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System-related interventions to reduce diagnostic errors: a narrative review.

Abstract：

BACKGROUND:Diagnostic errors (missed, delayed or wrong diagnosis) have recently gained attention and are associated with significant preventable morbidity and mortality. The authors reviewed the recent literature and identified interventions that address system-related factors that contribute directly to diagnostic errors. METHODS:The authors conducted a comprehensive search using multiple search strategies. First, they performed a PubMed search to identify articles exclusively related to diagnostic error or delay published in English between 2000 and 2009. They then sought papers from references in the initial dataset, searches of additional databases, and subject matter experts. Articles were included if they formally evaluated an intervention to prevent or reduce diagnostic error; however, papers were also included if interventions were suggested and not tested to inform the state of the science on the subject. Interventions were characterised according to the step in the diagnostic process they targeted: patient-provider encounter; performance and interpretation of diagnostic tests; follow-up and tracking of diagnostic information; subspecialty and referral-related issues; and patient-specific care-seeking and adherence processes. RESULTS:43 articles were identified for full review, of which six reported tested interventions and 37 contained suggestions for possible interventions. Empirical studies, although somewhat positive, were non-experimental or quasi-experimental and included a small number of clinicians or healthcare sites. Outcome measures in general were underdeveloped and varied markedly among studies, depending on the setting or step in the diagnostic process. CONCLUSIONS:Despite a number of suggested interventions in the literature, few empirical studies in the past decade have tested interventions to reduce diagnostic errors. Advancing the science of diagnostic error prevention will require more robust study designs and rigorous definitions of diagnostic processes and outcomes to measure intervention effects.

journal_name

BMJ Qual Saf

journal_title

BMJ quality & safety

authors

Singh H,Graber ML,Kissam SM,Sorensen AV,Lenfestey NF,Tant EM,Henriksen K,LaBresh KA

doi

10.1136/bmjqs-2011-000150

subject

Has Abstract

pub_date

2012-02-01 00:00:00

pages

160-70

issue

eissn

2044-5415

issn

2044-5423

pii

bmjqs-2011-000150

journal_volume

pub_type

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System-related interventions to reduce diagnostic errors: a narrative review.