Doctors reviewing patient chart in ER setting

Second Opinion Saves the Day: How Peer Feedback Prevents Errors in Emergency Care

Jordan Keane in Health & Wellness December 2025 • 4 min read.

"A new study highlights the power of quick, systematic peer reviews in emergency departments to catch medical errors and improve patient safety."

Emergency departments are high-stakes environments. Doctors face immense pressure, often making critical decisions with limited information and multiple patients demanding their attention. These decisions, though vital, are frequently made in isolation, leaving room for errors and oversights.

Recognizing this challenge, Freund et al. conducted a study to investigate whether systematic peer feedback could reduce the incidence of adverse events in emergency settings. Their research focused on implementing a structured 'cross-check' system where physicians regularly reviewed each other's cases.

This article delves into the findings of their study, exploring how this simple intervention can significantly improve patient safety in the fast-paced environment of the emergency department.

The 'Cross-Check' Intervention: A Simple Yet Powerful Tool

Doctors reviewing patient chart in ER setting

The study employed a cluster-randomized design across six emergency departments in French hospitals. Three departments implemented the intervention, while the other three served as controls. The intervention involved brief, structured meetings between emergency physicians, or peers.

Here’s how the 'cross-check' system worked:

Scheduled Meetings: Physicians met three times daily at fixed times.
Case Reviews: They discussed the medical situation, prior actions, findings, and treatment plans for their current patients.
Feedback Exchange: Colleagues provided feedback and shared their perspectives on the cases.

These meetings lasted about nine minutes, during which an average of seven patients were discussed. Researchers then analyzed data from 1,680 patients, identifying medical errors and adverse events through a two-stage review of electronic health records.

Peer Power: Transforming Emergency Care

The results of the study were striking. The intervention group, which received peer feedback, experienced a 40% reduction in the relative risk of adverse events compared to the control group (6.4% vs. 10.7%). This translates to preventing one adverse event for every 24 patients treated with the cross-check system.

The most significant impact was observed in reducing 'near misses' – potential errors that could have caused harm. While severe, preventable adverse events didn't show a statistically significant reduction, likely due to smaller sample size, the trend favored the intervention group. Notably, errors in sepsis management were frequently implicated in these severe events.

While the study focused on daytime weekday treatments, the potential benefits of extending peer feedback to nights and weekends, when staffing is often leaner, are worth considering. The 'cross-check' system offers a practical, scalable approach to enhancing patient safety in the challenging environment of the emergency department.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

Everything You Need To Know

What exactly is the 'cross-check' system?

The 'cross-check' system is a structured peer review process implemented in emergency departments. It involves physicians meeting regularly to discuss their cases, review medical situations, prior actions, findings, and treatment plans for their patients. Colleagues provide feedback and share their perspectives on the cases, aiming to catch potential errors and improve patient safety. This system contrasts with traditional, isolated decision-making in emergency settings.

Why is the 'cross-check' intervention considered important?

The 'cross-check' intervention is significant because it dramatically reduces medical errors and adverse events in emergency departments. The study showed a 40% reduction in the relative risk of adverse events in the intervention group compared to the control group. This means that by implementing the 'cross-check' system, healthcare professionals can prevent adverse events, ultimately leading to improved patient outcomes and a safer environment for both patients and doctors.

What are the implications of using the 'cross-check' system?

Implementing the 'cross-check' system has several implications. It necessitates a shift from isolated decision-making to a collaborative approach within emergency departments. The system requires scheduled meetings, typically three times daily, which can potentially alter the workflow and time management of physicians. Moreover, the effectiveness of the 'cross-check' system relies on the willingness of physicians to actively participate, provide constructive feedback, and embrace a culture of open communication. The implementation of this system could serve as a model for patient safety protocols in other high-pressure medical environments.

How does 'peer review' work in the context of this information?

A 'peer review' is a process where medical professionals review each other's work, providing feedback and ensuring accuracy and quality. The 'cross-check' system is a structured form of peer review. This system focuses on the timely exchange of information and the collaborative approach to make decisions in real time. The study by Freund et al. shows the benefits of 'peer review' in emergency care by reducing medical errors and improving patient outcomes, highlighting the value of having multiple viewpoints to improve the safety of patients.

How was the study designed to evaluate the effectiveness of the 'cross-check' system?

The study conducted by Freund et al. used a cluster-randomized design. Six emergency departments in French hospitals were selected, with three departments implementing the 'cross-check' intervention and the other three serving as controls. Researchers then analyzed data from 1,680 patients, identifying medical errors and adverse events through a two-stage review of electronic health records. This design allows researchers to compare outcomes between the intervention and control groups, demonstrating the effectiveness of the 'cross-check' system in reducing adverse events in the intervention group, which received peer feedback.