The COVID-19 pandemic led to unprecedented numbers of patients seen in the emergency department (ED), some who had COVID-19, some who had a different diagnosis, and some who had both. This study analyzes patients who presented to the ED with COVID-19 and signs of another diagnosis that was missed. Approximately one-third of patients with a second concurrent diagnosis experienced a diagnostic delay. Factors that may have influenced the missed diagnosis include ED overcrowding and anchoring heuristics.

The uncertainty and pressure of the COVID-19 pandemic can introduce cognitive biases leading to diagnostic errors. Researchers asked primary care providers taking care of COVID-19 adult patients to describe cases when their clinical reasoning was “disrupted” due to the pandemic. The most common cognitive biases were anchoring bias, confirmation bias, availability bias, and cognitive dissonance.

Use of personal protective equipment is necessary to reduce the spread of infectious diseases, such as COVID-19, in healthcare settings. The alertness levels of ICU staff who regularly wore full personal protective equipment (FPPE), i.e., respirator mask, body covering suit, visor, gloves, and hat, were tested when not wearing FPPE and after two hours wearing FPPE. Results show health care worker alertness can be negatively impacted by wearing FPPE for as little as two hours.

Many non-urgent, non-cancer surgeries were postponed or canceled during COVID-19 surges resulting in a potential loss of surgeons’ “currency”. This commentary discusses the benefits of, and barriers to, dual surgeon operating as a way to increase currency as elective surgeries are resumed.

Using case studies, this commentary describes how availability bias, diagnostic momentum, and premature closure resulted in delayed diagnosis for three pediatric patients first diagnosed with COVID-19. The authors highlight cognitive and systems factors that influenced this diagnostic error.

The COVID-19 pandemic highlighted the continued existence of structural racism and its disproportionate impact on the health of communities of color. This study examines the experiences of non-White and White communities and the negative impact of structural racism on the non-White communities. The authors call for bold action emphasizing the need for structural changes.  

Implicit and explicit bias can reduce the effectiveness and safety of care. Based on a review of the literature, the authors conclude that the strain placed on provider resources, staff, and supplies by the COVID-19 pandemic may exacerbate implicit bias among pediatric providers. The authors discuss implicit bias at the individual, organizational, educational, and research levels, provide specific calls to action for pediatric healthcare providers, and discuss the role of pediatric psychologists in supporting other providers.

Prescribing medications for indications that are not approved by the Food and Drug Administration (FDA) is common but poses a risk for medication errors. The authors of this study used simulation modeling to explore the influence of physician personal preference on off-label medication use during the COVID-19 pandemic.  

Situational awareness during critical incidents is a key component of teamwork. This study found that a mutual care training can increase situational awareness for healthcare workers and consequently improve mental health and well-being before and during the COVID-19 pandemic.