Hi I need help with an assignment for a systematic review appraisal and qualitative review appraisal I will attach 6 total documents 2 are labeled example and 2 are labeled  Qualitative Review template form and systematic Review template form you will use and the 2 articles are the articles that goes with each appraisal the systematic article with the systematic appraisal form and the qualitative article I have attached with the qualitative appraisal form. just use the examples as a guide to fill out the templates. Just wanna make it clear that two separate templates need to be filled out the two I have attached below each based on each article.
APPENDIX E
Appraisal Guide
Findings of a Qualitative Study
Citation:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
Synopsis
What experience, situation, or subculture does the researcher seek to understand?
Does the researcher want to produce a description of an experience, a social process, or an event,
or is the goal to generate a theory?
How was data collected?
How did the researcher control his or her biases and preconceptions?
Are specific pieces of data (e.g., direct quotes) and more generalized statements (themes,
theories) included in the report?
What are the main findings of the study?
Credibility
Is the study published in a source
that required peer review?
Yes
No
Not clear
Were the methods used appropriate
to the study purpose?
Yes
No
Not clear
Was the sampling of observations or
interviews appropriate and varied
enough to serve the purpose of the study?
Yes
No
Not clear
*Were data collection methods
effective in obtaining in-depth data?
Yes
No
Not clear
Did the data collection methods
avoid the possibility of oversight,
underrepresentation, or
overrepresentation from certain
types of sources?
Yes
No
Not clear
Were data collection and analysis
intermingled in a dynamic way?
Yes
No
Not clear
Brown
APP E-1
*Is the data presented in ways that
provide a vivid portrayal of what was
experienced or happened and its
context?
Yes
No
Not clear
*Does the data provided justify
generalized statements, themes,
or theory?
Yes
No
Not clear
ARE THE FINDINGS CREDIBLE?
Yes All
Yes Some
No
Clinical Significance
*Are the findings rich and informative?
Yes
No
Not clear
*Is the perspective provided
potentially useful in providing
insight, support, or guidance
for assessing patient status
or progress?
Yes
Some
No
ARE THE FINDINGS
CLINICALLY SIGNIFICANT?
Yes All
Yes Some
Not clear
No
* = Important criteria
Comments
___________________________________________________________________________
___________________________________________________________________________
APP E-2
Brown
APPENDIX C
Appraisal Guide
Conclusions of a Systematic Review with Narrative Synthesis
Citation:
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
Synopsis
What organization or persons produced the systematic review (SR)?
How many persons were involved in conducting the review?
What topic or question did the SR address?
How were potential research reports identified?
What determined if a study was included in the analysis?
How many studies were included in the review?
What research designs were used in the studies?
What were the consistent and important across-studies conclusions?
Credibility
Was the topic clearly defined?
Yes
No
Not clear
Was the search for studies and other
evidence comprehensive and unbiased?
Yes
No
Not clear
Was the screening of citations for
inclusion based on explicit criteria?
Yes
No
Not clear
*Were the included studies assessed
for quality?
Yes
No
Not clear
Were the design characteristics and
findings of the included studies displayed
or discussed in sufficient detail?
Yes
No
Not clear
*Was there a true integration (i.e., synthesis) of the findings—not
merely reporting of findings from
each study individually?
Yes
No
Not clear
Brown
APP C-1
*Did the reviewers explore why differences
in findings might have occurred?
Yes
No
Not clear
Did the reviewers distinguish between
conclusions based on consistent findings
from several good studies and those
based on inferior evidence (number or quality)?
Yes
No
Not clear
Which conclusions were supported by
consistent findings from two or more
good or high-quality studies?
List
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
ARE THE CONCLUSIONS
CREDIBLE?
Yes All
Yes Some
No
Clinical Significance
*Across studies, is the size of the
treatment or the strength of the
association found or the
meaningfulness of qualitative findings
strong enough to make a difference
in patient outcomes or experiences of care?
Yes
No
Not clear
Are the conclusions relevant to the
care the nurse gives?
