Inattentional Blindness in Healthcare
What is the influence inattentional blindness has on healthcare that causes medical errors? Medical errors are the third most leading cause of death within the United States and result in over 250,000 deaths each year that are preventable (Melnyk et al., 2018). This seems to be a common problem within healthcare systems across the world as there are over 400,000 deaths each year due to medical errors, with 83% of them being preventable (Silva et al., 2016; Khoo et al., 2012).
For decades, one of the most popular theories within medical error literature is the idea that inattentional blindness is present within the healthcare field.
Medical errors are the unintended act or on that does not achieve its intended outcome, the failure of a planned action to be completed as intended, the use of a wrong plan to achieve an aim, or a deviation from the process of care that may or may not cause harm to the patient (Daniel, 2016).
Although medical errors are the third leading cause of death within the United States, it is not included within the rankings of cause of death or on death certificates (Daniel, 2016).
Inattentional blindness is defined as, “the failure to notice an unexpected stimulus in one’s field of vision while performing other attention demanding tasks,” which will be explained further within this blog (Wolf et al., 2014, p. 28). For this blog, it was of interest to investigate the overall concept of inattentional blindness and its’ association with medical errors.
In 1999, psychologists Daniel Simons and Christopher Chabris created a research study including a video they played for participants (Rosenbaum, 2013; Pannapacker, 2012; Hays, 2010). In the video, they had six individuals split into two different teams, three were wearing white shirts, the other three were wearing black shirts. The players were taking turns passing a basketball to their teammates (Rosenbaum, 2013; Pannapacker, 2012; Hays, 2010). Study participants were asked to count how many times the white shirt team had passed the basketball. (Rosenbaum, 2013; Pannapacker, 2012; Hays, 2010). During the video, a woman dressed in a gorilla suit walked across the screen and pounded her chest, she remained in the video for 5 seconds of the 26 second video (Rosenbaum, 2013; Pannapacker, 2012; Hays, 2010). After the video, participants were asked to answer how many passes they counted, then they were asked if they noticed the gorilla. (Rosenbaum, 2013; Pannapacker, 2012; Hays, 2010). 50% of the participants did not notice the gorilla, as they were focused on the basketball players. (Rosenbaum, 2013; Pannapacker, 2012; Hays, 2010).
A couple examples of medical errors:
A young female recovered well after a successful transplant operation, she was readmitted for anon-specific complaints that were evaluated with extensive tests, including pericardiocentesis. (Daniel, 2016). She was discharged but came back to the hospital days later with intra-abdominal hemorrhage and cardiopulmonary arrest (Daniel, 2016). An autopsy revealed that the needle inserted during the pericardiocentesis grazed the liver causing a pseudoaneurysm that resulted in subsequent rupture and death (Daniel, 2016). The death certificate listed the cause of death as cardiovascular issues (Daniel, 2016).
In 2005, a woman in shock had a femoral venous line sited using the Seldinger technique, a technique used to obtain safe access to central vein (Leung et al., 2017). Over the following several days, multiple chest x-rays were taken, and a CT scan showed pulmonary embolism (Leung et al., 2017). On the 5th day, during placement of an IVC filter, it was discovered that the guidewire from the femoral line placement was still inside the patient (Leung et al., 2017).
Both of these medical error cases involved healthcare workers missing an important component of a procedure.
There was a survey to study the prevalence of inattentional blindness in anesthesiology by the Public Library of Science, online through Facebook (Cassai et al., 2021). They created a survey that consisted of five simulated cases with questions investigating the anesthetic management of day-case surgeries. (Cassai et al., 2021). Each case had an introduction, a chest radiography, an electrocardiogram, preoperative blood testing and the last case had a gorilla embedded in the chest radiography. (Cassai et al., 2021). There were a total of 699 individuals who participated in the study, all living from a total of 17 different countries (Cassai et al., 2021). Only 34 (4.9%) participants were able to spot the gorilla (Cassai et al., 2021). This study showed that inattentional blindness is common in anesthesia, and ever-growing attention is deemed necessary to improve patient safety (Cassai et al., 2021).
It can be presumed that there is a pattern with inattentional blindness within critical roles of healthcare.
It is estimated that preventable medical errors in the United States cost nearly $21 billion annually (Silva et al., 2016). Medication errors harm an estimated 1.5 million people each year, costing at least $3.5 billion annually (Silva et al., 2016). In 2006, at least 1.5 million preventable medical errors occurred totaling in more than $7 billion (Silva et al., 2016). In the year 2008, it was estimated that a total of $17.1 billion from medical errors that harmed patients, which was .72% of the $2.391 trillion spent on healthcare that year in the United States (Bos et al., 2011).
As said before, an estimated total of 83% medical errors are preventable (Khoo et al., 2012). It is believed that more than 7 million patients are impacted by medication errors annually that are preventable (Silva et al., 2016). In the year 2006 it is believed that 1.5 million medication errors occurred that were preventable, which cost around $7 million (Silva et al., 2016). It is estimated that within the United States there is over 250,000 deaths each year due to a medical error that was preventable (Silva et al., 2016). In 1996 there were a total of 564,000 impatient injuries in Utah and Colorado that were preventable (Bos et al., 2011). Medical errors are the third leading cause of death within America, 50% of those affecting hospitalized patients (Melnyk et al., 2018).
There is a lack of concern for the number of medical errors occurring in healthcare service facilities, worldwide. Medical errors are the third leading cause of death in the United States, there are over 400,000 individual deaths each year due to medical errors, roughly eighty-three percent of those being preventable (Silva et al., 2016). From the given studies, it is explained that the concept of inattentional blindness is one reason for the high number of medical errors (Easdown., 2017; Leung et al., 2017; Hughes-Hallett, 2015; Joel, 2013; Cassai et al., 2021; Drew et al., 2013). If an individual working within the healthcare field focuses too much of their attention in a particular area, it can cause them to miss the obvious (Wolf et al., 2014). As stated by Atula Gawade, an endocrine surgeon, writer, and professor at Harvard Medical School, “the real problem is not how to stop bad doctors from harming, even killing, their patients. It’s how to prevent good doctors from doing so,” (Leung et al., 2017). From the reviewed literature, it is shown that there are psychological and mental factors leading to medical errors, there is physical damages towards patients due to medical errors, and there are financial effects toward the economy because of those errors.
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