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Improving decision-making and cognitive bias using innovative approaches to simulated scenario and debrief design
  1. Zaina Jabur1,
  2. Mary Lavelle2,
  3. Chris Attoe3
  1. 1Psychological Medicine, South London and Maudsley NHS Foundation Trust, London, UK
  2. 2Patient Safety at the Patient Safety and Translational Research Centre, Imperial College NHS Trust, London, UK
  3. 3Maudsley Simulation, South London and Maudsley NHS Foundation Trust, London, UK
  1. Correspondence to Dr Zaina Jabur, South London and Maudsley Simulation Department, London SW9 9NT, UK; zainab.jabur{at}

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The simplest approach to improving doctors’ decision-making is to educate them about the existence of the biases… (Bornstein and Emler, 2001).1


Over the last 20 years, healthcare systems globally have reduced the number of acute inpatient psychiatry beds, diverting resources to community-based teams. This has led to an increased number of patients from all specialities presenting to the emergency department. The Economist Intelligence Unit has projected a global trend of decreases in the number of hospital beds per 1000 population until 2019, despite growing demand from growing and ageing populations as well as the need for community-care and home-care beds.2

This trend is especially noted in mental health. Since 2013, most UK mental health trusts have regularly experienced a lack of inpatient bed availability, with these problems widely described and addressed in national policy and guidance.3

When patients are in crisis, they are assessed by multidisciplinary mental health teams. Mental health professionals must balance the potential costs and benefits of several courses of action. These decisions and their consequences are complex, having significant implications for individuals, families, professionals and healthcare systems.

However, clinicians appear not to use the same process to make decisions or agree on treatment options. Clinicians tend to focus on finding the right decision rather than understanding the decision-making process that influences actions. Many different factors, including bias, contribute to variability in clinical decision-making, with some clinical presentations managed more consistently than others.1

To address this subjectivity and bias in practice, bring clinical practice in line with evidence-based guidelines and …

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