Clinical Decision Making Scottish Intensive Care临床决策苏格兰重症监护.ppt

An Introduction to Clinical Decision Making Dr Graham R. Nimmo Chair, Scottish Clinical Decision Making Special Interest Group Clinical Skills Managed Educational Network and Scottish Clinical Skills Network Overview Intro to clinical decision making (CDM) The five second rule: a case based CDM challenge How do we think and make decisions? What affects our CDM? How can we improve CDM and enhance patient safety? Next? CDM and non-technical skills Team working Decision making Situation awareness Task management Diagnosis Prognosis CDM exercise 1 Think about your choice of speciality, profession, job What influenced you in that decision making? CDM exercise 2 Look at the next slide and ask yourself: “Which beach would I rather be on?” A or B ? CDM in the acutely ill 21 year old with known asthma In respiratory ward Phone call Decisions Recognition The five second rule CDM in the acutely ill In the ward Assessment and management Looks…. Obs…. Actions System 1 thinking: (intuitive) Cognitive style Heuristic Cognitive awareness Low Cost Low Automaticity High Rate Fast Reliability Low Errors Usually Effort Low Predictive power Low Emotional component High Scientific rigour Low Importance of CDM in managing sick patients Patients still die from ‘simple’ things either missed, delayed or done sub-optimally Decisions including diagnosis Approx 80% of clinical time spent in the cognitive domain 1. Advanced First Aid ASSESSMENT Hello, how are you ? Response Airway: patent ? Breathing ACTION Look: obstruction Listen: ? noise Clear or secure: headtilt/chin lift or jaw thrust? Airway: oral or nasal? High concn oxygen: m