Yes
No
Not clear
ARE THE CONCLUSIONS
CLINICALLY SIGNIFICANT?
Yes All
Yes Some
No
Applicability
Does the SR address a problem,
situation, or decision we are addressing in our setting?
Yes
No
Not clear
Are the patients in the studies or a
subgroup of patients in the studies
similar to those we see?
Yes
No
Not clear
What changes, additions, training, or
purchases would be needed to implement
and sustain a clinical protocol based
on these conclusions?
Specify and list
____________________________________________________________________________
APP C-2
Brown
____________________________________________________________________________
Is what we will have to do to implement
the new protocol realistically achievable
by us (resources, capability, commitment)?
How will we know if our patients are
benefiting from our new protocol?
Yes
No
Not clear
Specify
____________________________________________________________________________
____________________________________________________________________________
ARE THESE CONCLUSIONS
APPLICABLE TO OUR SETTING?
Yes All
Yes Some
No
SHOULD WE PROCEED TO DESIGN
A PROTOCOL INCORPORATING
THESE CONCLUSIONS?
Yes All
Yes Some
No
* = Important criteria
Comments
____________________________________________________________________________
____________________________________________________________________________
Brown
APP C-3
Interventions to reduce the incidence of medical error and its financ… health care systems: A systematic review of systematic reviews – PMC
2/15/24, 10:51 AM
As a library, NLM provides access to scientific literature. Inclusion in an NLM database does
not imply endorsement of, or agreement with, the contents by NLM or the National Institutes
of Health.
Learn more: PMC Disclaimer | PMC Copyright Notice
Front Med (Lausanne). 2022; 9: 875426.
PMCID: PMC9363709
Published online 2022 Jul 27. doi: 10.3389/fmed.2022.875426
PMID: 35966854
Interventions to reduce the incidence of medical error and its financial burden in health
care systems: A systematic review of systematic reviews
Ehsan Ahsani-Estahbanati, 1 Vladimir Sergeevich Gordeev, 2 , 3 and Leila Doshmangir
1,4,*
Abstract
Background and aim
Improving health care quality and ensuring patient safety is impossible without addressing medical er?
rors that adversely a?ect patient outcomes. Therefore, it is essential to correctly estimate the incidence
rates and implement the most appropriate solutions to control and reduce medical errors. We identified
such interventions.
Methods
We conducted a systematic review of systematic reviews by searching four databases (PubMed, Scopus,
Ovid Medline, and Embase) until January 2021 to elicit interventions that have the potential to decrease
medical errors. Two reviewers independently conducted data extraction and analyses.
Results
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9363709/
Page 1 of 23
Interventions to reduce the incidence of medical error and its financ… health care systems: A systematic review of systematic reviews – PMC
2/15/24, 10:51 AM
Seventysix systematic review papers were included in the study. We identified eight types of interven?
tions based on medical error type classification: overall medical error, medication error, diagnostic er?
ror, patients fall, healthcare-associated infections, transfusion and testing errors, surgical error, and pa?
tient suicide. Most studies focused on medication error (66%) and were conducted in hospital settings
(74%).
Conclusions
Despite a plethora of suggested interventions, patient safety has not significantly improved. Therefore,
policymakers need to focus more on the implementation considerations of selected interventions.
Keywords: medical error, financial burden, hospital, intervention, quality of care, public health
Introduction
A medical error is a preventable adverse e?ect of medical care (“iatrogenesis”). It can be defined as the
“failure of a planned action to be completed as intended or the use of a wrong plan to achieve an aim”
(1). As the associated burden is evident, medical errors have drawn considerable attention from acade?
mics, hospital managers, and major health stakeholders. Medical errors have a significant adverse im?
pact on patients’ outcomes and workers’ mental health. They are associated with a considerable finan?
cial burden and undermine public trust in the health system (2–4). Medical errors, including healthcarerelated adverse events, occur in 8–12% of hospitalisations in Europe (5). At least 50% of hospitalized
patients’ harm could be preventable (6). Overall, healthcare-associated infections incidence is estimated
at 4.1 million patients a year in Europe, with the four main types of error being urinary tract infections
(27%), lower respiratory tract infections (24%), surgical site infections (17%), and bloodstream infec?
tions (10.5%) (5). In the US (2007), 1.7 million healthcare-associated infections occur annually. They
result in excess healthcare costs of $35.7–$45 billion for inpatient hospital services (7, 8).
