TY - JOUR T1 - Research to improve diagnosis: time to study the real world JF - BMJ Quality & Safety JO - BMJ Qual Saf DO - 10.1136/bmjqs-2021-014071 SP - bmjqs-2021-014071 AU - Sumant R. Ranji AU - Eric J Thomas Y1 - 2022/01/05 UR - http://qualitysafety.bmj.com/content/early/2022/01/05/bmjqs-2021-014071.abstract N2 - More than a decade ago, diagnostic errors were named as the ‘next frontier’ in patient safety.1 In spite of this, our understanding of the epidemiology of diagnostic errors and approaches to preventing them has only recently begun to mature. Recent systematic reviews document an unacceptably high burden of diagnostic error in both outpatients2 and hospitalised patients.3 Given this landscape, clinicians and healthcare leaders would benefit from understanding which approaches to preventing diagnostic error are effective. A systematic review of strategies to reduce diagnostic error published in 20134 identified several promising strategies, such as technology-based system interventions like computerised diagnostic decision support, but acknowledged a need for higher quality evaluation of these interventions.In the 8 years since the earlier review was published, interest in diagnostic safety has greatly increased, thanks in part to the publication of influential reports by the US National Academies of Sciences, Engineering, and Medicine5 (NASEM), in 2015, and the US National Quality Forum, in 2019, and an increase in publications on diagnostic error. The systematic review by Dave and colleagues6 in this issue of BMJ Quality & Safety largely replicates the prior review, and therefore provides important insights into progress from 2012 through the end of 2019, given the two reports noted above and developments such as technology-based tools for improving diagnosis. The authors used the same search criteria as the original review and followed the accepted standards for conducting and reporting a systematic review. In contrast to the earlier study, Dave and colleagues’ review attempted to assess the effectiveness of interventions on patient-level outcomes, such as diagnostic accuracy for a targeted condition; studies that only measured changes in diagnostic processes, or simulation-based studies, were excluded.7 8The authors found 20 studies of diagnostic safety strategies, and categorised them into … ER -