title: Patient safety strategies targeted at diagnostic errors: a systematic review.
abstract: Missed, delayed, or incorrect diagnosis can lead to inappropriate patient care, poor patient outcomes, and increased cost. This systematic review analyzed evaluations of interventions to prevent diagnostic errors. Searches used MEDLINE (1966 to October 2012), the Agency for Healthcare Research and Quality's Patient Safety Network, bibliographies, and prior systematic reviews. Studies that evaluated any intervention to decrease diagnostic errors in any clinical setting and with any study design were eligible, provided that they addressed a patient-related outcome. Two independent reviewers extracted study data and rated study quality. There were 109 studies that addressed 1 or more intervention categories: personnel changes (n = 6), educational interventions (n = 11), technique (n = 23), structured process changes (n = 27), technology-based systems interventions (n = 32), and review methods (n = 38). Of 14 randomized trials, which were rated as having mostly low to moderate risk of bias, 11 reported interventions that reduced diagnostic errors. Evidence seemed strongest for technology-based systems (for example, text message alerting) and specific techniques (for example, testing equipment adaptations). Studies provided no information on harms, cost, or contextual application of interventions. Overall, the review showed a growing field of diagnostic error research and categorized and identified promising interventions that warrant evaluation in large studies across diverse settings.
authors: Stanford Center for Health Policy/Center for Primary Care and Outcomes Research, Stanford University, Stanford, California, USA. Kathryn.McDonald@stanford.edu
authors: Kathryn M
authors: KM
authors: McDonald
authors: Brian
authors: B
authors: Matesic
authors: Despina G
authors: DG
authors: Contopoulos-Ioannidis
authors: Julia
authors: J
authors: Lonhart
authors: Eric
authors: E
authors: Schmidt
authors: Noelle
authors: N
authors: Pineda
authors: John P A
authors: JP
authors: Ioannidis
mesh_terms: D003365:Costs and Cost Analysis; D003951:Diagnostic Errors / Q000191:economics / Q000517:prevention & control*; D058016:Health Facility Administration / Q000191:economics / Q000592:standards*; D006801:Humans; D009937:Organizational Objectives; D017063:Outcome Assessment, Health Care; D061214:Patient Safety / Q000191:economics / Q000592:standards*; D016032:Randomized Controlled Trials as Topic; D017751:Safety Management / Q000191:economics / Q000379:methods*; D060145:Text Messaging