Causes of Medical Errors and Their Relative Importance: Systematic Review

Abstract

Context: Recently, many health systems worldwide have renewed their interest in identifying the dimensions, causes, and contributing factors of medical errors (MEs), as well as strategies to reduce the associated risks. Objectives: The present study aimed to identify the underlying reasons for MEs and assess the relative importance of their occurrence. Data Sources: A comprehensive search was conducted in Iranian (SID) and international databases (PubMed, Web of Science, and Scopus) to identify studies on MEs worldwide. The search included manuscripts published from 2000 to May 2025. Study Selection: The review included articles published in English and Persian, considering various document types such as original articles, book chapters, and clinical guidelines. Review articles, editorials, letters, commentaries, and conference abstracts were excluded. Only full-text studies were eligible for inclusion. Data Extraction: The study utilized the PRISMA 2020 statement for reporting systematic reviews and assessed the quality of the included research studies using the Joanna Briggs tool. The findings were qualitatively synthesized by organizing the identified causes of MEs into thematic categories. A meta-analysis was not conducted due to the heterogeneity of study designs and reported outcomes. Results: Of the 3339 publications screened, 42 were included for data extraction. The causes of MEs were categorized into eight groups: Patient, team, task, drug, equipment, organization, healthcare service provider, and work environment. Among the included studies, eight were conducted in Iran, with common causes related to healthcare providers, particularly insufficient knowledge and communication issues. In studies from other countries, knowledge deficits were more frequent in low-income settings, whereas interpersonal communication failures were prominent in high-income settings. Conclusions: The study highlights the diverse causes of MEs across different settings, emphasizing the need for targeted strategies to address specific issues related to healthcare providers, communication, and knowledge deficits.