The medical errors can be classified based on their content or “what went wrong” (e.g., medication,
surgical, transfusion, healthcare-associated infection) (9–15); location or “where did it happen” (e.g.,
intensive care unit, operation theater, emergency department, children’s ward) (15–18); sta? or “who
made an error” (e.g., doctor, pharmacists, nurse) (10, 19, 20); error’s severity or “how harmful was it”
(e.g., error, no harm, near miss) (21–25); and “who was a?ected” (e.g., patient, family, medical sta?)
(26, 27). Depending on the type of medical errors, studies suggest various solutions, from simple activi?
ties (e.g., hand hygiene to prevent healthcare-associated infection) to more complex ones such as using
technological instruments or methods to prevent retained surgical instruments errors (7, 15).
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9363709/
Page 2 of 23
Interventions to reduce the incidence of medical error and its financ… health care systems: A systematic review of systematic reviews – PMC
2/15/24, 10:51 AM
Despite the ongoing e?orts to reduce and prevent the burden of medical errors and related patient harm,
global e?orts have not yet achieved substantial change over the past 15 years due to various reasons (6).
Unclear policies, insu?cient or unreliable data to drive patient safety improvements, unskilled health
care professionals, lack of organizational leadership capacity, and non-participation of patients and fam?
ilies in the care process led to unsustainable and insignificant improvements in health care safety (2).
Hence the primary goal of this article was to conduct a systematic review of systematic reviews to elicit
interventions that can reduce medical errors or medical error costs in hospitals and analyse interven?
tions implementation results where available. Specifically, we focused on interventions that can reduce
health care costs, patient’s harm and death, improve health services quality, patient’s satisfaction, and
safety.
Methods
Literature search and study selection
Inclusion criteria for articles considered in this review were as follows: (a) systematic reviews; (b) stud?
ies published in English language; (c) studies on solutions regarding medical error reduction or medical
error costs; (d) studies on interventions in hospitals or the whole of the healthcare sector, which entered
the study regardless of whether these reviews were based on reported errors, an examination of medical
profiles, observational studies or other methods. We excluded studies (a) published in languages other
than English; (b) studies conducted in settings other than the hospital; (c) studies focused only on a spe?
cific type of medical error/activity/patient subgroup, or a sporadic type of medical error (e.g., wrongsite surgery in neurosurgery); (d) studies focusing on a particular group of employees where generalis?
ability to other groups would not be feasible (i.e., only nurses, physicians, pharmacists); (e) conference
abstracts, narrative reviews, editorial and other types of studies but systematic reviews; (f) studies relat?
ed to adverse events only; and (g) studies with no e?ect on medical errors.
Search strategy
To identify relevant interventions, we searched the four databases (PubMed, Scopus, Ovid Medline and
Embase) from Oct 1977 until January 2021 and selected English-only publications. Multiple keywords
related to medical errors were researched and customized for each database. We used the filters for
searching papers on interventions to reduce medical error to maximize the sensitivity of our literature
search. We did not make any limitations on the outcomes. Additionally, references from the included
systematic reviews were checked and added to selected studies. Our search strategy was adjusted for
each database accordingly. For example, following combination was used for Pubmed database:
((((((((((((((((medical errors[MeSH Terms] OR “recording error”[Title/Abstract]) OR “no harm”[Ti?
tle/Abstract] OR “patient fall*”[Title/Abstract]) OR “hospital infection”[Title/Abstract]) OR “transfu?
sion error”[Title/Abstract]) OR “prescription error”[Title/Abstract]) OR “prescribing error”[Title/Ab?
