Table 4. Studies that Tested System Interventions to Address Dimensions of Diagnostic Error.

Provider-patient Encounter
Perno, J. F., et al (2005). Significant reduction in delayed diagnosis of injury with implementation of a pediatric trauma service. Pediatr Emerg Care, 21(6), 367-371.	UBA	Designated pediatric trauma response team	48 months	Care team	Unknown care teams; A total of 3265 patients were included; no patients were excluded.	Incidence of delayed diagnosis of injury (DDI) among pediatric trauma patients.	Y; speculated reasons included team dedicated only to trauma
Howard, J., et al. (2006). Reducing missed injuries at a level II trauma center. J Trauma Nurs, 13(3), 89-95.	Post- test only	Comprehensive reevaluation (i.e., tertiary examination) of trauma patients within 24 hours of admission	6 months	A trauma clinical nurse specialist, 2 emergency physicians, and the trauma medical director	4 healthcare providers, 90 patients	Incidence of missed injuries	Y; tertiary “repeat” examination and review of all lab and radiology studies
Diagnostic Tests
Weatherburn, et al (2000). The effect of a picture archiving and communications system (PACS) on diagnostic performance in the accident and emergency department. (J Accid Emerg Med, 17(3), 180-184.)	CBA	Implementation of Picture Archiving and Communications System (PACS), which acquires, transports, and stores radiographic images electronically, with accident and emergency (A&E) clinicians	Pre-PACS data collection period based on conventional film images: 3/ 31/92 to 10/30/92; Post- PACS data collection period: 4/1/96 to 10/30/96	Accident and emergency (A&E) department.	# of A&E attenders: 14,256 (film), 17,071 (PACS)	Misdiagnosis (false negative) rates for adults and children	Y; Speculated reasons include 1) clinicians could manipulate soft copy images in PACS 2) potential for images to be viewed simultaneously in A&E and Radiology.pro mpting more consultations
Follow-up and Tracking
Singh, H., et al. (2009). Improving follow-up of abnormal cancer screens using electronic health records(BMC Med Inform Decis Mak, 9, 49)	UBA	Added a code to the software configuration that links patients to their PCP for tests ordered by others.	10 months	Primary care physicians	One large urban facility and satellite clinics; 490 alerts	Rates of timely follow- up of positive FOBTs pre- and post- intervention	Y; improved electronic communication of abnormal test results
Poon, E. G., et al (2002). Real-time notification of laboratory data requested by users through alphanumeric pagers. (J Am Med Inform Assoc, 9(3), 217-222).	Post- test only	Implementation of Result Notification via Alphanumeric Pagers (ReNAP), an application that notifies clinicians of patient laboratory results via an alphanumeric pager once results are filed into the patient database.	12 months	Inpatient and clinic physicians	During the 12 month period between Feb 2000 and Jan 2001, 780 different clinicians used ReNAP; a total of 22,775 requests were made during this time period.	# of laboratory notification requests made, user satisfaction scores	Y; improved electronic communication of test results
Piva, E., et al. (2009). Evaluation of effectiveness of a computerized notification system for reporting critical values. (Am J Clin Pathol, 131(3), 432- 441.)	UBA	Implementation of a computerized notification system for critical lab values (email, text message, video alert)	2 months	Clinicians	14 Departments (including Emergency Department) in one large hospital	Percentage of successful notifications (acknowledge d within 1 hour), time to notification.	Y; improved electronic communication of abnormal test results

Key (study design):

• ■UBA (Uncontrolled before and after study)
• ■CBA (Controlled before and after study)
• ■Post-test only (measures only taken after intervention was implemented)