September, 2009 - SUPPORT Summary of a systematic review | print this article |
A patient safety incident (PSI) is an event or circumstance which could have resulted, or did result, in unnecessary harm to a patient. The term encompasses the more frequently used terms medical error and system failure, and is now preferred. PSIs are a common cause of morbidity and mortality in a variety of health care settings. Some situations, as complex or urgent care, carry a greater risk, but significant errors may occur in any setting.
PSIs are common and have important consequences for patients and the healh care system. Some situations, as complex or urgent care, carry a greater risk, but significant errors may occur in any setting.
Given the multifaceted dimension of this phenomenon, there is a wide array of possible interventions. Nowadays, different ways of categorizing interventions to diminish PSIs are in use (see related literature). In this review they are classified into prescription (errors in the prescription, dosing or omission of pharmaceutical inteventions), diagnosis (errors related to the prescription of inappropriate/harmful diagnostic test or misdiagnosis errors beyond the inherent limitations of applied diagnostic tests) or management errors (different from prescription or diagnosis). Also, there are many possible definitions of a medical error. This review considered any definition, provided that authors explicitly stated reduction of error as an outcome.
|Review Objectives: To critically review the existing evidence on interventions aimed at reducing errors in health care delivery.|
|/||What the review authors searched for||What the review authors found|
Randomized controlled trials (RCTs) that evaluated an intervention versus placebo or no intervention and specified the aim of reducing medical errors. Authors also looked for other study designs. Since conclusions did not change, they focused on RCTs, and so does this summary.
|Thirteen RCTs were found. All of them evaluated a different intervention: Utilization of protocol by triage nurse, teaching acute illness observation scales to mothers, pain relief for abdominal pain needing possible surgical resolution, nurse practitioner vs. junior doctor providing care, computerized reminders, multidisciplinary approach, leaflets, automated bedside diagnosis, syringe marked with doses, team intervention, self-medication program, illumination in the workplace, pharmacist participation in rounds.
|Participants||Any health care facility
||Pediatric outpatient (2), psychiatric outpatient (1), army outpatient (1), pediatric emergency room (1), adult emergency room (1), inpatient medical (1), acute hospital (3), inpatient geriatric units (1), surgical unit (2).
||All studies were conducted in high-income countries: USA (8), Canada (2), UK (3).
|Outcomes||Any definition of medical error was considered, provided that authors explicitly stated reduction of error as an outcome
||Medication errors (9), Diagnosis errors (4), Other management errors (3). Reported errors were not serious. No study reported on mortality and only 2 studies reported clinical harm to patient.
|Date of most recent search: March 2000|
|Limitations: This systematic review has moderate limitations, mainly because the search is not very comprehensive and has not been updated since 2000. It was not possible to pool the studies, since the populations, interventions, comparisons and outcomes were too diverse. The high proportion of positive findings reported raise concerns about the possibility of publication bias.|
Ioannidis JP, Lau J. Evidence on interventions to reduce medical errors: an overview and recommendations for future research. J Gen Intern Med. 2001;16(5):325-34. See in PubMed
This review found thirteen studies conducted in many different settings in high-income countries. Each study evaluated a different intervention. Nine studies addressed interventions to reduce errors in medication, four interventions to reduce errors in diagnosis and three interventions to reduce other management errors. Error rates in the control groups of these studies were common, ranging from 10% to 63%.
Nine studies evaluated very different interventions aimed to diminish prescription, dosing or omission errors. Eight out of nine interventions evaluated may decrease medication errors, but serious errors or mortality were not measured in these studies.
Four studies evaluated very different interventions aimed to diminish prescription of inappropriate/harmful diagnostic test or misdiagnosis errors beyond the inherents limitations of applied diagnostic tests. None of the four interventions evaluated seemed to decrease diagnosis errors.
Three studies evaluated very different interventions aimed to diminish management errors. Two of the three interventions evaluated seemed to probably decrease them. Two of the three interventions were categorized as interventions to reduce management errors as well as interventions to reduce medication errors (Computarized reminders of “corollary orders”, multidisciplinary approach coordinated by a “senior care unit”). They are described above.
|MONITORING & EVALUATION|
*Judgements made by the authors of this summary, not necessarily those of the review authors, based on the findings of the review and consultation with researchers and policymakers in low- and middle-income countries. For additional details about how these judgements were made see: http://www.support-collaboration.org/summaries/methods.htm
Elder NC, Dovey SM. Classification of medical errors and preventable adverse events in primary care: a synthesis of the literature. J Fam Pract. 2002 Nov;51(11):927-32.
Runciman W, Hibbert P, Thomson R, Van Der Schaaf T, Sherman H, Lewalle P. Towards an International Classification for Patient Safety: key concepts and terms.Int J Qual Health Care. 2009 Feb;21(1):18-26.
World alliance for patient safety. Summary of the evidence on patient safety: implications for research. World alliance for patient safety, 2009.
Hodgkinson B, Koch S, Nay R. Strategies to reduce medication errors with reference to older adults. International Journal of Evidence-Based Healthcare 2006;4(1):2-41.
This summary was prepared by
Gabriel Rada, Pontificia Universidad Católica de Chile, Chile
Conflict of interest
None declared. For details, see: Conflicts of Interest
This summary has been peer reviewed by: Itziar Larizgoitia, Switzerland; Alda do Rosário Elias Mariano, Mozambique; Pierre Ongolo-Zogo, Cameroon; Tracey Perez Koehlmoos, Bangladesh; Agustín Ciapponi, Argentina
This summary should be cited as
Rada G. What are the impacts of interventions to reduce medical errors? A SUPPORT Summary of a systematic review. September 2009.