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Interventions targeted at reducing diagnostic error: systematic review
  1. Neha Dave1,
  2. Sandy Bui1,
  3. Corey Morgan1,
  4. Simon Hickey1,
  5. Christine L Paul1,2
  1. 1School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
  2. 2The University of Newcastle Hunter Medical Research Institute, New Lambton, New South Wales, Australia
  1. Correspondence to Neha Dave, School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308, Australia; nehadave1998{at}gmail.com

Abstract

Background Incorrect, delayed and missed diagnoses can contribute to significant adverse health outcomes. Intervention options have proliferated in recent years necessitating an update to McDonald et al’s 2013 systematic review of interventions to reduce diagnostic error.

Objectives (1) To describe the types of published interventions for reducing diagnostic error that have been evaluated in terms of an objective patient outcome; (2) to assess the risk of bias in the included interventions and perform a sensitivity analysis of the findings; and (3) to determine the effectiveness of included interventions with respect to their intervention type.

Methods MEDLINE, CINAHL and the Cochrane Database of Systematic Reviews were searched from 1 January 2012 to 31 December 2019. Publications were included if they delivered patient-related outcomes relating to diagnostic accuracy, management outcomes and/or morbidity and mortality. The interventions in each included study were categorised and analysed using the six intervention types described by McDonald et al (technique, technology-based system interventions, educational interventions, personnel changes, structured process changes and additional review methods).

Results Twenty studies met the inclusion criteria. Eighteen of the 20 included studies (including three randomised controlled trials (RCTs)) demonstrated improvements in objective patient outcomes following the intervention. These three RCTs individually evaluated a technique-based intervention, a technology-based system intervention and a structured process change. The inclusion or exclusion of two higher risk of bias studies did not affect the results.

Conclusion Technique-based interventions, technology-based system interventions and structured process changes have been the most studied interventions over the time period of this review and hence are seen to be effective in reducing diagnostic error. However, more high-quality RCTs are required, particularly evaluating educational interventions and personnel changes, to demonstrate the value of these interventions in diverse settings.

  • diagnostic errors
  • healthcare quality improvement
  • performance measures
  • patient-centred care
  • patient safety

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All data relevant to the study are included in the article or uploaded as supplementary information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Footnotes

  • Contributors Each author’s contribution has been outlined further, as per the CRediT (Contribution Roles Taxonomy) classification: ND: conceptualisation (equal); data curation (lead); formal analysis (equal); investigation (equal); methodology (equal); project administration (lead); supervision (lead); validation (lead); visualisation (lead); and writing – original draft preparation (lead); writing – review and editing (lead). SB: conceptualisation (equal); data curation (supporting); formal analysis (equal); investigation (equal); methodology (equal); validation (equal); writing – original draft preparation (equal); and writing – review and editing (equal). CM: conceptualisation (equal); investigation (equal), methodology (equal); validation (equal); writing – original draft preparation (equal); and writing – review and editing (supporting). SH: conceptualisation (equal); investigation (equal); methodology (equal); validation (equal); and writing – original draft preparation (supporting). CLP: conceptualisation (equal); methodology (equal); supervision (supporting); validation (equal); and writing – review and editing (equal). All authors provide final approval of the manuscript and supporting files to be published. All authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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