ing these cognitive
improvement strate-
gies in mind.
• Avoid confirma-
tion bias. It's easy to rush to comply with what you expect to see or
hear, instead of what is actually present. For example, we in our
research encountered a case where a guide wire stylus that had been
inadvertently retained following a procedure was "missed" and not
reported on radiology reports. Even though the clinicians caring for
the patient subconsciously "saw" the wire, they dismissed their own
concerns because they were not validated in official radiology reports.
One might assume a lack of attention was to blame for the multiple
misses, but this deference to the "official" report well highlights the
confirmation bias that can cloud our decision making, and in this case
led to the repeated failures to act upon correct and important obser-
vations.
• Focus when it counts most. It might be nearly impossible to per-
form surgery with razor sharp focus for the duration of a procedure,
but you can zero in on the task at hand during critical stages (anesthe-
sia induction, technically challenging maneuvers, implant placement
and the counting of objects, for example). We can take a cue from
commercial aviation on this. Pilots pay attention during every portion
of a flight, of course, but are instructed to avoid all distractions and
focus with greater intensity on their responsibilities during the critical
intervals of takeoff and ascent and descent and landing — the so
called "sterile cockpit" when no extraneous conversation is allowed.
• Cognitive training. To improve the cognitive performance of
our teams, it is critical that we track the root causes of adverse
events and huddle as a group to discuss these errors and how
they could have been avoided. One can even use the details of the
S E P T E M B E R 2 0 1 9 • O U T PA T I E N T S U R G E R Y. N E T • 3 1
We must at some point also be able to
rely on our internal checklists
to protect patients.
