Review Article| Volume 38, ISSUE 2, P185-194, April 2022

Diagnostic Time-Outs to Improve Diagnosis


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribers receive full online access to your subscription and archive of back issues up to and including 2002.

      Content published before 2002 is available via pay-per-view purchase only.


      Subscribe to Critical Care Clinics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Committee on Diagnostic Error in Health Care, Board on Health Care Services, Institute of Medicine, The National Academies of Sciences, Engineering, and Medicine
        Balogh E.P. Miller B.T. Ball J.R. Improving diagnosis in health care. National Academies Press, Washington, DC2015 (Available at:) (Accessed July 18, 2016)
        • Abbas Q.
        • Memon F.
        • Laghari P.
        • et al.
        Potentially preventable mortality in the pediatric intensive care unit: findings from a retrospective mortality analysis.
        Cureus. 2020; 12: e7358
        • Custer J.W.
        • Winters B.D.
        • Goode V.
        • et al.
        Diagnostic errors in the pediatric and neonatal ICU: a systematic review.
        Pediatr Crit Care Med. 2015; 16: 29-36
        • Graber M.L.
        • Franklin N.
        • Gordon R.
        Diagnostic error in internal medicine.
        Arch Intern Med. 2005; 165: 1493-1499
        • Croskerry P.
        Bias: a normal operating characteristic of the diagnosing brain.
        Diagnosis. 2014; 1: 23-27
        • Ely J.W.
        • Graber M.L.
        • Croskerry P.
        Checklists to reduce diagnostic errors.
        Acad Med. 2011; 86: 307-313
        • Ely J.W.
        • Graber M.L.
        Preventing diagnostic errors in primary care.
        Am Fam Physician. 2016; 94: 426-432
        • Sloman S.A.
        The empirical case for two systems of reasoning.
        Psychol Bull. 1996; 119: 3
        • Croskerry P.
        Diagnostic failure: a cognitive and affective approach.
        in: Henriksen K. Battles J.B. Marks E.S. Advances in patient safety: from research to implementation (volume 2: concepts and methodology). Advances in patient safety. Agency for Healthcare Research and Quality (US), 2005 (Available at:) (Accessed August 1, 2021)
        • Patel V.L.
        • Buchman T.G.
        Cognitive overload in the ICU.
        (Available at:) (Accessed August 1, 2021)
        • Patel V.L.
        • Zhang J.
        • Yoskowitz N.A.
        • et al.
        Translational cognition for decision support in critical care environments: a review.
        J Biomed Inform. 2008; 41: 413-431
        • Sweller J.
        Cognitive load theory, learning difficulty, and instructional design.
        Learn Instruction. 1994; 4: 295-312
        • Sutcliffe K.
        • Wears R.
        Still not safe: patient safety and the middle-managing of American medicine.
        Oxford University Press, New York2019
        • Croskerry P.
        From mindless to mindful practice--cognitive bias and clinical decision making.
        N Engl J Med. 2013; 368: 2445-2448
        • Berner E.S.
        • Graber M.L.
        Overconfidence as a cause of diagnostic error in medicine.
        Am J Med. 2008; 121: S2-S23
        • Emil S.
        Surgical strategies in complex gastroschisis.
        Semin Pediatr Surg. 2018; 27: 309-315
        • Suominen J.
        • Rintala R.
        Medium and long-term outcomes of gastroschisis.
        Semin Pediatr Surg. 2018; 27: 327-329
        • Sibbald M.
        • de Bruin A.B.H.
        • Yu E.
        • et al.
        Why verifying diagnostic decisions with a checklist can help: insights from eye tracking.
        Adv Health Sci Educ Theory Pract. 2015; 20: 1053-1060
        • Trowbridge R.L.
        Twelve tips for teaching avoidance of diagnostic errors.
        Med Teach. 2008; 30: 496-500
        • Huang G.C.
        • Kriegel G.
        • Wheaton C.
        • et al.
        Implementation of diagnostic pauses in the ambulatory setting.
        BMJ Qual Saf. 2018; 27: 492-497
        • Berkwitt A.
        • Osborn R.
        • Grossman M.
        Walking a tightrope: balancing the risk of diagnostic error in inpatient pediatrics.
        Hosp Pediatr. 2016; 6: 566-568
        • Marsicek S.M.
        • Odom B.
        • Woodard A.
        • et al.
        Time for a time-out: the value of a diagnostic time-out in prolonged fever and lymphadenopathy.
        Hosp Pediatr. 2019; 9: 139-141
        • Royce C.S.
        • Hayes M.M.
        • Schwartzstein R.M.
        Teaching critical thinking: a case for instruction in cognitive biases to reduce diagnostic errors and improve patient safety.
        Acad Med. 2019; 94: 187-194
        • West R.F.
        • Meserve R.J.
        • Stanovich K.E.
        Cognitive sophistication does not attenuate the bias blind spot.
        J Pers Soc Psychol. 2012; 103: 506-519
        • Holmboe E.S.
        • Durning S.J.
        Assessing clinical reasoning: moving from in vitro to in vivo.
        Diagnosis (Berl). 2014; 1: 111-117
        • Dunlop M.
        • Schwartzstein R.M.
        Reducing diagnostic error in the intensive care unit. Engaging uncertainty when teaching clinical reasoning.
        ATS Scholar. 2020; 1: 364-371
        • Oakes M.C.
        • Porto M.
        • Chung J.H.
        Advances in prenatal and perinatal diagnosis and management of gastroschisis.
        Semin Pediatr Surg. 2018; 27: 289-299
        • McDonald K.M.
        • Matesic B.
        • Contopoulos-Ioannidis D.G.
        • et al.
        Patient safety strategies targeted at diagnostic errors: a systematic review.
        Ann Intern Med. 2013; 158: 381-389