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Table 1 Insights for acute care medicine from diverse sources

From: Patient safety and acute care medicine: lessons for the future, insights from the past

Example

Insight

Engineering

Most errors are neither random nor unpredictable

Benefits of Standard Operating Procedures

Usefulness of second-opinions; fail-safes; time-outs

Benefits of a systems approach to error and education

Apply the Swiss-cheese model to understanding error

Cognitive Psychology

Benefits and detriments of:

 

   Gestalt, Law of Prägnanz, premature closure; availability and anchoring heuristics

Human/Machine Interface

Humans excel at pattern-recognition;

Computers excel at calculation and vigilance

The best system mitigates shortcomings

Chess

Need to concurrently manage multiple threats

Two patterns of attention: Focus of predator; gaze of prey

Benefits of risk-free simulation