Commentary Errors in clinical reasoning: causes and remedial strategies. Citation Text: Scott IA. Errors in clinical reasoning: causes and remedial strategies. BMJ. 2009;338:b1860. doi:10.1136/bmj.b1860. Copy Citation Format: DOIGoogle ScholarPubMedBibTeXEndNote X3 XMLEndNote 7 XMLEndnote taggedPubMedIdRIS Download Citation Save Save to your library Print Share Facebook Twitter Linkedin Copy URL June 24, 2009 Scott IA. BMJ. 2009;338:b1860. View more articles from the same authors. This commentary analyzes how cognitive errors occur and shares strategies to minimize their incidence and impact. PubMed citation Available at Save Save to your library Print Share Facebook Twitter Linkedin Copy URL Cite Citation Citation Text: Scott IA. Errors in clinical reasoning: causes and remedial strategies. BMJ. 2009;338:b1860. doi:10.1136/bmj.b1860. Copy Citation Format: DOIGoogle ScholarPubMedBibTeXEndNote X3 XMLEndNote 7 XMLEndnote taggedPubMedIdRIS Download Citation Related Resources From the Same Author(s) Patient harm from cardiovascular medications. August 25, 2021 Pain management best practices from multispecialty organizations during the COVID-19 pandemic and public health crises. April 29, 2020 The gaps in specialists' diagnoses. April 11, 2018 Minimizing inappropriate medications in older populations: a ten-step conceptual framework. April 4, 2012 An adverse event screening tool based on routinely collected hospital-acquired diagnoses. May 30, 2012 Scoping review of studies evaluating frailty and its association with medication harm. June 22, 2022 COVID-19 pandemic and the tension between the need to act and the need to know. October 14, 2020 Medication use and cognitive impairment among residents of aged care facilities. June 23, 2021 Developing critical thinking skills for delivering optimal care July 28, 2021 Seroprevalence of SARS-CoV-2 among frontline health care personnel in a multistate hospital network--13 academic medical centers, April-June 2020. September 23, 2020 Countering cognitive biases in minimising low value care. June 7, 2017 Prescriber barriers and enablers to minimising potentially inappropriate medications in adults: a systematic review and thematic synthesis. January 14, 2015 Reducing inappropriate polypharmacy: the process of deprescribing. April 1, 2015 Using EMR-enabled computerized decision support systems to reduce prescribing of potentially inappropriate medications: a narrative review. October 10, 2018 Perspective Where Does Risk-Adjusted Mortality Fit Into a Safety Measurement Program? March 1, 2015 Communication errors in radiology—pitfalls and how to avoid them. August 1, 2018 Evaluation of clinical practice guidelines on fall prevention and management for older adults: a systematic review. January 12, 2022 Preventing home medication administration errors. March 14, 2022 Grading recommendations for enhanced patient safety in sentinel event analysis: the recommendation improvement matrix. June 12, 2024 Determination of unnecessary blood transfusion by comprehensive 15-hospital record review. January 25, 2023 The effectiveness and risks of long-term opioid therapy for chronic pain: a systematic review for a National Institutes of Health Pathways to Prevention Workshop. December 21, 2016 Why do interns make prescribing errors? A qualitative study. February 13, 2008 Performance variability in perioperative sentinel events: report on a nationwide data set. April 20, 2022 Adverse events among emergency department patients with cardiovascular conditions: a multicenter study. March 10, 2021 "Good catch, Kiddo"--enhancing patient safety in the pediatric emergency department through simulation. December 9, 2020 Clinical predictors for unsafe direct discharge home patients from intensive care units. October 21, 2020 Prospective validation of classification of intraoperative adverse events (ClassIntra): international, multicentre cohort study. October 7, 2020 Publication of inspection frameworks: a qualitative study exploring the impact on quality improvement and regulation in three healthcare settings. October 6, 2021 Unit of measurement used and parent medication dosing errors. July 30, 2014 Resilience and regulation, an odd couple? Consequences of Safety-II on governmental regulation of healthcare quality. May 13, 2020 Using patient safety reporting systems to understand the clinical learning environment: a content analysis. January 9, 2019 Automation of the I-PASS tool to improve transitions of care. October 23, 2019 Statewide NICU central-line–associated bloodstream infection rates decline after bundles and checklists. March 30, 2011 Medication details documented on hospital discharge: cross-sectional observational study of factors associated with medication non-reconciliation. March 2, 2011 Learning from error: identifying contributory causes of medication errors in an Australian hospital. March 19, 2008 The uptake of technologies designed to influence medication safety in Canadian hospitals. February 20, 2008 Potential drug interactions and duplicate prescriptions among cancer patients. May 2, 2007 Speaking up about safety concerns: multi-setting qualitative study of patients' views and