Interventions targeted at reducing diagnostic error: systematic review.

BACKGROUND: Incorrect, delayed and missed diagnoses can contribute to significant adverse health outcomes. Intervention options have proliferated in recent years necessitating an update to McDonald et al's 2013 systematic review of interventions to reduce diagnostic error. OBJECTIVES: (1) To describe the types of published interventions for reducing diagnostic error that have been evaluated in terms of an objective patient outcome; (2) to assess the risk of bias in the included interventions and perform a sensitivity analysis of the findings; and (3) to determine the effectiveness of included interventions with respect to their intervention type. METHODS: MEDLINE, CINAHL and the Cochrane Database of Systematic Reviews were searched from 1 January 2012 to 31 December 2019. Publications were included if they delivered patient-related outcomes relating to diagnostic accuracy, management outcomes and/or morbidity and mortality. The interventions in each included study were categorised and analysed using the six intervention types described by McDonald et al (technique, technology-based system interventions, educational interventions, personnel changes, structured process changes and additional review methods). RESULTS: Twenty studies met the inclusion criteria. Eighteen of the 20 included studies (including three randomised controlled trials (RCTs)) demonstrated improvements in objective patient outcomes following the intervention. These three RCTs individually evaluated a technique-based intervention, a technology-based system intervention and a structured process change. The inclusion or exclusion of two higher risk of bias studies did not affect the results. CONCLUSION: Technique-based interventions, technology-based system interventions and structured process changes have been the most studied interventions over the time period of this review and hence are seen to be effective in reducing diagnostic error. However, more high-quality RCTs are required, particularly evaluating educational interventions and personnel changes, to demonstrate the value of these interventions in diverse settings.

Evaluating probe techniques and a situated theory of situation awareness.

Probe techniques for measuring situation awareness (SA) vary in whether scenarios are paused and displays visible while questions are presented. We examined which technique is least intrusive on workload and performance in air traffic control, and which is most sensitive at capturing differences in SA when automation varies. We also tested predictions from the situated SA theory, which holds that operators offload specific and low-priority information onto displays to limit internal processing. To accomplish these goals, Experiments 1 and 2 manipulated whether radar displays were visible and scenarios paused during queries. Experiment 2 also manipulated the amount of automation by varying the percentage of aircraft equipped with NextGen tools. We found all probe techniques were equally sensitive at capturing SA differences for different levels of equipage, but those that paused scenarios were least intrusive. Moreover, consistent with situated SA, blanking displays impaired ability to answer questions about specific but not general information. Experiment 3 recorded eye gaze frequency and duration during queries when scenarios were visible and not paused and, as predicted by situated SA, found participants were more likely to look at radar displays while answering specific and low-priority questions than general and high-priority questions. (PsycINFO Database Record

Insulin Pumps and Remote Software Updates: A New Way Forward.

This article discusses the future direction of insulin pump technology and its relationship to the software update process. A user needs analysis revealed that respondents wanted an insulin pump software update process to function much in the same way as smartphone updates. Users of insulin pumps have the same expectations as with other ubiquitous technology such as smartphones, tablets, and laptops. The development of a software update system within a regulated environment that meets the needs of insulin pump users by allowing optional software updates that provide access to pump improvements, feature additions, or access to algorithms that provide therapy-changing technologies is a new way forward for the management of a complicated disease that affects more than 450,000 people using insulin pumps in the United States.