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9363709/
Page 3 of 23
Interventions to reduce the incidence of medical error and its financ… health care systems: A systematic review of systematic reviews – PMC
2/15/24, 10:51 AM
stract]) OR “CPR error”[Title/Abstract]))) OR “medication error”[Title/Abstract]) OR “near miss”[Ti?
tle/Abstract]) OR “suicide”[Title/Abstract]) OR “sentinel event”[Title/Abstract]) OR “never event”[Ti?
tle/Abstract]) AND systematic[sb]). An overview of the full search strategy can be found in Appendix
1.
Data extraction
Two researchers independently extracted data from selected reviews. A third reviewer resolved any dis?
agreements between the two reviewers. The following data were extracted: author, year, aim of the
study, setting, medical error type, interventions, and the overall results if reported. Only reviews that
met our selection criteria were extracted and analyzed.
Data analysis
The interventions of reviews were classified based on the medical error types. We additionally checked
for the overlap between primary studies included in systematic reviews. Since there was no complete
overlap between the reviews, none of the studies were excluded.
Results
Search results
The initial search provided 2108 records (Figure 1). After eliminating duplicate papers, titles and ab?
stract screening, 181 reviews underwent the full-text assessment. In total 76 reviews met the inclusion
criteria, 105 were excluded for various reasons (Figure 1).
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9363709/
Page 4 of 23
Interventions to reduce the incidence of medical error and its financ… health care systems: A systematic review of systematic reviews – PMC
2/15/24, 10:51 AM
Figure 1
PRISMA flow diagram for the review process.
Characteristics of the included systematic reviews
More than half of systematic reviews (67%) were published between 2013 and 2020 (n = 51). 66% of
reviews were about medication error (n = 49), and 74% were related to all hospital settings (n = 56).
The included studies reported on interventions for eight types of medical errors: overall medical error
(13 interventions), medication error (37 interventions), patients’ fall (11 interventions), healthcare-asso?
ciated infections (21 interventions), diagnostic errors (7 interventions), transfusion and testing errors (8
interventions), surgical errors (3 interventions), and patients’ suicide (13 interventions) (Table 1).
Table 2 provides an overview of the impact of interventions on medical error reduction by intervention
group. A more detailed overview of the impact of studies, including their aim, setting, and overall re?
sults can be found in Supplementary Table 1.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9363709/
Page 5 of 23
Interventions to reduce the incidence of medical error and its financ… health care systems: A systematic review of systematic reviews – PMC
2/15/24, 10:51 AM
Table 1
Interventions to reduce medical error by medical error category.
Medical error category
Interventions groups
Number of
interventions
Overall medical error (1–10)
Medication error (4, 5, 7, 11–57)
Use of electronic systems
7
Process interventions
4
Patient-centered intervention
1
Inter-professional education
1
Use of electronic systems
10
Pharmacists and clinical pharmacist role
1
Process interventions
Leadership or managerial manners and strategies
19
Smart pumps impact
6
1
Patients’ fall (5, 58–62)
Education and professional skills
3
Methods/tools evaluating patients’ fall risk
3
Process and patient care programs
Hourly rounding programs
3
Organizational and workplace culture
1
1
Healthcare-associated infections (18, 21,
Caregivers’ education and behavioral change
42, 58, 61, 63–69)
interventions
4
Process interventions
8
Managerial and organizational interventions
5
Use of medication interventions
Environment/equipment cleaning
3
1
Diagnostic errors (5, 70, 71)
Digital and electronic interventions
3
Patient identification and checking
2
Quality improvement methodologies
2
Transfusion and testing errors (72, 73)
Identification of patients (labeling and barcoding)
8
Surgical errors (18, 42, 74, 75)
Use of checklists and counting materials
2
Use of radio-frequency identification technology
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9363709/
Page 6 of 23
Interventions to reduce the incidence of medical error and its financ… health care systems: A systematic review of systematic reviews – PMC
2/15/24, 10:51 AM
Table 2
Impact of interventions on medical error reduction by intervention group.