experiences. December 15, 2010 Implementation of the I-PASS handoff program in diverse clinical environments: a multicenter prospective effectiveness implementation study. November 16, 2022 Survival from in-hospital cardiac arrest during nights and weekends. February 27, 2008 CDC central-line bloodstream infection prevention efforts produced net benefits of at least $640 million during 1990–2008. June 18, 2014 Patient safety in the cardiac operating room: human factors and teamwork: a scientific statement from the American Heart Association. August 21, 2013 Enabling a learning healthcare system with automated computer protocols that produce replicable and personalized clinician actions. August 4, 2021 Outcomes of missed diagnosis of pediatric appendicitis, new-onset diabetic ketoacidosis, and sepsis in five pediatric hospitals. September 13, 2023 Accuracy in patient understanding of common medical phrases. December 21, 2022 Clinical features and preventability of delayed diagnosis of pediatric appendicitis. September 29, 2021 Vital signs: improving antibiotic use among hospitalized patients. March 26, 2014 Interpretive diagnostic error reduction in surgical pathology and cytology: guideline from the College of American Pathologists Pathology and Laboratory Quality Center and the Association of Directors of Anatomic and Surgical Pathology. June 17, 2015 Associations between in-hospital mortality, health care utilization, and inpatient costs with the 2011 resident duty hour revision. May 15, 2019 The admission conference call: a novel approach to optimizing pediatric emergency department to admitting floor communication. May 29, 2019 Veterans Affairs initiative to prevent methicillin-resistant Staphylococcus aureus infections. April 27, 2011 Findings of the first consensus conference on medical emergency teams. August 16, 2006 Clinician well-being assessment and interventions in Joint Commission-accredited hospitals and federally qualified health centers. October 4, 2023 Inappropriate diagnosis of pneumonia among hospitalized adults. April 10, 2024 Implementing a human factors approach to RCA(2) : tools, processes and strategies. March 10, 2021 Evaluation of a second victim peer support program on perceptions of second victim experiences and supportive resources in pediatric clinical specialties using the second victim experience and support tool (SVEST). November 3, 2021 Understanding the "Swiss cheese model" and its application to patient safety. July 21, 2021 Complication rates, hospital size, and bias in the CMS Hospital-Acquired Condition Reduction Program. January 25, 2017 Working with influenza-like illness: presenteeism among US health care personnel during the 2014–2015 influenza season. November 22, 2017 Quantifying and characterizing adverse events in dermatologic surgery. May 15, 2013 Effect of nonpayment for preventable infections in U.S. hospitals. October 24, 2012 Thirty-day outcomes support implementation of a surgical safety checklist. January 9, 2013 Misdiagnosis, mistreatment, and harm - when medical care ignores social forces. April 8, 2020 Failure to debrief after critical events in anesthesia is associated with failures in communication during the event. March 20, 2019 Simulated laparoscopic operating room crisis: an approach to enhance the surgical team performance. July 2, 2008 Unexpected increased mortality after implementation of a commercially sold computerized physician order entry system. December 14, 2005 Exploring emergency physician–hospitalist handoff interactions: development of the Handoff Communication Assessment. March 17, 2010 Surveillance of medical device-related hazards and adverse events in hospitalized patients. March 6, 2005 Development of patient safety measures to identify inappropriate diagnosis of common infections. July 17, 2024 Bedside clinicians' perceptions on the contributing role of diagnostic errors in acutely ill patient presentation: a survey of academic and community practice. March 16, 2022 Comparing the variability of ingredient, strength, and dose form information from electronic prescriptions with RxNorm drug product descriptions. August 31, 2022 How safe are paediatric emergency departments? A national prospective cohort study. August 3, 2022 Pediatric surgical errors: a systematic scoping review. July 20, 2022 Radiologist age and diagnostic errors. October 18, 2023 Infection control measure performance in long-term care hospitals and their relationship to Joint Commission accreditation. July 10, 2024 The impact of racism on child and adolescent health. July 1, 2019 ASHP Guidelines on the Safe Use of Automated Compounding Devices for the Preparation of Parenteral Nutrition Admixtures. June 15, 2022 The effects of leadership curricula with and without implicit bias training on graduate medical education: a multicenter randomized trial. May 18, 2022 Emotional safety is patient safety. February 15, 2023 Communication and birth experiences among Black birthing people who experienced preterm birth. February 14, 2024 Concerns regarding tablet splitting: a systematic review. December 7, 2022 Home health agency patient experience measures and their relationship