Investigation of Human Errors in Emergency Department of Imam Khomeini Hospital Emergency Department of Jiroft Using Systematic Human Error Reduction and Prediction Approach

Introduction: In examining the unfortunate events that have taken place in the industrial and health sectors, human error is considered as the main cause of these events. Given the sensitivity and importance of medical careers, the occurrence of errors can lead to irreparable consequences. The purpose of this study was to investigate the human error in the emergency department of Imam Khomeini Hospital in Jiroft. Methods: This study was a cross-sectional and descriptive one. Emergency nurses' job duties have been analyzed by interviewing emergency nurses and studying nursing job guidelines and procedures using hierarchical task analysis. Finally, using the Systematic Human Error Reduction and Prediction Approach, human errors in nursing care were analyzed. Results: Generally, 4 tasks, 18 sub-tasks and 91 types of errors related to nursing activities were identified. Number of errors found, 27 (30%) Action errors, 18 (20%) Checking errors, 19 (21%) Retrieval errors, 12 (13%) communication errors, and 15 (16%) selection errors Were. As can be seen, the largest number of errors was related to the type of Action errors. Conclusion: Considering the results of the present study, the highest numbers of errors were related to Action and Checking errors respectively, which due to the sensitivity of nursing jobs and especially in the emergency department, require the use of highly skilled people to perform tasks that require high concentration and accuracy.

Action errors impair active working memory maintenance

The ability to detect and correct action errors is paramount to safe and efficient behavior. Its underlying processes are subject of intense scientific debate. The recent adaptive orienting theory of error processing (AOT) proposes that errors trigger a cascade of processes that purportedly begins with a broad suppression of active motoric and – crucially – cognitive processes. While the motoric effects of errors are well established, an empirical test of their purported suppressive effects on active cognitive processes is still missing. Here, we provide data from six experiments clearly demonstrating such effects. Participants maintained information in verbal working memory (WM) and performed different response conflict tasks during the delay period. Motor error commission during the delay period consistently reduced accuracy on the WM probe, demonstrating an error-related impairment of WM maintenance. We discuss the broad theoretical and practical implications of this finding, both for the AOT and beyond.

Reduced competition between tool action neighbors in left hemisphere stroke

When pantomiming the use of tools, patients with limb apraxia after left hemisphere stroke (LCVA) produce more spatiotemporal hand action errors with tools associated with conflicting actions for use versus grasp-to-pick-up (e.g., corkscrew) than tools having a single action for both use and grasp (e.g., hammer). There are two possible accounts for this pattern of results. Reduced performance with ‘conflict’ tools may simply reflect weakened automaticity of use action activation, which is evident only when the use and grasp actions are not redundant. Alternatively, poor use performance may reflect reduced ability of appropriate tool use actions to compete with task-inappropriate action representations. To address this issue, we developed a Stroop-like experiment in which 21 LCVA and 8 neurotypical participants performed pantomime actions in blocks containing two tools that were similar (“neighbors”) in terms of hand action or function, or unrelated on either dimension. In a congruent condition, they pantomimed the use action associated with the visually presented tool, whereas in an incongruent condition, they pantomimed the use action for the other tool in the block. Relative to controls and other task conditions, LCVA participants showed reductions in hand action errors in incongruent relative to congruent action trials; furthermore, the degree of reduction in this incongruence effect was related to the participants’ susceptibility to grasp-on-use conflict in a separate test of pantomime to the sight of tools. Support vector regression lesion-symptom mapping analyses identified the left inferior frontal gyrus, supramarginal gyrus, and superior longitudinal fasciculus as core neuroanatomical sites associated with abnormal performance on both tasks. Collectively, the results indicate that weakened activation of tool use actions in limb apraxia gives rise to reduced ability of these actions to compete for task-appropriate selection when competition arises within single tools (grasp-on-use conflict) as well as between two tools (reduced neighborhood effects).

Motivational Sensitivities Linked to Impulsive Motor Errors in Parkinson’s Disease

Objectives: We investigated how broad motivational tendencies are related to the expression and suppression of action impulses in Parkinson’s disease (PD). Methods: Sixty-nine participants with PD completed a Simon response conflict task and Behavioral Inhibition System (BIS) and Behavioral Activation System (BAS) scales based on Gray’s (1987) reinforcement sensitivity theory. Analyses determined relationships between BIS, BAS, and the susceptibility to making impulsive action errors and the proficiency of inhibiting interference from action impulses. Results:BIS scores correlated positively with rates of impulsive action errors, indicating that participants endorsing low BIS tendencies were much more susceptible to acting on strong motor impulses. Analyses of subgroups with high versus low BIS scores confirmed this pattern and ruled out alternative explanations in terms of group differences in speed-accuracy tradeoffs. None of the scores on the BIS or BAS scales correlated with reactive inhibitory control. Conclusions: PD participants who endorse diminished predilection toward monitoring and avoiding aversive experiences (low BIS) show much greater difficulty restraining fast, impulsive motor errors. Establishing relationships between motivational sensitivities and cognitive control processes may have important implications for treatment strategies and positive health outcomes in participants with PD, particularly those at risk for falling and driving difficulties related to impulsive reactions. (JINS, 2018, 24, 128–138)