Strategies to reduce diagnostic errors: a systematic review

Julie Abimanyi-Ochom,Shalika Bohingamu Mudiyanselage,Jennifer J Watts,Max Catchpool,Marnie Firipis,Sithara Wanni Arachchige Dona

doi:10.1186/s12911-019-0901-1

Julie Abimanyi-Ochom, Shalika Bohingamu Mudiyanselage + Show 4 more

Open Access

https://doi.org/10.1186/s12911-019-0901-1

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Abstract

BackgroundTo evaluate the effectiveness of audit and communication strategies to reduce diagnostic errors made by clinicians.MethodsMEDLINE complete, CINHAL complete, EMBASE, PSNet and Google Advanced. Electronic and manual search of articles on audit systems and communication strategies or interventions, searched for papers published between January 1990 and April 2017. We included studies with interventions implemented by clinicians in a clinical environment with real patients.ResultsA total of 2431 articles were screened of which 26 studies met inclusion criteria. Data extraction was conducted by two groups, each group comprising two independent reviewers. Articles were classified by communication (6) or audit strategies (20) to reduce diagnostic error in clinical settings. The most common interventions were delivered as technology-based systems n = 16 (62%) and within an acute care setting n = 15 (57%). Nine studies reported randomised controlled trials. Three RCT studies on communication interventions and 3 RCTs on audit strategies found the interventions to be effective in reducing diagnostic errors.ConclusionDespite numerous studies on interventions targeting diagnostic errors, our analyses revealed limited evidence on interventions being practically used in clinical settings and a bias of studies originating from the US (n = 19, 73% of included studies). There is some evidence that trigger algorithms, including computer based and alert systems, may reduce delayed diagnosis and improve diagnostic accuracy. In trauma settings, strategies such as additional patient review (e.g. trauma teams) reduced missed diagnosis and in radiology departments review strategies such as team meetings and error documentation may reduce diagnostic error rates over time.Trial registrationThe systematic review was registered in the PROSPERO database under registration number CRD42017067056.

Highlights

To evaluate the effectiveness of audit and communication strategies to reduce diagnostic errors made by clinicians
Regardless of the numerous studies on diagnostic errors [12,13,14,15,16,17], very few have investigated the effectiveness of strategies aimed at reducing diagnostic errors especially in a clinical setting [7, 19, 20], including audit and communication strategies
Study characteristics We identified 26 studies (Fig. 1) on strategies to reduce diagnostic error that met the criteria for full review

Summary

Introduction

To evaluate the effectiveness of audit and communication strategies to reduce diagnostic errors made by clinicians. “Audit systems” were defined as systems that provide an individual or organisational performance measure against professional standards or targets to provide feedback to the individual or organisation [21,22,23,24]. This includes interventions such as processes, systems, models, programs and procedures aimed to ensure certain activities are carried out effectively and consistently to achieve the objectives [26]. The Committee on Diagnostic Error in Health Care supports processes for effective and timely communication between diagnostic testing, health professionals and treating health professionals and recommends that they should be implemented across all health care settings in the diagnostic process [7]

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