to Joint Commission accreditation. June 7, 2023 The good, the bad, and the ugly: operative staff perspectives of surgeon coping with intraoperative errors. June 14, 2023 The burden of opioid-related adverse drug events on hospitalized previously opioid-free surgical patients. March 10, 2021 Reducing inappropriate outpatient medication prescribing in older adults across electronic health record systems. January 13, 2021 Impact of COVID-19 on inpatient clinical emergencies: a single-center experience. June 9, 2021 Survey of nurses' experiences applying The Joint Commission's medication management titration standards. November 3, 2021 Coping with errors in the operating room: intraoperative strategies, postoperative strategies, and sex differences. September 22, 2021 Association between surgeon technical skills and patient outcomes. September 9, 2020 Effect of delays in the 2-week-wait cancer referral pathway during the COVID-19 pandemic on cancer survival in the UK: a modelling study. August 19, 2020 Developing a standard handoff process for operating room–to-ICU transitions: multidisciplinary clinician perspectives from the Handoffs and Transitions in Critical Care (HATRICC) study. August 1, 2018 Use of unsolicited patient observations to identify surgeons with increased risk for postoperative complications. March 1, 2017 The development and implementation of cognitive aids for critical events in pediatric anesthesia: the Society for Pediatric Anesthesia Critical Events Checklists. March 15, 2017 Evidence review conducted for the Agency for Healthcare Research and Quality Safety Program for Improving Surgical Care and Recovery: focus on anesthesiology for colorectal surgery. May 9, 2018 An ethnographic study of health information technology use in three intensive care units. August 30, 2017 Systemic error in radiology. August 9, 2017 Increasing patient safety with neonates via handoff communication during delivery: a call for interprofessional health care team training across GME and CME. August 30, 2017 Caregiver fatigue: implications for patient and staff safety—part 1 and part 2. September 7, 2016 Quantitative analysis of the content of EMS handoff of critically ill and injured patients to the emergency department. August 10, 2016 Resident wellness in US ophthalmic graduate medical education: the resident perspective. May 23, 2018 View More Related Resources Annual Perspective Equity in Patient Safety March 27, 2024 "It's probably an STI because you're gay": a qualitative study of diagnostic error experiences in sexual and gender minority individuals. May 24, 2023 Annual Perspective Improving Diagnostic Safety and Quality April 26, 2023 Cognitive bias and dissonance in surgical practice: a narrative review. April 26, 2023 The woman who cried pain: do sex-based disparities still exist in the experience and treatment of pain? February 8, 2023 Pursuit of "endpoint diagnoses" as a cognitive forcing strategy to avoid premature diagnostic closure. December 21, 2022 Affective influences on clinical reasoning and diagnosis: insights from social psychology and new research opportunities. October 19, 2022 Effect on diagnostic accuracy of cognitive reasoning tools for the workplace setting: systematic review and meta-analysis. September 14, 2022 Patterns of error in interpretive pathology. August 17, 2022 Developing critical thinking skills for delivering optimal care July 28, 2021 Gender biases in estimation of others' pain. April 28, 2021 The critical need for nursing education to address the diagnostic process. February 17, 2021 Misdiagnosis and failure to diagnose in emergency care: causes and empathy as a solution. November 11, 2020 Understanding context specificity: the effect of contextual factors on clinical reasoning. September 2, 2020 The role of cognitive bias in breast radiology diagnostic and judgment errors. May 27, 2020 Clinical reasoning as a core competency. October 30, 2019 Building the bridge to quality: an urgent call to integrate quality improvement and patient safety education with clinical care October 2, 2019 What causes prescribing errors in children? Scoping review. August 28, 2019 Framing of clinical information affects physicians' diagnostic accuracy. August 28, 2019 Intentional rounding—an integrative literature review. August 7, 2019 What interventions could reduce diagnostic error in emergency departments? A review of evidence, practice and consumer perspectives. July 24, 2019 Controversies in diagnosis: contemporary debates in the diagnostic safety literature. July 17, 2019 A simulation-based approach to training in heuristic clinical decision-making. June 19, 2019 Health Professions Education. June 12, 2019 Patient Safety. May 22, 2019 The design and conduct of Project RedDE: a cluster-randomized trial to reduce diagnostic errors in pediatric primary care. May 15, 2019 Laney's story: the problem of delayed diagnosis of pediatric stroke. April 24, 2019 Recommendations from a national panel on quality improvement in obstetrics. April 24, 2019 Saving without compromising: teaching trainees to safely provide high value care. April 17, 2019 An IDEA: safety training to improve critical thinking by individuals and teams. April 10, 2019 View More See More About The Topic Health Care Providers Educators Diagnostic Errors Epidemiology of Errors and Adverse Events Cognitive Errors ("Mistakes") View More
