Evidence on interventions to reduce medical errors - An overview and recommendations for future research

OBJECTIVE: To critically review the existing evidence on interventions aime d at reducing errors in health care delivery. DESIGN: Systematic review of randomized trials on behavioral, educational, informational, and management interventions relating to medical errors. Per tinent studies were identified from MEDLINE, EMBASE, the Cochrane Clinical Trials Registry, and communications with experts. SETTING: Both inpatients and outpatients qualified. No age or disease restr ictions were set. MEASUREMENTS: Outcomes were medical errors, including medication, prescript ion, and diagnostic errors, and excluding preventive medicine errors and si mple ordering of redundant tests. MAIN RESULTS: Thirteen randomized studies qualified for evaluation. The tri als varied extensively in their patient populations (mean age, 2 weeks to 8 3 years), study setting, definition of errors, and interventions. Most stud ies could not afford masking and rigorous allocation concealment. In 9 of 1 3 studies, error rates in the control arms were very high (10% to 63%), and large treatment benefits from the studied interventions were demonstrated for the main outcome. Interventions were almost always effective in a sampl e of 24 nonrandomized studies evaluated for comparison. Actual patient harm from serious errors was rarely recorded. CONCLUSIONS: Medical errors were very frequent in the studies we identified , arising sometimes in more than half of the cases where there is an opport unity for error. Relatively simple interventions may achieve large reductio ns in error rates. Evidence on reduction of medical errors needs to be bett er categorized, replicated, and tested in study designs maximizing protecti on from bias. Emphasis should be placed on serious errors.