Literature DB >> 22129930

System-related interventions to reduce diagnostic errors: a narrative review.

Hardeep Singh1, Mark L Graber, Stephanie M Kissam, Asta V Sorensen, Nancy F Lenfestey, Elizabeth M Tant, Kerm Henriksen, Kenneth A LaBresh.   

Abstract

BACKGROUND: Diagnostic errors (missed, delayed or wrong diagnosis) have recently gained attention and are associated with significant preventable morbidity and mortality. The authors reviewed the recent literature and identified interventions that address system-related factors that contribute directly to diagnostic errors.
METHODS: The authors conducted a comprehensive search using multiple search strategies. First, they performed a PubMed search to identify articles exclusively related to diagnostic error or delay published in English between 2000 and 2009. They then sought papers from references in the initial dataset, searches of additional databases, and subject matter experts. Articles were included if they formally evaluated an intervention to prevent or reduce diagnostic error; however, papers were also included if interventions were suggested and not tested to inform the state of the science on the subject. Interventions were characterised according to the step in the diagnostic process they targeted: patient-provider encounter; performance and interpretation of diagnostic tests; follow-up and tracking of diagnostic information; subspecialty and referral-related issues; and patient-specific care-seeking and adherence processes.
RESULTS: 43 articles were identified for full review, of which six reported tested interventions and 37 contained suggestions for possible interventions. Empirical studies, although somewhat positive, were non-experimental or quasi-experimental and included a small number of clinicians or healthcare sites. Outcome measures in general were underdeveloped and varied markedly among studies, depending on the setting or step in the diagnostic process.
CONCLUSIONS: Despite a number of suggested interventions in the literature, few empirical studies in the past decade have tested interventions to reduce diagnostic errors. Advancing the science of diagnostic error prevention will require more robust study designs and rigorous definitions of diagnostic processes and outcomes to measure intervention effects.

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Year:  2011        PMID: 22129930      PMCID: PMC3677060          DOI: 10.1136/bmjqs-2011-000150

Source DB:  PubMed          Journal:  BMJ Qual Saf        ISSN: 2044-5415            Impact factor:   7.035


  62 in total

1.  Level of diagnostic confidence, accuracy, and reasons for mistakes in teleradiology for minor injuries.

Authors:  Sapal Tachakra
Journal:  Telemed J E Health       Date:  2002       Impact factor: 3.536

2.  Understanding diagnostic errors in medicine: a lesson from aviation.

Authors:  H Singh; L A Petersen; E J Thomas
Journal:  Qual Saf Health Care       Date:  2006-06

Review 3.  Profiles in patient safety: A "perfect storm" in the emergency department.

Authors:  Samuel G Campbell; Pat Croskerry; William F Bond
Journal:  Acad Emerg Med       Date:  2007-05-30       Impact factor: 3.451

Review 4.  Overconfidence as a cause of diagnostic error in medicine.

Authors:  Eta S Berner; Mark L Graber
Journal:  Am J Med       Date:  2008-05       Impact factor: 4.965

5.  Reducing diagnostic errors through effective communication: harnessing the power of information technology.

Authors:  Hardeep Singh; Aanand Dinkar Naik; Raghuram Rao; Laura Ann Petersen
Journal:  J Gen Intern Med       Date:  2008-04       Impact factor: 5.128

6.  Defining health information technology-related errors: new developments since to err is human.

Authors:  Dean F Sittig; Hardeep Singh
Journal:  Arch Intern Med       Date:  2011-07-25

7.  A new sociotechnical model for studying health information technology in complex adaptive healthcare systems.

Authors:  Dean F Sittig; Hardeep Singh
Journal:  Qual Saf Health Care       Date:  2010-10

8.  Patient preferences for and satisfaction with methods of communicating test results in a primary care practice.

Authors:  Surbhi Leekha; Kris G Thomas; Rajeev Chaudhry; Matthew R Thomas
Journal:  Jt Comm J Qual Patient Saf       Date:  2009-10

9.  Sharing electronic laboratory results in a patient portal--a feasibility pilot.

Authors:  Jonathan S Wald; Karen Burk; Kate Gardner; Raisa Feygin; Elizabeth Nelson; Marianna Epstein; Eric G Poon; Blackford Middleton
Journal:  Stud Health Technol Inform       Date:  2007