Pain management best practices from multispecialty organizations during the COVID-19 pandemic and public health crises. April 29, 2020
Minimizing inappropriate medications in older populations: a ten-step conceptual framework. April 4, 2012
An adverse event screening tool based on routinely collected hospital-acquired diagnoses. May 30, 2012
Seroprevalence of SARS-CoV-2 among frontline health care personnel in a multistate hospital network--13 academic medical centers, April-June 2020. September 23, 2020
Prescriber barriers and enablers to minimising potentially inappropriate medications in adults: a systematic review and thematic synthesis. January 14, 2015
Using EMR-enabled computerized decision support systems to reduce prescribing of potentially inappropriate medications: a narrative review. October 10, 2018
Evaluation of clinical practice guidelines on fall prevention and management for older adults: a systematic review. January 12, 2022
Grading recommendations for enhanced patient safety in sentinel event analysis: the recommendation improvement matrix. June 12, 2024
Determination of unnecessary blood transfusion by comprehensive 15-hospital record review. January 25, 2023
The effectiveness and risks of long-term opioid therapy for chronic pain: a systematic review for a National Institutes of Health Pathways to Prevention Workshop. December 21, 2016
Performance variability in perioperative sentinel events: report on a nationwide data set. April 20, 2022
Adverse events among emergency department patients with cardiovascular conditions: a multicenter study. March 10, 2021
"Good catch, Kiddo"--enhancing patient safety in the pediatric emergency department through simulation. December 9, 2020
Clinical predictors for unsafe direct discharge home patients from intensive care units. October 21, 2020
Prospective validation of classification of intraoperative adverse events (ClassIntra): international, multicentre cohort study. October 7, 2020
Publication of inspection frameworks: a qualitative study exploring the impact on quality improvement and regulation in three healthcare settings. October 6, 2021
Resilience and regulation, an odd couple? Consequences of Safety-II on governmental regulation of healthcare quality. May 13, 2020
Using patient safety reporting systems to understand the clinical learning environment: a content analysis. January 9, 2019
Statewide NICU central-line–associated bloodstream infection rates decline after bundles and checklists. March 30, 2011
Medication details documented on hospital discharge: cross-sectional observational study of factors associated with medication non-reconciliation. March 2, 2011
Learning from error: identifying contributory causes of medication errors in an Australian hospital. March 19, 2008
The uptake of technologies designed to influence medication safety in Canadian hospitals. February 20, 2008
Speaking up about safety concerns: multi-setting qualitative study of patients' views and experiences. December 15, 2010
Implementation of the I-PASS handoff program in diverse clinical environments: a multicenter prospective effectiveness implementation study. November 16, 2022
CDC central-line bloodstream infection prevention efforts produced net benefits of at least $640 million during 1990–2008. June 18, 2014
Patient safety in the cardiac operating room: human factors and teamwork: a scientific statement from the American Heart Association. August 21, 2013
Enabling a learning healthcare system with automated computer protocols that produce replicable and personalized clinician actions. August 4, 2021
Outcomes of missed diagnosis of pediatric appendicitis, new-onset diabetic ketoacidosis, and sepsis in five pediatric hospitals. September 13, 2023
Clinical features and preventability of delayed diagnosis of pediatric appendicitis. September 29, 2021
Interpretive diagnostic error reduction in surgical pathology and cytology: guideline from the College of American Pathologists Pathology and Laboratory Quality Center and the Association of Directors of Anatomic and Surgical Pathology. June 17, 2015
Associations between in-hospital mortality, health care utilization, and inpatient costs with the 2011 resident duty hour revision. May 15, 2019
The admission conference call: a novel approach to optimizing pediatric emergency department to admitting floor communication. May 29, 2019
Veterans Affairs initiative to prevent methicillin-resistant Staphylococcus aureus infections. April 27, 2011
Clinician well-being assessment and interventions in Joint Commission-accredited hospitals and federally qualified health centers. October 4, 2023
Evaluation of a second victim peer support program on perceptions of second victim experiences and supportive resources in pediatric clinical specialties using the second victim experience and support tool (SVEST). November 3, 2021
Complication rates, hospital size, and bias in the CMS Hospital-Acquired Condition Reduction Program. January 25, 2017
