Washington University Emergency Medicine Journal Club – April 2025
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You are working in D-pod. Volumes are high and you feel some pressure to move patients through. Some cases are easy for you. Others make you stop and think but. You are pleased with your efficiency, but wonder whether you missed anything?
Thinking about your thinking (metacognition), you recall lectures from Dr. Wagner and others on fast and slow “type 1 and type 2” thinking, and wonder whether you may have fallen in any cognitive traps…
In the ED, high acuity, time pressures, resource constraints, limited information for decision-making, handoffs and interruptions, make preventing and mitigating diagnostic errors a high priority but this is also challenging. A recent study from 2022, (albeit with significant methodological flaws), reported estimated rates for diagnostic error (5.7%), misdiagnosis-related harms (2.0%), and serious misdiagnosis-related harms (0.3%) which, though comparable to those found in other clinical settings would translate to more than 7 million errors, 2.5 million harms, and 350,000 patients suffering potentially preventable permanent disability or death.
In this April 2025 journal club, we will explore recent literature drawn primarily from the upcoming Academic Emergency Medicine Special Issue on Diagnostic Error.
Manuscripts explore physician judgment from first impressions, cognition, decision-making and diagnostic error in the ED, debates about how this works and potential implications for education and more sophisticated ways of thinking about error, adverse events and the system we work within.
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Article 1: Treloar EC, Abraham A, Smith E, Herath M, Watson M, Pennifold N, Foley K, Maddern G, Wichmann M. Can first impressions predict patient outcomes? Acad Emerg Med. 2025 Mar;32(3):351-354. doi: 10.1111/acem.15053. Epub 2024 Nov 27. PMID: 39604170. Answer Key (Pending)
Article 2: Hartigan S, Brooks M, Hartley S, Miller RE, Santen SA, Hemphill RR. Review of the Basics of Cognitive Error in Emergency Medicine: Still No Easy Answers. West J Emerg Med. 2020 Nov 2;21(6):125-131. doi: 10.5811/westjem.2020.7.47832. PMID: 33207157; PMCID: PMC7673867. Answer Key (Pending)
Article 3: Pelaccia T, Sherbino J, Wyer P, Norman G. Diagnostic reasoning and cognitive error in emergency medicine: Implications for teaching and learning. Acad Emerg Med. 2025 Mar;32(3):320-326. doi: 10.1111/acem.14968. Epub 2024 Oct 21. PMID: 39428907; PMCID: PMC11921069. Answer Key (Pending)
Article 4: Ladell MM, Jacobson NL, Yale SC, McDermott KL, Papautsky EL, Catchpole KR, Scanlon MC. The problem with how we view medical (and diagnostic) error in emergency medicine. Acad Emerg Med. 2025 Mar;32(3):340-347. doi: 10.1111/acem.15076. Epub 2025 Mar 3. PMID: 40033164; PMCID: PMC11921065. Answer Key (Pending)
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