Role of cognition in generating and mitigating clinical errors.

Given the complexities of current clinical practice environments, strategies to reduce clinical error must appreciate that error detection and recovery are integral to the function of complex cognitive systems. In this review, while acknowledging that error elimination is an attractive notion, we use evidence to show that enhancing error detection and improving error recovery are also important goals. We further show how departures from clinical protocols or guidelines can yield innovative and appropriate solutions to unusual problems. This review addresses cognitive approaches to the study of human error and its recovery process, highlighting their implications in promoting patient safety and quality. In addition, we discuss methods for enhancing error recognition, and promoting suitable responses, through external cognitive support and virtual reality simulations for the training of clinicians. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.