Characteristics inherent to the emergency department (ED), such as overcrowding and unfamiliar patients, make it susceptible to errors. This article describes a novel process for identification of ED errors by adding the question, "Would you have done something differently?" to the chart review process. Adding this question and requiring a detailed explanation of what they would have done differently allowed for differentiation between a true medical error and a judgment call that coincides with an adverse event. Near misses, adverse events, and adverse events attributable to error were significantly higher when reviewers would have done something differently.