10.  Patient preferences for notification of normal laboratory test results: a report from the ASIPS Collaborative.

Authors:  Donna M Baldwin; Javán Quintela; Christine Duclos; Elizabeth W Staton; Wilson D Pace
Journal:  BMC Fam Pract       Date:  2005-03-08       Impact factor: 2.497

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  35 in total

1.  Exploring Physician Perspectives of Residency Holdover Handoffs: A Qualitative Study to Understand an Increasingly Important Type of Handoff.

Authors:  Jonathan A Duong; Trevor P Jensen; Sasha Morduchowicz; Michelle Mourad; James D Harrison; Sumant R Ranji
Journal:  J Gen Intern Med       Date:  2017-02-13       Impact factor: 5.128

2.  Supporting novice clinicians cognitive strategies: System design perspective.

Authors:  Roosan Islam; Jeanmarie Mayer; Justin Clutter
Journal:  IEEE EMBS Int Conf Biomed Health Inform       Date:  2016-02

3.  Application of human factors to improve usability of clinical decision support for diagnostic decision-making: a scenario-based simulation study.

Authors:  Pascale Carayon; Peter Hoonakker; Ann Schoofs Hundt; Megan Salwei; Douglas Wiegmann; Roger L Brown; Peter Kleinschmidt; Clair Novak; Michael Pulia; Yudi Wang; Emily Wirkus; Brian Patterson
Journal:  BMJ Qual Saf       Date:  2019-11-27       Impact factor: 7.035

4.  Patient involvement in diagnosing cancer in primary care: a systematic review of current interventions.

Authors:  Jane Heyhoe; Caroline Reynolds; Alice Dunning; Olivia Johnson; Alex Howat; Rebecca Lawton
Journal:  Br J Gen Pract       Date:  2018-02-12       Impact factor: 5.386

5.  Peers without fears? Barriers to effective communication among primary care physicians and oncologists about diagnostic delays in cancer.

Authors:  Allison Lipitz-Snyderman; Minal Kale; Laura Robbins; David Pfister; Elizabeth Fortier; Valerie Pocus; Susan Chimonas; Saul N Weingart
Journal:  BMJ Qual Saf       Date:  2017-06-27       Impact factor: 7.035

6.  Types and origins of diagnostic errors in primary care settings.

Authors:  Hardeep Singh; Traber Davis Giardina; Ashley N D Meyer; Samuel N Forjuoh; Michael D Reis; Eric J Thomas
Journal:  JAMA Intern Med       Date:  2013-03-25       Impact factor: 21.873

7.  Online public reactions to frequency of diagnostic errors in US outpatient care.

Authors:  Traber Davis Giardina; Urmimala Sarkar; Gato Gourley; Varsha Modi; Ashley N D Meyer; Hardeep Singh
Journal:  Diagnosis (Berl)       Date:  2016-02-19

8.  Seen through their eyes: residents' reflections on the cognitive and contextual components of diagnostic errors in medicine.

Authors:  Alexis R Ogdie; James B Reilly; Wyki G Pang; Shimrit Keddem; Frances K Barg; Joan M Von Feldt; Jennifer S Myers
Journal:  Acad Med       Date:  2012-10       Impact factor: 6.893

9.  Root cause analysis reports help identify common factors in delayed diagnosis and treatment of outpatients.

Authors:  Traber Davis Giardina; Beth J King; Aartee P Ignaczak; Douglas E Paull; Laura Hoeksema; Peter D Mills; Julia Neily; Robin R Hemphill; Hardeep Singh
Journal:  Health Aff (Millwood)       Date:  2013-08       Impact factor: 6.301

10.  Developing checklists to prevent diagnostic error in Emergency Room settings.

Authors:  Mark L Graber; Asta V Sorensen; Jon Biswas; Varsha Modi; Andrew Wackett; Scott Johnson; Nancy Lenfestey; Ashley N D Meyer; Hardeep Singh
Journal:  Diagnosis (Berl)       Date:  2014-06-19
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