Working with influenza-like illness: presenteeism among US health care personnel during the 2014–2015 influenza season. November 22, 2017
Failure to debrief after critical events in anesthesia is associated with failures in communication during the event. March 20, 2019
Simulated laparoscopic operating room crisis: an approach to enhance the surgical team performance. July 2, 2008
Unexpected increased mortality after implementation of a commercially sold computerized physician order entry system. December 14, 2005
Exploring emergency physician–hospitalist handoff interactions: development of the Handoff Communication Assessment. March 17, 2010
Surveillance of medical device-related hazards and adverse events in hospitalized patients. March 6, 2005
Development of patient safety measures to identify inappropriate diagnosis of common infections. July 17, 2024
Bedside clinicians' perceptions on the contributing role of diagnostic errors in acutely ill patient presentation: a survey of academic and community practice. March 16, 2022
Comparing the variability of ingredient, strength, and dose form information from electronic prescriptions with RxNorm drug product descriptions. August 31, 2022
Infection control measure performance in long-term care hospitals and their relationship to Joint Commission accreditation. July 10, 2024
ASHP Guidelines on the Safe Use of Automated Compounding Devices for the Preparation of Parenteral Nutrition Admixtures. June 15, 2022
The effects of leadership curricula with and without implicit bias training on graduate medical education: a multicenter randomized trial. May 18, 2022
Communication and birth experiences among Black birthing people who experienced preterm birth. February 14, 2024
Home health agency patient experience measures and their relationship to Joint Commission accreditation. June 7, 2023
The good, the bad, and the ugly: operative staff perspectives of surgeon coping with intraoperative errors. June 14, 2023
The burden of opioid-related adverse drug events on hospitalized previously opioid-free surgical patients. March 10, 2021
Reducing inappropriate outpatient medication prescribing in older adults across electronic health record systems. January 13, 2021
Survey of nurses' experiences applying The Joint Commission's medication management titration standards. November 3, 2021
Coping with errors in the operating room: intraoperative strategies, postoperative strategies, and sex differences. September 22, 2021
Effect of delays in the 2-week-wait cancer referral pathway during the COVID-19 pandemic on cancer survival in the UK: a modelling study. August 19, 2020
Developing a standard handoff process for operating room–to-ICU transitions: multidisciplinary clinician perspectives from the Handoffs and Transitions in Critical Care (HATRICC) study. August 1, 2018
Use of unsolicited patient observations to identify surgeons with increased risk for postoperative complications. March 1, 2017
The development and implementation of cognitive aids for critical events in pediatric anesthesia: the Society for Pediatric Anesthesia Critical Events Checklists. March 15, 2017
Evidence review conducted for the Agency for Healthcare Research and Quality Safety Program for Improving Surgical Care and Recovery: focus on anesthesiology for colorectal surgery. May 9, 2018
An ethnographic study of health information technology use in three intensive care units. August 30, 2017
Increasing patient safety with neonates via handoff communication during delivery: a call for interprofessional health care team training across GME and CME. August 30, 2017
Quantitative analysis of the content of EMS handoff of critically ill and injured patients to the emergency department. August 10, 2016
Resident wellness in US ophthalmic graduate medical education: the resident perspective. May 23, 2018
"It's probably an STI because you're gay": a qualitative study of diagnostic error experiences in sexual and gender minority individuals. May 24, 2023
The woman who cried pain: do sex-based disparities still exist in the experience and treatment of pain? February 8, 2023
Pursuit of "endpoint diagnoses" as a cognitive forcing strategy to avoid premature diagnostic closure. December 21, 2022
Affective influences on clinical reasoning and diagnosis: insights from social psychology and new research opportunities. October 19, 2022
Effect on diagnostic accuracy of cognitive reasoning tools for the workplace setting: systematic review and meta-analysis. September 14, 2022
Misdiagnosis and failure to diagnose in emergency care: causes and empathy as a solution. November 11, 2020
Understanding context specificity: the effect of contextual factors on clinical reasoning. September 2, 2020
Building the bridge to quality: an urgent call to integrate quality improvement and patient safety education with clinical care October 2, 2019
What interventions could reduce diagnostic error in emergency departments? A review of evidence, practice and consumer perspectives. July 24, 2019
The design and conduct of Project RedDE: a cluster-randomized trial to reduce diagnostic errors in pediatric primary care. May 15, 2019