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Decision Fatigue – Is This Cognitive Bias Affecting You?

January 6, 2021

Written by Clay Smith

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Emergency physicians did not appear to be influenced by decision fatigue with regard to consults or CT scan ordering over an eight hour shift.

Why does this matter?
A cognitive bias that may affect emergency clinicians is decision fatigue. Making repeated decisions may impair executive function and influence subsequent decision making. Judges, for example, are more likely to deny parole, which is a safer and easier decision, later in the day. Is this impacting us in the ED?

Decisions, decisions…
This was a retrospective study at a single center over 2 years with patients who were moderate acuity but not admitted. The authors used decision making about obtaining a consult or ordering a CT over an eight hour shift. Their hypothesis was, “that emergency physicians would request more consultations and order more CT scans for patients seen towards the end of the shift due to fatigue biasing clinicians towards safer and easier decisions.” Contrary to their hypothesis, they found that consultations and CT scans actually decreased over the course of the shift. There was a decrease in ED length of stay and no increase in 72-hour return visits to the ED in the later hours of the shift. Assuming CT-ordering and asking for consultation are valid measures of decision fatigue, it appears that emergency physicians are not impacted by this cognitive bias on an eight hour shift. This phenomenon is real, even if it was not found in this study. Be on guard for how decision fatigue could be impacting your performance, especially if you do 12 hour shifts.

Decision fatigue in the Emergency Department: How does emergency physician decision making change over an eight-hour shift? Am J Emerg Med. 2020 Dec;38(12):2506-2510. doi: 10.1016/j.ajem.2019.12.020. Epub 2019 Dec 16.

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