Figure 2: Negative feedback loop (victim of its own success).

This figure illustrates how a prognostic model can become a victim of its own success. In the pre-implementation validation phase, the model is trained on historical data to predict the risk of hypotension in patients with sepsis within 6 h. It identifies patients at high risk with a high probability of hypotension and performs well. In the post-implementation evaluation phase, clinicians act on the model’s predictions by administering early interventions such as fluid boluses and hydrocortisone, successfully preventing hypotension. Therefore, the observed incidence of hypotension among patients at high risk declines. Although the model recommended preventive treatment, its predictions appear to overestimate risk, leading to a perceived decline in discrimination capacity and calibration.