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Official Journal of the Society to Improve Diagnosis in Medicine (SIDM)

Editor-in-Chief: Graber, Mark L. / Plebani, Mario

Ed. by Argy, Nicolas / Epner, Paul L. / Lippi, Giuseppe / Singhal, Geeta / McDonald, Kathryn / Singh, Hardeep / Newman-Toker, David

Editorial Board: Basso , Daniela / Crock, Carmel / Croskerry, Pat / Dhaliwal, Gurpreet / Ely, John / Giannitsis, Evangelos / Katus, Hugo A. / Laposata, Michael / Lyratzopoulos, Yoryos / Maude, Jason / Sittig, Dean F. / Sonntag, Oswald / Zwaan, Laura

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What interventions could reduce diagnostic error in emergency departments? A review of evidence, practice and consumer perspectives

Breanna WrightORCID iD: https://orcid.org/0000-0003-3630-7357 / Nicholas Faulkner
  • BehaviourWorks Australia, Monash Sustainable Development Institute, Monash University, Melbourne, VIC, Australia
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Peter Bragge
  • BehaviourWorks Australia, Monash Sustainable Development Institute, Monash University, Melbourne, VIC, Australia
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Mark Graber
  • Society to Improve Diagnosis in Medicine (SIDM), New York, NY, USA
  • RTI International, Raleigh, NC, USA
  • Stony Brook University, Stony Brook, NY, USA
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
Published Online: 2019-05-22 | DOI: https://doi.org/10.1515/dx-2018-0104


The purpose of this article is to synthesise review evidence, practice and patient perspectives on interventions to reduce diagnostic error in emergency departments (EDs). A rapid review methodology identified nine systematic reviews for inclusion. Six practice interviews were conducted to identify local contextual insights and implementation considerations. Finally, patient perspectives were explored through a citizen panel with 11 participants. The rapid review found evidence for the following interventions: second opinion, decision aids, guided reflection and education. Practitioners suggested three of the four interventions from the academic review: second opinion, decision aids and education. Practitioners suggested four additional interventions: improving teamwork, engaging patients, learning from mistakes and scheduled test follow-up. Patients most favoured interventions that improved communication through education and patient engagement, while also suggesting that implementation of state-wide standards to reduce variability in care and sufficient staffing are important to address diagnostic errors. Triangulating these three perspectives on the evidence allows for the intersections to be highlighted and demonstrates the usefulness of incorporating practitioner reflections and patient values in developing potential interventions.

This article offers supplementary material which is provided at the end of the article.

Keywords: clinician perspective; diagnosis; diagnostic error; emergency department; emergency medicine; mixed methods; patient engagement; patient safety; teamwork


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About the article

Received: 2018-12-05

Accepted: 2019-05-04

Published Online: 2019-05-22

Conflict of interest: The authors have no conflicts of interest to declare.

Author contributions: BW and PB conceived the study and methodology. BW, PB and NK undertook data curation and analysis. MG provided guidance on structure and data analysis. BW drafted the manuscript, and all authors contributed substantially to its revision and editing. All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

Research funding: This research was conducted with funding from the Victorian Managed Insurance Authority (VMIA) Research and Innovation Program; Ref: VMIA-MIRI 2016. The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.

Employment or leadership: None declared.

Honorarium: None declared.

Competing interests: The funding organisation(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.

Citation Information: Diagnosis, 20180104, ISSN (Online) 2194-802X, ISSN (Print) 2194-8011, DOI: https://doi.org/10.1515/dx-2018-0104.

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