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Related Experiment Video

Updated: Jun 2, 2026

Use of a Psychophysiological Script-driven Imagery Experiment to Study Trauma-related Dissociation in Borderline Personality Disorder
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Deviations from protocol in a complex trauma environment: errors or innovations?

Kanav Kahol1, Mithra Vankipuram, Vimla L Patel

  • 1Simulation and Education Training Center, Banner Good Samaritan Medical Center, Phoenix, AZ 85016, USA. kanav@asu.edu

Journal of Biomedical Informatics
|April 19, 2011
PubMed
Summary
This summary is machine-generated.

In complex clinical settings, clinician expertise influences deviations from standard protocols. Experts make both errors and innovations, while novices primarily make errors, impacting patient safety.

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09:12

The Resident-intruder Paradigm: A Standardized Test for Aggression, Violence and Social Stress

Published on: July 4, 2013

Area of Science:

  • Clinical practice and patient safety
  • Cognitive science in healthcare
  • Medical error and innovation analysis

Background:

  • Standardized protocols are crucial for consistent healthcare but often require adaptation in dynamic clinical environments.
  • Deviations from protocols can be either errors with harmful outcomes or innovations that improve efficiency and accuracy.
  • Limited understanding exists regarding the cognitive processes underlying protocol errors versus innovations.

Purpose of the Study:

  • To investigate how clinician expertise affects the classification of protocol deviations as errors or innovations.
  • To analyze the relationship between expertise, patient condition criticality, and deviation types in a trauma setting.

Main Methods:

  • Field observations were conducted in a Level 1 trauma unit.
  • Data from 10 trauma cases were analyzed using a customized activity-error-innovation ontology, timestamps, and team member expertise.
  • Deviations were categorized based on observed actions and their relation to standard protocols.

Main Results:

  • Clinician expertise and patient condition criticality significantly influenced the frequency and nature of protocol deviations.
  • Expert clinicians exhibited deviations that were a mix of errors and innovations.
  • Novice clinicians predominantly made deviations classified as errors.

Conclusions:

  • Expertise plays a critical role in distinguishing between errors and innovations in clinical practice.
  • Current protocol design and compliance measurement strategies may need re-evaluation for complex, dynamic healthcare environments.
  • Further research into the cognitive underpinnings of clinical deviations is warranted to optimize patient care and safety.