Diagnostic Expertise in the Emergency Department

The healthcare community has, in recent years, paid increased attention to errors in the diagnostic process, especially in emergency departments (EDs). However, the expertise of frontline professionals could be an important factor in mitigating risks, preventing diagnostic errors, and improving performance. The current research focused on identifying expertise in ED personnel, complementing efforts to examine errors in reasoning or diagnosis. Data were collected from a three-year, multi-site examination of various EDs. Through the analysis of 43 Critical Decision Method interviews (Klein, Calderwood, & MacGregor, 1989), we identified six aspects of ED expertise: technical, perceptual, organizational, teamwork, emotional, and sensemaking. We also identified barriers to the development of expertise in the ED, such as limited follow-up and feedback on cases. Our findings were consistent with other naturalistic examinations of expertise. Finally, we discuss implications for ED practice, diagnostic safety, and training.