Aviation model cognitive risk factors applied to medical malpractice cases.
OBJECTIVE
Aviation accidents have been reduced substantially by training pilots to avoid high-risk behaviors caused by cognitive errors. To determine whether similar cognitive cause factors or errors are involved in medical malpractice cases, and to evaluate the reliability of identifying such factors, physicians reviewed state and federal malpractice cases in a legal database.


METHODS
Reviewing physicians evaluated 30 cases meeting inclusion criteria from state and federal malpractice cases for the year 2004 in the 8th US Circuit Court of Appeals region, using criteria for cognitive factors derived from aviation. The cases were categorized into three classes based on the degree of agreement between the reviewers. The results as to prevalence of the factors and reliability of identifying the factors were then analyzed statistically.


RESULTS
Fifty-nine percent of the cases met criteria for strong and good correlation with the factors. Cognitive factors involving IMSAFE (illness, medications, stress, alcohol, physiogical (f), and emotional) and medical team management/leadership can be reliably identified. Other factors, such as hazardous attitudes and loss of situational awareness, were identified with minimal reliability.


CONCLUSIONS
The aeronautical cognitive causative approach can be translated into a medical approach to reliably identify cognitive causes of errors in a significant proportion of medical malpractice cases from a legal database.
Stripe
Stephen C
SC
Center for Family Medicine Minot, University of North Dakota, School of Medicine and Health Sciences, Minot, ND 58701, USA. sstripe@medicine.nodak.edu
Best
Lyle G
LG
Cole-Harding
Shirley
S
Fifield
Bryce
B
Talebdoost
Farzin
F
D000060:Accidents, Aviation; D015984:Causality; D003071:Cognition; D006801:Humans; D008318:Malpractice; D008485:Medical Audit; D019300:Medical Errors; D008960:Models, Psychological; D012308:Risk Management; D014481:United States