ERcast: Clinical Perspectives Podcast Preview
The summary below is from an episode of ERcast: Clinical Perspectives
Case review in emergency medicine is as much about cognitive bias and peer support as technical critique. Retrospective outcome knowledge reliably distorts judgment, and informal debriefs can carry medicolegal risk if they sit outside protected quality-improvement processes.
Reviewing ED Cases Well
- Retrospective bias trap: Hindsight bias makes missed alternatives look obvious once the outcome is known, so fair review starts by reconstructing the clinician’s decision point with only the information available at that moment.
- Protected versus discoverable review: Formal quality-improvement review may carry peer-review protections, while casual conversations about a bad outcome can be discoverable depending on state law. We get into that opening move in the episode.
- Clarify the review request: The first task is defining what the colleague wants: a quick curbside, a second set of eyes, a structured QI review, or simply space to debrief after a hard case.
- Support before technical advice: After an adverse outcome, many clinicians are looking first for a trusted listener rather than an immediate list of alternative decisions, a distinction that changes the entire tone of the conversation.
- Consultant-specific concerns: When feedback comes from a non-EM specialist, the actionable issue is often one small ED handoff or workflow detail rather than a broad failure in emergency care.
- Would you do differently: The WYHDSD question has been proposed as a screening tool for possible ED error, but most reviewed cases still fall within reasonable practice rather than clear deviation.
Subscribe to ERcast: Clinical Perspectives to listen to the episode.
References:
- Arastehmanesh D, Mangino A, Eshraghi N, Wolfe RE, Grossman SA. Can Asking Emergency Physicians Whether or Not They Would Have Done Something Differently (WYHDSD) be a Useful Screening Tool to Identify Emergency Department Error? J Emerg Med. 2023 Sep;65(3):PMID: 37689413.
Faculty
- Matthew DeLaney, MD, FACEP, FAAEM
Dr. Matthew DeLaney is an emergency medicine physician and educator based in Birmingham, Alabama. A native of Mobile, he earned his medical degree from the University of South Alabama and completed his emergency medicine residency at Maine Medical Center.Dr. DeLaney has experience in both community and academic emergency medicine and is known for his commitment to teaching and medical education. He lives in Birmingham with his wife, Erin, who is also a physician, and their two daughters.
- Drew Kalnow, DO
Dr. Drew Kalnow is an emergency medicine physician and educator based in Columbus, Ohio. He completed his emergency medicine training at OhioHealth Doctors Hospital Emergency Medicine Residency. Dr. Kalnow is passionate about advancing emergency medicine through high-quality education, with a particular focus on simulation, learning theory, and innovative teaching.
- Andy Little, DO
Dr. Andy Little is an emergency medicine physician and educator. He earned his medical degree from the Ohio University Heritage College of Osteopathic Medicine and completed his emergency medicine residency at OhioHealth Doctors Hospital Emergency Medicine Residency, where he served as Chief Resident. He has received multiple national awards, including recognition from the American Osteopathic Association, American College of Osteopathic Emergency Physicians, and Emergency Medicine Residents' Association.