Overall Medication Patients’ Healthcare- Diagnostic Transfusion Surgical Patients’
medical error
fall
error
associated
error
infections
Caregivers’ education
++2
and behavioral change
reviews (58,
interventions
64)
and testing
errors
suicide
errors
+ 2 reviews
(65, 69)
Digital and electronic
++1
review (5)
+ 1 review
(70)
Education and
++2
professional skills
reviews
(58, 59)
+1
review
(60)
Use of electronic
++2
+ + 12
systems
reviews
reviews (4,
(3, 4) + 22, 24–31,
2
56, 57)
reviews
+ 13
(1, 2)
reviews (5,
34, 35, 44–
53)
Environment/equipment
++ 1
cleaning
review (63)
Identification of
++ 1
patients (labeling and
review (72)
barcoding)
+1 review
(73)
++ e?ective in reduction / significant reduction, + some evidence of reduction.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9363709/
Page 7 of 23
Interventions to reduce the incidence of medical error and its financ… health care systems: A systematic review of systematic reviews – PMC
2/15/24, 10:51 AM
Interventions based on medical error types
Overall medical error This group of interventions was not restricted to a specific medical error type. It
included four interventions groups (i.e., use of electronic systems, patient-centered intervention,
process interventions, and inter-professional education). In total, ten reviews focused on overall medical
errors (28–37) and included 257 primary studies (Table 1). Five reviews focused on the use of electron?
ic systems to reduce overall medical error levels using health information systems, computerized
provider order entry systems combined with clinical decision support systems, diagnostic and clinical
decision-making aids, error-resistant systems, computer-enabled discharge communication, personal
digital assistants, human simulation training) (28–32). Four reviews presented the process interventions
such as failure mode and e?ects analysis, proactive technique, systematic safety processes, teamwork
and communication training interventions, and reactive systematic safety processes in reducing risks,
medical errors and adverse events (32–34, 37). One study referred to a patient-centered intervention,
i.e., documentation through patient involvement and feedback on the medical file (35). Reeves et al.
focused on interprofessional education (36) (Supplementary Table 1).
Reviews confirmed that using electronic systems could reduce (28, 29) or e?ectively and significantly
(30, 31) reduce medical errors. For example, Charles et al. (29) stated that computerized provider order
entry reduces medical error and adverse drug events. The e?ect would be more when combined with
clinical decision support systems to alert healthcare providers of medical errors (29). Studies that fo?
cused on other intervention groups [i.e., process interventions (32–34, 37), patient-centered interven?
tion (35), and inter-professional education (36)] presented some evidence of their potential to reduce
medical errors (Table 2). For example, using process interventions minimizes risks and improves ser?
vice quality (33). In contrast, interprofessional education could reduce medical errors and enhance be?
havior culture in the emergency department (36).
Medication error This intervention group related to medication errors and specific subcategories (pre?
scribing, dispensing, administering, transcription and dose errors). These interventions fell into five
groups: use of electronic systems, pharmacists and clinical pharmacist involvement in the treatment
process, process interventions, leadership or managerial manners, and strategies and smart pumps im?
pact. Overall, 49 reviews focused on interventions to reduce medication errors. This was the most
prominent intervention category, including 1,380 primary studies (Table 1). Twentyfive reviews fo?
cused on using electronic systems (14, 16, 31, 32, 38–58). Twelve reviews focused on pharmacists and
clinical pharmacist involvement in the treatment process (13, 17, 32, 41, 59–66). Five reviews presented
leadership or managerial manners interventions (12, 56, 67–69). The remaining 12 reviews stated
process interventions (9, 12, 32, 34, 67, 70–76), and two reviews focused on smart pumps impact (32,
77) (Table 2).
