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Strategies to reduce diagnostic errors: a systematic review

机译：减少诊断错误的策略：系统回顾

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To evaluate the effectiveness of audit and communication strategies to reduce diagnostic errors made by clinicians. MEDLINE complete, CINHAL complete, EMBASE, PSNet and Google Advanced. Electronic and manual search of articles on audit systems and communication strategies or interventions, searched for papers published between January 1990 and April 2017. We included studies with interventions implemented by clinicians in a clinical environment with real patients. A total of 2431 articles were screened of which 26 studies met inclusion criteria. Data extraction was conducted by two groups, each group comprising two independent reviewers. Articles were classified by communication (6) or audit strategies (20) to reduce diagnostic error in clinical settings. The most common interventions were delivered as technology-based systems n?=?16 (62%) and within an acute care setting n?=?15 (57%). Nine studies reported randomised controlled trials. Three RCT studies on communication interventions and 3 RCTs on audit strategies found the interventions to be effective in reducing diagnostic errors. Despite numerous studies on interventions targeting diagnostic errors, our analyses revealed limited evidence on interventions being practically used in clinical settings and a bias of studies originating from the US (n?=?19, 73% of included studies). There is some evidence that trigger algorithms, including computer based and alert systems, may reduce delayed diagnosis and improve diagnostic accuracy. In trauma settings, strategies such as additional patient review (e.g. trauma teams) reduced missed diagnosis and in radiology departments review strategies such as team meetings and error documentation may reduce diagnostic error rates over time. The systematic review was registered in the PROSPERO database under registration number CRD42017067056 .
机译：评估审核和沟通策略的有效性，以减少临床医生所犯的诊断错误。 MEDLINE完成，CINHAL完成，EMBASE，PSNet和Google Advanced。电子和人工搜索有关审计系统和交流策略或干预措施的文章，搜索1990年1月至2017年4月之间发表的论文。我们纳入了由临床医生在具有真实患者的临床环境中实施的干预措施研究。共筛选了2431篇文章，其中26篇研究符合纳入标准。数据提取由两组进行，每组包括两个独立的审阅者。通过交流（6）或审核策略（20）对文章进行分类，以减少临床环境中的诊断错误。最常见的干预措施是基于技术的系统，n？=？16（62％），在急性护理环境中，n？=？15（57％）。九项研究报告了随机对照试验。三项针对通信干预措施的RCT研究和三项针对审计策略的RCT研究发现，这些干预措施可有效减少诊断错误。尽管针对针对诊断错误的干预措施进行了大量研究，但我们的分析显示，针对临床上实际使用的干预措施的证据有限，并且源自美国的研究存在偏倚（n = 19，占纳入研究的73％）。有证据表明，包括基于计算机和警报系统在内的触发算法可以减少延迟诊断并提高诊断准确性。在创伤情况下，诸如增加患者复查（例如，创伤小组）之类的策略可减少漏诊诊断;而在放射科，诸如团队会议和错误记录之类的复查策略可随着时间的流逝降低诊断错误率。该系统评价已在PROSPERO数据库中注册，注册号为CRD42017067056。

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