Table 1 Clinical studies and type of noise identified
Clinical Study | Type of Noise | Location of Practice and Clinical Environment | Type of Data Collection and Findings | Quality of Evidence |
|---|---|---|---|---|
Ebell et al., [9] | Pattern noise - Stable pattern noise | USA Family medicine, Internal medicine | Observational data collection. Physicians’ estimates of survival may be unrelated to the outcomes of the patient. | IV |
Figon et al., [11] | Pattern noise - Stable pattern noise | France Family medicine | Survey data collection. Physicians may be unable to differentiate between pertinent information and background noise. | IV |
Peace et al., [19] | Level noise Pattern noise - Occasion noise Pattern noise - Stable pattern noise | USA, UK Cardiology | Observational data collection. The varied competence of decision makers can contribute to noise in medical decision making. Stress, time pressure, and fatigue can all contribute to noise in decision making. Fear of making a type I or type II error can also contribute to noise. | IV |
Cornou et al., 2010 | Level noise | France Urology | Retrospective, quantitative data collection. Faced with the same patient characteristics, different urologists made different judgements about initiating or changing medication for a patient. | III |
Williamson et al., [24] | Level noise | USA Neurosurgery | Survey data collection. Neurosurgeon decision making in traumatic brain injury (TBI) was found to be highly variable, even in the presence of evidence- based prognostic estimates. | IV |
Rutkow et al., [22] | System noise Level noise Pattern noise - Occasion noise | USA General surgery, Gynecology, Otorhinolaryngology, Ophthalmology, Urology | Survey data collection. From one surgeon to the next, for some common surgical situations, the opinions provided differed to a major degree. A surgeon’s judgment with regard to the same surgical situation also differed over time. | IV |
Roy et al., [21] | Level noise | Canada Neurosurgery | Survey data collection. In a group of homogeneous physicians there were significantly diverging opinions regarding the management of cerebral aneurysms. | IV |
Pollack et al., [20] | System noise | USA Pediatric intensive care | Survey data collection. Higher severity- adjusted mortality in teaching hospitals may be explained by the presence of residents caring for patients in the ICU. | IV |
Chamberlain et al., [4] | System noise | USA Emergency medicine | Observational data collection. Emergency departments with residents, such as those at teaching hospitals, are less effective in deciding which pediatric patients require hospital admission. | III |
Divard et al., [7] | Level noise | France, USA Nephrology, Transplant surgery | Electronic Health Record data collection. While an individual physician may occasionally predict the risk of long- term allograft failure in a patient correctly, other physicians are unlikely to have the same accuracy. | III |
Cozmuta et al., [6] | System noise Level noise Pattern noise - Stable pattern noise | USA Rheumatology | Survey data collection. Physicians greater than 56 years of age were more heavily influenced by the risks of all infection- related adverse events compared to their younger counterparts. | IV |
Elstein et al., [10] | Pattern noise - Stable pattern noise | USA Critical care medicine | Questionnaire data collection. Some physicians were found to order many interventions, while others ordered fewer, regardless of the content of the case, the prognostic estimate given, or the physician’s estimate of the gain to the patient from being treated. | IV |
McKinlay et al., [15] | Level noise | USA Oncology, Surgery | Observational data collection. Surgeons were more certain of their breast cancer diagnoses compared with nonsurgeons and were found to be less likely to order radiologic tests or a tissue sample for metastatic evaluation than were nonsurgeons. | IV |
Murji et al., [17] | Pattern noise - Occasion noise | Canada Obstetrics and gynecology | Observational data collection. Obstetrics and gynecology residents’ ability to make sound clinical patient-care decisions was hindered when distractions were present when operating, with 63% of residents making at least 1 unsafe clinical decision while operating. | II |