Occur most often when we take shortcuts in our thinking (heuristics).
We rely on heuristics in ED.
There isn't time to brainstorm every patient's problems.
Heuristics allow our ED's to run - without them we won't cope with the volume.
Common biases in EM:
Search satisfying/premature closure
Some things we already do - red flags, checklists, education (simulation, courses to help us think systematically under pressure). Serial histories and exams (triage nurse, ED doctor, med reg, med consultant, etc)., medical schools incorporating critical thinking and cognitive bias teaching in curricula.
Change in behaviour = requires step by step approach/phases.
Pre contemplation, contemplation, preparation, action, maintenance.
Most de-biasing techniques based on thinking about thinking (metacognition).
With regards to thinking: two types
Type 1 - most common, snap judgments, pattern recognition. Very ED.
Type 2 - analytical, methodical, covering all bases. Very med reg.
Further de-biasing techniques:
Sometimes just experience (years of practice) - then able to switch from mostly type 1 to type 2 thinking when the need arises (environmental/patient/situational cues).
M&M when conducted in a non-blaming way can be productive; Identifies near misses or adverse outcomes in real patients and allow for us to learn.
Hungry, angry, late, tired?
Forcing functions: forcing ourselves to act a certain way.
Eg. 'anyone over 50 with severe abdo pain = AAA until proven otherwise"
'Force' triage nurses to only put in objective findings and presenting complaint into triage note and not diagnoses (eg. not 'tachycardia in AF')
Protocols/checklists used by department to cover all bases.
Always think the opposite
Always be skeptical
Think of a list of differentials and ask yourself why it couldn't be this this or this.
Hopefully this summary allows people to identify common biases, recognise situations where risk of bias is high, and know of strategies to combat specific biases most common to each person (individually).