Diagnostic Safety Issue Briefs

Starting in 2019, AHRQ supported the development of a series of papers on different diagnostic safety topics. The purpose of the papers was to develop, based on research conducted to date, more resources to improve diagnostic safety and quality, during a time when research to improve diagnostic safety was still an emerging field as compared to research to understand and prevent treatment-related mishaps. The papers fall under two types—either a "call to action" or a "state of the science." The majority of these papers were published as AHRQ issue briefs, but several were also published in peer reviewed journals and made open access.

Summary and Current State of the Science

Current State of Diagnostic Safety: Implications for Research, Practice, and Policy

Measurement and Reporting of Diagnostic Safety

Strategies for Improving Clinician Psychological Safety in Reporting and Discussing Diagnostic Error

Operational Measurement of Diagnostic Safety: State of the Science

Cognition, Clinical Reasoning, Education, and Training

Cognitive Load Theory and Its Impact on Diagnostic Accuracy

Improved Diagnostic Accuracy Through Probability-Based Diagnosis

Distributed Cognition and the Role of Nurses in Diagnostic Safety in the Emergency Department

Improving Education—A Key to Better Diagnostic Outcomes

Evidence on Use of Clinical Reasoning Checklists for Diagnostic Error Reduction

System Design and Teamwork

Diagnostic Stewardship as a Model To Improve the Quality and Safety of Diagnosis

Learning from AHRQ's Diagnostic Safety Culture Survey at a Tertiary Care Health System in Brazil: A Case Study

Diagnostic Safety Across Transitions of Care Throughout the Healthcare System: Current State and a Call to Action

Reinforcing the Value and Roles of Nurses in Diagnostic Safety: Pragmatic Recommendations for Nurse Leaders and Educators

Leadership To Improve Diagnosis: A Call to Action

Patient Experience and Engagement

The Patient’s Role in Diagnostic Safety and Excellence: From Passive Reception Toward Co-Design

Patient Experience as a Source for Understanding the Origins, Impact, and Remediation of Diagnostic Errors. Vol.1: Why Patient Narratives Matter

Patient Experience as a Source for Understanding the Origins, Impact, and Remediation of Diagnostic Errors. Vol.2: Eliciting Patient Narratives

Health Information Technology for Engaging Patients in Diagnostic Decision Making in Emergency Departments

Specific Populations

Diagnostic Excellence in U.S. Rural Healthcare: A Call to Action

State of the Science and Future Directions To Improve Diagnostic Safety in Older Adults

Pediatric Diagnostic Safety: State of the Science and Future Directions

The Contribution of Diagnostic Errors to Maternal Morbidity and Mortality During and Immediately After Childbirth: State of the Sciences

Technology

Electronic Test Result Communication in the Era of the 21st Century Cures Act

Documenting Diagnosis: Exploring the Impact of Electronic Health Records on Diagnostic Safety

Reimagining Healthcare Teams: Leveraging the Patient-Clinician-AI Triad To Improve Diagnostic Safety

Telediagnosis for Acute Care: Implications for the Quality and Safety of Diagnosis