Cognitive Pressure and Diagnostic Performance in Emergency Medicine: Clinical Challenges and Patient Outcomes in Acute Care
DOI:
https://doi.org/10.64784/211Palabras clave:
Emergency medicine, clinical decision-making, time pressure, diagnostic accuracy, cognitive bias, neurological emergencies, internal medicine, patient safety, overcrowding, triage systems, decision fatigue, stroke, sepsis, healthcare systems, emergency department, risk stratification, multidisciplinary care, diagnostic error, emergency protocols, clinical reasoningResumen
Emergency medicine requires rapid and accurate clinical decision-making in environments characterized by uncertainty, cognitive overload, overcrowding, and limited time availability. The present review analyzes the principal factors influencing decision-making under time pressure in emergency departments, with emphasis on neurological and internal medicine emergencies. The study explores the relationship between diagnostic reasoning, cognitive biases, treatment delay, risk stratification, organizational stressors, and patient outcomes. A narrative review methodology based on the Scientific Method and evidence-based analysis was employed. Scientific literature was obtained from internationally recognized databases including PubMed, Scopus, NCBI, and peer-reviewed medical journals. The review incorporated studies related to emergency medicine, cognitive psychology, patient safety, neurological emergencies, internal medicine emergencies, triage systems, and healthcare management. The analysis included evidence from international healthcare systems with special consideration of emergency care realities in Mexico, Colombia, and Ecuador. The findings demonstrate that increasing time pressure is associated with reduced diagnostic accuracy and greater vulnerability to cognitive biases such as anchoring bias, premature closure, confirmation bias, and availability bias. Overcrowding was identified as one of the principal systemic factors negatively affecting emergency department workflow, contributing to diagnostic delay, treatment postponement, prolonged length of stay, and increased physician workload. Acute ischemic stroke, sepsis, and acute coronary syndrome showed the strongest association between delayed intervention and adverse patient outcomes.
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