Achieving Quality in Clinical Decision Making: Cognitive Strategies and Detection of Bias
Abstract
Clinical decision making is a cornerstone of high‐quality care in emergency medicine. The density of decision making is unusually high in this unique milieu, and a combination of strategies has necessarily evolved to manage the load. In addition to the traditional hypothetico‐deductive method, emergency physicians use several other approaches, principal among which are heuristics. These cognitive short‐cutting strategies are especially adaptive under the time and resource limitations that prevail in many emergency departments (EDs), but occasionally they fail. When they do, we refer to them as cognitive errors. They are costly but highly preventable. It is important that emergency physicians be aware of the nature and extent of these heuristics and biases, or cognitive dispositions to respond (CDRs). Thirty are catalogued in this article, together with descriptions of their properties as well as the impact they have on clinical decision making in the ED. Strategies are delineated in each case, to minimize their occurrence. Detection and recognition of these cognitive phenomena are a first step in achieving cognitive de‐biasing to improve clinical decision making in the ED.
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Providers make decisions at different points in medical emergencies.
“As in this study and prior work [17], providers make decisions at different points in medical emergencies.”
From To Recommend or Not to Recommend: Designing and Evaluating AI-Enabled Decision Support for Time-Critical Medical Events (2025) · cites this paper as [17]
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- Authors
- Croskerry, P.
- Affiliations
- Dalhousie University (CA)
- Corresponding author
- Croskerry, Pat
- ORCID
- Croskerry, Pat
- Venue
- Academic Emergency Medicine
- Publisher
- Wiley
- Published
- 2002-11
- Volume
- 9
- Issue
- 11
- Pages
- 1184-1204
- ISSN
- 1069-6563 (ISSN-L)
- 1553-2712
- OpenAlex
- W1964143014
- Cited by
- 938
- References
- 8
- Citations by year
- 2026: 42 · 2025: 50 · 2024: 42 · 2023: 44 · 2022: 50 · 2021: 61 · 2020: 86 · 2019: 76 · 2018: 58 · 2017: 44 · 2016: 43 · 2015: 36 · 2014: 46 · 2013: 46 · 2012: 40
- FWCI
- 6.33
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Academic Emergency Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
- Social Sciences › Decision Sciences › General Decision Sciences › Decision-Making and Behavioral Economics
- Health Sciences › Medicine › Emergency Medicine › Emergency and Acute Care Studies
- Keywords
- clinical decision-making, cognitive biases, heuristics, cognitive debiasing, emergency medicine, cognitive errors, emergency department, decision strategies
- MeSH terms
- Decision Making, Emergency Medical Services, Emergency Service, Hospital, Humans, Judgment, Pattern Recognition, Automated, Quality of Health Care
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