors in critically ill children, and to identify the range that practitioners agree is a dosing error for different drug classes and clinical scenarios. METHODS:We conducted a nationwide three staged modified Delphi from May to December 2019. Expert clinicians included Canadian pediatric intensive care unit (PICU) physicians, pharmacists and nurses, with a least 5?years' experience. Outcomes were underlying principles of drug dosing, and error thresholds, as defined by proportion above and below reference range, for common PICU medications and clinical scenarios. RESULTS:Forty-four participants met eligibility, and response rates were 95, 86 and 84% for all three rounds respectively. Consensus was achieved for 13 of 15 principles, and 23 of 30 error thresholds. An over-dosed drug that is intercepted, an under-dose of a possibly life-saving medication, dosing 50% above or below target range and not adjusting for a drug interaction were agreed principles of dosing error. Altough there remained much uncertainty in defining dosing error, expert clinicians agreed that, for most medication categories and clinical scenarios, dosing over or below 10% of reference range was considered an error threshold. CONCLUSION:Dosing principles and threshold are complex in pediatric critical care, and expert clinicians were uncertain about whether many scenarios were considered in error. For most intermittent medications, dosing over 10% below or above reference range was considered a dosing error, although this was largely influenced by clinical context and drug properties. This consensus driven error threshold will help guide routine clinical dosing practice, standardized reporting and drug quality improvement in pediatric critical care.

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Situation awareness errors in anesthesia and critical care in 200 cases of a critical incident reporting system.

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