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9363709/
Page 8 of 23
Interventions to reduce the incidence of medical error and its financ… health care systems: A systematic review of systematic reviews – PMC
2/15/24, 10:51 AM
Similarly to overall medical error interventions, reviews focusing on electronic systems provided evi?
dence that they could reduce (14, 16, 32, 38–48) or e?ectively and significantly (31, 49–58) reduce
medication errors. For example, the most significant results were noted for computerized provider order
entry in 96% error interception and 90% reduction of medication errors (41, 44). There was evidence
that leadership or managerial manners intervention could e?ectively and significantly reduce medica?
tion errors (12, 56, 67–69). For example, redesign of diabetes prescribing charts incorporating prescrib?
ing guidelines, diabetes prescription error management pathway, and mandatory e-learning reduced
insulin prescription errors from 65 to 2% (67) (Table 2, Supplementary Table 1). Reviews on pharma?
cists and clinical pharmacist involvement in the treatment process presented evidence of some to a very
e?ective and significant reduction on medical errors. For example, pharmacists’ participation in medical
treatment leads to a 43% reduction in prescribing errors and a 27% reduction in overall medication er?
rors (63, 64). Most reviews on process interventions had also shown that such intervention could e?ec?
tively and significantly reduce medication errors (9, 12, 34, 67, 70–74), with only a few (32, 75, 76, 78)
presenting only some evidence of medication error reduction. For example, double-checking reduce
medication error from 2.98 to 2.12 per 1,000 medication administered and dispensing error from 9.8 to
6 (73).
Patients’ fall This group of interventions focused on interventions that could reduce patients’ falls by
using four di?erent categories of interventions (professional skills and education, methods/tools evalu?
ating patients’ fall risk, process and patient care programs, organizational and workplace culture). In
total, six reviews (10, 26, 27, 32, 79, 80) focused on fall prevention and included 14 primary studies.
Three reviews focused on using education and professional skills interventions (10, 27, 79). Two re?
views presented using methods and tools evaluating patients’ fall risk (27, 32). Cumbler et al. reported
process and patient care programs as beneficial interventions (27). One study focused on hourly round?
ing programs (80), and Braithwaite et al. presented organizational and workplace culture interventions
(26) (Table 2).
Based on the results of reviews, education and professional skills interventions e?ectively reduced or
led to a significant reduction in patients’ falls (10, 27, 80), while another review showed some evidence
of a reduction in patients’ falls (79). For example, there were patients’ fall di?erences in intervention
groups vs. control groups through patient-centered interventions (180 in intervention group vs. 319 in
control group) (79). There was evidence that methods/tools evaluating patients’ fall risk intervention
could e?ectively and significantly reduce medical errors (27), and other reviews showed that could re?
duce patients’ falls (32). For example, using the Morse fall scale decreased falls (27). Two remaining
studies focused on e?ectively and significantly reducing patients’ falls (27, 80), and the other had some
evidence of reduction (26). For example, sta? education, care planning, patient training in rehabilitation
and nutritionist support lead to a reduction in falls from 16.28 to 6.29 per 1,000 patient days (27) (
Table 2, Supplementary Table 1).
Healthcare-associated infections
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9363709/
Page 9 of 23
Interventions to reduce the incidence of medical error and its financ… health care systems: A systematic review of systematic reviews – PMC
2/15/24, 10:51 AM
Twelve reviews and 382 primary studies focused on five groups of interventions that could reduce
healthcare-associated infections (caregivers’ educational and behavioral change interventions, process
interventions, managerial and organizational interventions, using medication interventions and environ?
ment/equipment cleaning) (Table 1). Four reviews focused on the caregivers’ education and behavioral
changes (10, 81–83). Three reviews focused on process interventions (65, 72, 84). Four reviews pre?
sented the managerial and organizational interventions (26, 69, 81, 83). Three reviews reported medica?
tion interventions (65, 85, 86). Schabrun et al. focused on equipment cleaning (87) (Table 2).
