Lit Matters 1: Identifying Medical Error By Asking: WYHDSD?

Medical error review in emergency medicine often blurs true error, adverse outcome, and reasonable judgment under pressure. A single peer-review question — would you have done something differently — may be a practical ED quality-assurance screen with very high sensitivity and an exceptional negative predictive value.

WYHDSD as an Error Screen

• Single-question screen: Asking a peer reviewer whether they would have done something differently identified nearly all adjudicated ED errors, with 97.4% sensitivity and a 99.8% negative predictive value.
• Practical QA signal: A “no” answer was rarely associated with missed error, making WYHDSD most useful as a rule-out screen when a case enters quality review in the first place.
• High-risk case selection: The cohort came from classic QA triggers such as 72-hour return with admission, early ICU upgrade, death within 24 hours, or clinician-initiated referral. We get into why that matters in the episode.
• Error versus outcome: The study usefully separates error from adverse events, underscoring that a bad outcome alone is not synonymous with a mistake in emergency care decision-making.
• Adjudication caveat: Reviewer judgments were not blinded from the usual historical review context, so WYHDSD looks compelling as an adjunct now but not yet a clean replacement for existing QA methods.