Mortality and morbidity rounds (MMR) in pathology: Relative contribution of cognitive bias vs. systems failures to diagnostic error

Quentin Eichbaum, Brian Adkins, Laura Craig-Owens, Donna Ferguson, Daniel Long, Aaron Shaver, Charles Stratton

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


Heuristics and cognitive biases are thought to play an important role in diagnostic medical error. How to systematically determine and capture these kinds of errors remains unclear. Morbidity and mortality rounds (MMRs) are generally focused on reducing medical error by identifying and correcting systems failures. However, they may also provide an educational platform for recognizing and raising awareness on cognitive errors. A total of 49 MMR cases spanning the period 2008-2015 in our pathology department were examined for the presence of cognitive errors and/or systems failures by eight study participant raters who were trained on a subset of 16 of these MMR cases (excluded from the main study analysis) to identify such errors. The Delphi method was used to obtain group consensus on error classification on the remaining 33 study cases. Cases with <75% inter-rater agreement were subjected to subsequent rounds of Delphi analysis. Inter-rater agreement at each round was determined by Fleiss' kappa values. Thirty-six percent of the cases presented at our pathology MMRs over an 8-year period were found to contain errors likely due to cognitive bias. These data suggest that the errors identified in our pathology MMRs represent not only systems failures but may also be composed of a significant proportion of cognitive errors. Teaching trainees and health professionals to correctly identify different types of cognitive errors may present an opportunity for quality improvement interventions in the interests of patient safety.

Original languageEnglish (US)
Pages (from-to)249-257
Number of pages9
Issue number3
StatePublished - Aug 27 2019
Externally publishedYes


  • cognitive bias
  • cognitive error
  • diagnostic error
  • mortality and morbidity rounds (MMR)
  • pathology
  • systems failure

ASJC Scopus subject areas

  • Medicine(all)


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