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Thought outside the box: Intensive care unit freakonomics and decision making in the intensive care unit

Mohan, Deepika MD, MPH; Angus, Derek C. MD, MPH, FRCP

doi: 10.1097/CCM.0b013e3181f202c3
Thinking Outside the Box: Proceedings of a Round Table Conference in Brussels, Belgium, March 2010

From The CRISMA Laboratory (Clinical Research, Investigation, and Systems Modeling of Acute Illness), Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA.

This work was performed at the University of Pittsburgh.

The authors have not disclosed any potential conflicts of interest.

For information regarding this article, E-mail: angusdc@ccm.upmc.edu

Abstract

Despite concerted efforts to improve the quality of care provided in the intensive care unit, inconsistency continues to characterize physician decision making. The resulting variations in care compromise outcomes and impose unnecessary decisional regret on clinicians and patients alike. Critical care is not the only arena where decisions fail to conform to the dictates of logic. Behavioral psychology uses scientific methods to analyze the influence of social, cognitive, and emotional factors on decisions. The overarching hypothesis underlying this “thought outside the box” is that the application of behavioral psychology to physician decision making in the intensive care unit will demonstrate the existence of cognitive biases associated with classic intensive care unit decisions; provide insight into novel strategies to train intensive care unit clinicians to better use data; and improve the quality of decision making in the intensive care unit as characterized by more consistent, patient-centered decisions with reduced decisional regret and work-related stress experienced by physicians.

© 2010 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins