Each month I meet with administrators at my hospital to review the quality of our cardiology program. At several meetings I\u2019ve complained that our performance thresholds are too high and fail to account for the random variation that is a part of everyday medicine. My administrators don\u2019t want excuses, though \u2014 they aim for perfection. But a discussion at our last meeting about door-to-balloon times for STEMI patients changed their minds.<\/p>\n
Last month a STEMI patient presented to the ER and underwent a timely PCI. During the procedure, a second STEMI patient arrived. Plans to quickly finish and transfer the first patient to the ICU were thwarted because the ICU was full. The team developed a work-around solution to take the first patient back to the ER to accommodate the second patient in the catheterization laboratory. Despite fast and creative action, the second patient had a door-to-balloon time of 118 minutes, falling short of the 90-minute threshold.<\/p>\n
So how were we to respond to this apparent lapse in quality? As we discussed the situation in our meeting, the answer became clear: No corrective action was required. The team had acted admirably. The lapse was due not to a systems defect but to the uncommon, unpredictable presentation of two STEMI patients simultaneously. The administrators realized how randomness affects our measured outcomes.<\/p>\n
Cognitive psychologists tell us that our minds are hardwired to try to find causes for occurrences. We often jump to erroneous conclusions by ascribing unwarranted explanations to events that happen randomly. Intuition can sometimes be helpful, as I\u2019ve discussed in previous blog posts<\/a>, but it can also lead us astray. Apparently, we evolved the tendency to jump to conclusions long before statistics and probability theory explained random variation.<\/p>\n