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Surrogates’ optimistic bias in the ICU

April 2012

Published in the April 2012 issue of Today’s Hospitalist

Surrogates’ optimistic bias in the ICU

SURROGATE DECISION-MAKERS IN THE ICU tend to put a much more optimistic spin on bad prognoses than is warranted, a disconnect that could influence the decisions that surrogates make for family members.

Researchers enrolled 80 surrogates in three San Francisco ICUs, giving them a questionnaire that contained different prognostic statements unrelated to their own family members’ cases. The surrogates were asked to interpret the survival odds conveyed in each statement.

While they accurately perceived the survival odds contained in statements that delivered good news, surrogates didn’t correctly interpret the low odds related to poor prognoses. They interpreted the survival odds as better than what was represented in the statements.

When misinterpreting prognoses, subjects stated that they wanted to preserve hope. They also said that doctors are not always aware of attributes that could improve patients’ odds of survival.

The study was published in the March 6 Annals of Internal Medicine. An unduly optimistic perception of bad news, authors concluded, “arise[s] partly from optimistic biases rather than simply from misunderstandings.”

Haloperidol linked to higher mortality rates

RESEARCHERS LOOKING AT 2001-05 MORTALITY DATA for U.S. nursing home residents who were prescribed antipsychotics found that mortality rates varied across the six drugs studied.

While risperidone was the most common antipsychotic prescribed to nursing home residents age 65 and older, haloperidol was associated with twice the mortality risk as risperidone. That risk was highest in the first 40 days of treatment with the drug, according to the study published in February in BMJ. The data also indicated that mortality risk rose with higher doses.

By contrast, the lowest mortality risk among the six antipsychotics studied was associated with quetiapine (Seroquel). The mortality risk associated with three other drugs “aripiprazole, olanzapine and ziprasidone “was similar to that of risperidone.

While prescribing an antipsychotic to control behavioral problems associated with dementia is an off-label use, authors noted that the use of antipsychotics in older dementia patients is on the rise.

More iPad love

MORE THAN THREE-QUARTERS OF RESIDENTS GIVEN IPADS to use in the hospital claimed the tablets allowed them to work more efficiently, saving them an estimated one hour each day and enabling them to spend more time in direct patient care.

According to a research letter published online last month by the Archives of Internal Medicine, the University of Chicago gave iPads to all 115 of its internal medicine residents in late 2010. Those residents were surveyed about their perceptions of workflow and efficiency both before the iPad implementation and several months after.

Survey results from residents found that nearly 80% believed the tablets allowed them to spend more time with patients because they spent less time at computer stations for documentation. While residents before and after the implementation of iPads filed the same number of orders, more of those orders were completed within two hours of admission once residents started using the tablet computers.