Inattentional blindness and pattern-matching failure: The case of failure to recognize clinical cues

Al‐Moteri, Modi; Symmons, Mark; Cooper, Simon; Plummer, Virginia

doi:10.1016/j.apergo.2018.07.001

Cited by 16 publications

(22 citation statements)

References 25 publications

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“…A second round of a deductive analysis was initiated to enable an in-depth exploration of data in line with the existing literature. In the deductive analysis phase, the emerged codes were aligned with the findings of the previous studies presented in Al Moteri et al [ 4 ], Al Moteri et al 2020 [ 6 ], Al-Azri [ 17 ], Al Moteri [ 18 ]. In particular, the theoretical frameworks constructed by Al-Azri [ 17 ], Al Moteri [ 18 ] have guided the presentation of themes and codes and their interrelationships ( Table 1 ).…”

Section: Discussionmentioning

confidence: 99%

“…Time pressure and uncertainty are widely recognised experienced phenomena that may have substantial negative effect on patient safety [ 3 , 4 ]. Failure to identify patients who have a serious and potentially life - threatening problem is well documented in literature [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

“…In spite of the abundance of literature addressing the characteristics of emergency settings [ 4 , 8 , 9 , 10 ], there has not been a mental structure model proposed to understand the thought processes of clinicians and to identify particular cognitive weaknesses [ 6 ]. A better understanding may inform changes in both practice and decision-making in the emergency department setting.…”

Section: Introductionmentioning

confidence: 99%

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Mental model for information processing and decision-making in emergency care

Al‐Moteri

2022

PLoS ONE

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Background Uncertainty and time pressure in emergency departments add a challenge to the rational decision-making process, specifically when encountering a critical patient who requires a prompt response. However, there has been little attempt to develop a mental structure model to understand the thought processes and identify cognitive weaknesses points in nurses’ decision-making. A better understanding can inform changes in both practice learning strategies and decision-making in emergency department. This study aims to better understand how newly employed nurses process information and initiate actions in emergency situations characterized by time constraints and uncertainty. Method Participants worked under time pressure and uncertainty to solve a simulated shock case by establishing an assumption of what type of shock the simulated patient might have and its cause. An 8-minute window was available to initiate action. Following the simulation, a retrospective think-aloud interview was conducted. Findings Participants’ ability to identify the category of shock was better than their ability to identify the underlaying cause of the shock. This influenced their ability to intervene correctly. Participants’ thinking process in an emergency situation can be organized using ABCDE acronym as follows: (1) awareness of the situation, followed by, an instant (2) generation of beliefs (presumption), (3) controlling the consequence (first-line management action), (4) involvement in deliberate thinking and, finally (5) execution, actions (second-line management action). The cognitive weakness was mainly noticed during the first-line management action when participants were involved in immediate lifesaving activities. Conclusion Classification of the steps involved in decision-making when encountering emergency situations may provide insight into the strengths and weaknesses of the thought process at different stages. Further studies are required.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Mental model for information processing and decision-making in emergency care

Al‐Moteri

2022

PLoS ONE

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“…In prior studies, between 17 and 35% of respondents successfully identified the subject of the IAB investigation. 4,7 Based on a 30% rate of correct identification, and seeking to increase the identification rate to 60%, a sample of 96 would be needed to have power of 80% at α = 0.05. In pilot testing of the experiment, after initial blinded review, all study confidants were asked to look for the inserted text and readily identified it.…”

Section: Methodsmentioning

confidence: 99%

“…Several recent studies have shown how IAB can affect care delivery in emergency medicine, otolaryngology, nursing, and anesthesiology settings. 4–6 Another recent study demonstrated how radiologists can be affected by IAB when interpreting CT images. 7 This study expands this research by measuring the prevalence of IAB among non-radiologist physicians when interpreting written radiology reports.…”

Section: Introductionmentioning

confidence: 99%

Don’t blink: inattentional blindness in radiology report interpretation

et al. 2021

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Objectives: Medical errors attributable to inattentional blindness (IAB) may contribute to adverse patient outcomes. IAB has not been studied in the context of reviewing written radiological reports. This cross-sectional, deception-controlled study measures IAB of physicians towards an unexpected stimulus while interpreting written radiological reports. Methods: Physicians and residents from multiple fields were asked to interpret four radiology text reports. Embedded in one was an unexpected stimulus (either an abnormally placed medical exam finding or a non-medical quote from the popular television show Doctor Who). Primary outcomes were differences in detection rates for the two stimuli. Secondary outcomes were differences in detection rates based on level of training and specialty. Results: The unexpected stimulus was detected by 47.8% (n = 43) of participants; the non-medical stimulus was detected more often than the medical stimulus (75.0% vs 21.7%, odds ratio 10.8, 95% confidence interval 4.1–28.7; p < 0.0001). No differences in outcomes were observed between training levels or specialties. Conclusion: Only a minority of physicians successfully detected an unexpected stimulus while interpreting written radiological reports. They were more likely to detect an abnormal non-medical stimulus than a medical stimulus. Findings were independent of the level of training or field of medical practice. Advances in knowledge: This study is the first to show that IAB is indeed present among internal medicine, family medicine, and emergency medicine providers when interpreting written radiology reports.

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