A pilot randomised controlled trial evaluating nurses’ professional judgement of emergency cases

Abstract

Purpose – The purpose of this study was to explore an area where recurrent critical decisions in healthcare are taken, capture decision outcomes and analyse the variance which is produced as a result of judgemental error. Design/method – The study took a non-practitioner’s (outsider) standpoint and utilised an experimental, blinded, randomized controlled trial using Simulation-Based Research (SBR) methods, with a control group and two experimental groups, to address the hypotheses and purpose of the study. A tailor-made web-application was developed specifically for participants to self-report and rate their mood, score triage judgements on fictitious emergency cases, provide a justification, and share details about their personality traits. Sessions were conducted at the hospital administration building and University campus, and participants were not allowed to interact with the academic personnel on the setup and configuration. Findings – Despite being inconclusive, results unveiled variances in judgements from the selected sample in a simulated environment. Under time pressure and distractions, participants performed better (a possible explanation being the inverted U theory). Participants shared the common personality traits of conscientiousness, agreeableness and extraversion. Neuroticism was one of the reported lower scores among all groups which could possibly indicate that the participants are well-trained to perform the task or that their personality traits fit the bill. Research limitations – The sample of participants was not representative of the whole population. Navigating a pandemic and post-pandemic environment led to underestimating the amount of time required to complete the project, hence the setting up of research sessions appointments was challenging, causing participant attrition. Future studies should consider re-testing the research software to improve temporal stability and response bias, and find alternative sources to share cross-border information related to hospital admissions or triage-related statistics. Practical implications – The risks of cognitive biases in emergency medicine and diagnostic error are significant; measures to mitigate these risks need to be put in place and may include improved staff training and education, implementation of cognitive aids and decision support tools, simulation-based research and the creation of a culture of safety and openness that promotes learning from errors. Originality/value – The term ‘noise’ in behavioural studies and academia (the unwanted variability in judgements) is being considered as much of a concern in professional decision-making as bias. The study itself is a demonstration of a real-life application of a noise audit and presents an opportunity to industry to further expand on such an approach at dealing with the analysis of variance.