Diagnostic error (incorrect, delayed, or missed diagnoses) is a contributor of significant adverse outcomes. This is a systematic review that 1) described the types of published interventions for reducing diagnostic error that have been evaluated in terms of an objective patient outcome, 2) assessed the risk of bias in the included interventions with a sensitivity analysis of the findings, and 3) determined the effectiveness of included interventions with respect to the intervention type. MEDLINE, CINAHL, and the Cochrane Database were studied from January 2012 to December 2019. Out of the 20 studies that met the inclusion criteria, 18 showed improvements in objective patient outcomes following the intervention. Interventions were categorized and analyzed using six intervention types: 1) technique-based interventions, 2) technology based system interventions, 3) structured process changes, 4) education interventions, 5) personnel changes, and 6) additional review methods.
- Technique based interventions involved altering a clinical approach, equipment, and/or procedures (such as the introduction of a treatment adjunct for differentiated thyroid cancer) that target the diagnostic performance in clinical practice. The conclusion was that such interventions are associated with increased likelihood of accurate diagnosis.
- Technology based system interventions used computer assistive diagnostic aids, decision support algorithms, and electronic alerting systems to trigger physicians to prompt action. All of the technology-based interventions resulted in a decrease in either diagnostic delay or missed diagnoses.
- Structured process changes involved feedback loops or alterations to diagnostic processes.
These three interventions are among the most studied interventions since 2012 and have been evaluated in high quality RCTs. In terms of bias, there is still a lack of low risk of bias RCTs in studies assessing diagnostic error-reducing strategies.