Review
Copyright ©2014 Baishideng Publishing Group Inc.
World J Anesthesiol. Nov 27, 2014; 3(3): 203-212
Published online Nov 27, 2014. doi: 10.5313/wja.v3.i3.203
Table 2 Cognitive de-biasing strategies[10]
PlanActionExample
Develop insight or awarenessIllustration of the errors caused by biases in the cognitive thinking process with the help of clinical examples leads to a better understanding and awarenessThe case of intraoperative low oxygen saturations presumed to be due to cold fingers, when the actual cause was endo-bronchial intubation
Consider alternativesForming a habit wherein alternative possibilities are always looked intoContinuing with the above example, establishing a habit of looking for other (true) causes of low oxygen saturation, rather than simply blaming the cold fingers could direct the anaesthetist to look for other causes including a possible endotracheal intubation
Metacognition (strategic knowledge)Emphasis on a reflective approach to problem solvingKnowing when and how to verify data is a good example of Strategic Knowledge
Decreased reliance on memoryUse of cognitive aids, pneumonics, guidelines and protocols protects against errors of memory and recallUse of guidelines and protocols in the use of intralipids to treat Local Anaesthetic toxicity
Specific trainingIdentify specific flaws and biases and providing appropriate training to overcome these flawsEarly recognition of a “cannot intubate, cannot ventilate” scenario to guard against fixation errors
Simulation exercisesThis is focussed at the common clinical scenarios prone for errors and emphasis on prevention of these errors secondary to human factorsUse of simulation training for difficult airway management
Cognitive forcing strategiesA coping strategy to avoid biases in particular clinical situations is often reflected in the practice of experienced cliniciansChecking for the availability of blood products as a routine ritual prior to the start of major surgery every single time can be considered as strategy to avoid
Minimize time pressuresAllowing adequate time for decision making rather than rushing throughAllowing time to check on patients airway prior to induction can help avoid surprises in airway management
AccountabilityEstablish clear accountability and follow up for decisions madeA decision to use frusemide intra operatively is followed up by checking the serum potassium levels
FeedbackGiving a reliable feedback to the decision maker, so that the errors are immediately appreciated and correctedJunior anaesthetist reminding the senior of the allergy to a certain antibiotic, when the antibiotic is about to be administered