title: Approaching the limits of knowledge: the influence of priming on error detection in simulated clinical rounds.
abstract: Errors are inevitable in all clinical settings, posing substantial risk to patients. Studies have shown detection and correction are essential to error management. This paper documents the use of Opensimulator, a virtual world development platform, to create a virtual Intensive Care Unit where error recovery can be studied in a controlled, yet realistic environment. Subjects participated in rounds presented by computer-generated characters. Errors were embedded in these presentations, and subjects were evaluated for their ability to detect them. Eight subjects were asked to evaluate two cases and answer related knowledge-based questions under two conditions: primed (forewarned of the presence of errors) and un-primed. Subjects frequently failed to detect errors despite having the prerequisite knowledge. Priming significantly improved detection, suggesting a role for interventions that aim to shift clinicians' error detection toward the limits of their knowledge. Such interventions may provide means to decrease adverse events resulting from human error.
authors.affiliation: Center for Cognitive Informatics and Decision Making, School of Biomedical Informatics, University of Texas Health Science Center, Houston, TX, USA.
authors.forename: Elie
authors.initials: E
authors.lastname: Razzouk
authors.forename: Trevor
authors.initials: T
authors.lastname: Cohen
authors.forename: Khalid
authors.initials: K
authors.lastname: Almoosa
authors.forename: Vimla
authors.initials: V
authors.lastname: Patel
mesh_terms: D002983:Clinical Competence; D003198:Computer Simulation; D006801:Humans; D007362:Intensive Care Units; D019300:Medical Errors; D056164:Teaching Rounds; D014584:User-Computer Interface