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Advancing the research agenda for diagnostic error reduction
  1. Laura Zwaan1,
  2. Gordon D Schiff2,3,
  3. Hardeep Singh4,5
  1. 1Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
  2. 2Division of General Medicine, Brigham and Women's Hospital
  3. 3Harvard Medical School, Boston, Massachusetts, USA
  4. 4Houston VA Health Services Research and Development Center of Excellence, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
  5. 5Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
  1. Correspondence to Dr Laura Zwaan, Department of Public and Occupational Health, EMGO Institute, VU University Medical Center, Van der Boechorststraat 7, Amsterdam 1081 BT, The Netherlands; Laura.zwaan{at}vumc.nl

Abstract

Diagnostic errors remain an underemphasised and understudied area of patient safety research. We briefly summarise the methods that have been used to conduct research on epidemiology, contributing factors and interventions related to diagnostic error and outline directions for future research. Research methods that have studied epidemiology of diagnostic error provide some estimate on diagnostic error rates. However, there appears to be a large variability in the reported rates due to the heterogeneity of definitions and study methods used. Thus, future methods should focus on obtaining more precise estimates in different settings of care. This would lay the foundation for measuring error rates over time to evaluate improvements. Research methods have studied contributing factors for diagnostic error in both naturalistic and experimental settings. Both approaches have revealed important and complementary information. Newer conceptual models from outside healthcare are needed to advance the depth and rigour of analysis of systems and cognitive insights of causes of error. While the literature has suggested many potentially fruitful interventions for reducing diagnostic errors, most have not been systematically evaluated and/or widely implemented in practice. Research is needed to study promising intervention areas such as enhanced patient involvement in diagnosis, improving diagnosis through the use of electronic tools and identification and reduction of specific diagnostic process ‘pitfalls’ (eg, failure to conduct appropriate diagnostic evaluation of a breast lump after a ‘normal’ mammogram). The last decade of research on diagnostic error has made promising steps and laid a foundation for more rigorous methods to advance the field.

  • Diagnostic errors
  • Patient safety
  • Medical error, measurement/epidemiology

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