Caregivers’ education and behavioral change e?ectively reduced healthcare-associated infections (10,
81), and the other two reviews showed some evidence of a reduction in healthcare-associated infections
(82, 83). For example, hand-hygiene campaigns reduced nosocomial infection rates (median e?ect
49%) (81). Boyd et al. presented an e?ective or significant reduction in healthcare-associated infections
(72), and two reviews showed that these interventions could reduce healthcare-associated infections
(65, 84). For example, the Keystone intensive care unit intervention for central line-associated blood?
stream infections and chlorhexidine for vascular catheter site care economically reduced healthcare-as?
sociated infections (65). One review stated that managerial and organizational interventions are signifi?
cant or e?ective in reducing healthcare-associated infections (81), while three studies have some evi?
dence on reducing healthcare-associated infections (26, 69, 83). For example, antibiotic stewardship,
antibiotic restriction, guidelines, education, and performance feedback showed a significant decrease
ranging from 13 to 82% (81). One review of medication interventions reported a significant decline
(28%) in surgical site infection using a chlorhexidine impregnated dressing that applied to the surgical
site (86). Another review demonstrated an e?ective reduction (82.1%) in colony-forming units after
cleaning pieces of equipment with alcohol (87).
Diagnostic error
Three studies that included 68 primary studies focused on three intervention categories (digital and
electronic interventions, patient identification and checking and quality improvement methodologies)
that a?ect diagnostic errors (2, 32, 88) (Table 1). Two studies presented the use of digital and electronic
interventions (2, 32). One study focused on the use of patient identification (2). Amaratunga et al. fo?
cused on quality improvement methodologies (88). One review focused on digital and electronic inter?
ventions showed a significant e?ect of interventions to reduce diagnostic error. The other one presented
some evidence of diagnostic error reduction (2, 32). For example, clinical decision support systems and
a web-based diagnostic reminder system significantly reduced diagnostic errors (32). Zhou et al. (2)
presented some evidence of a reduction in diagnostic error using patient identification. For example, the
patient identification check, obtaining informed consent, verifying the correct side and site, and a final
check by the radiologist decreased the incidence rate of diagnostic error from 0.03% (9 of 32,982) to
0.005% (2). Another review reported some evidence of a reduction in diagnostic error within radiology
by lean and Six Sigma approaches as quality improvement methodologies (88).
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9363709/
Page 10 of 23
Interventions to reduce the incidence of medical error and its financ… health care systems: A systematic review of systematic reviews – PMC
2/15/24, 10:51 AM
Transfusion and testing errors
Two reviews included 26 primary studies focused on the identification of patients (labeling and barcod?
ing) intervention (11, 89) (Table 1). The results of Snyder et al.’s review was e?ective in reducing trans?
fusion and testing errors (89), and another review showed some evidence on reducing transfusion and
testing errors (11) (Table 2). For example, labeling significantly reduces testing errors, so the most ef?
fective intervention in reducing transfusion and testing errors was barcoding systems, which reduced
2.26 errors to 0.17 errors per 10,000 specimens (89).
Surgical errors
Four reviews included 38 primary studies focused on two intervention groups to reduce surgical errors
(use of checklists and counting instruments and material and use of radio-frequency identification tech?
nology) (15, 65, 72, 90) (Table 1). Three reviews reported using checklists and counting materials inter?
ventions (65, 72, 90). Another review focused on radio-frequency identification technology (15) (
Table 2). Two reviews showed an e?ective reduction in surgical errors (72, 90) while, Etchells et al.’s
review had some evidence related to reducing surgical errors (65). For example, using checklists (or
similar interventions) could reduce equipment errors in the operating room by 48.6% (90). One review
showed some evidence to reduce retained surgical instrument errors, reduce the risk of counting errors,
and improve workflow using radio-frequency identification technology (15) (Table 2).
Patients’ suicide
Two reviews included 112 primary studies focused on reducing patients’ suicide (91, 92) (Table 1). One
review focused on reducing absconding and engagement with patient’s family intervention (91). Doup?
nik et al., focused on process and patient care interventions and contact interventions (92) (Table 2).
Bowers et al. reported measures to reduce absconding and engagement with patient’s family