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Diagnostic Safety and Quality

Diagnostic errors occur in all settings of care, contribute to about 10 percent of patient deaths, and are the primary reason for medical liability claims.  AHRQ is the lead Federal agency investing in research to improve diagnostic safety and reduce diagnostic error.

Since 2007, AHRQ has invested in research to discover findings that advance the knowledge of diagnostic safety and to develop practical tools and resources to improve diagnostic safety. AHRQ funds research to better understand how diagnostic errors happen and what can be done to prevent them.

Research Summit

The September 2016 AHRQ Research Summit on Improving Diagnosis in Health Care explored the state of the science of diagnosis in health care and discussed ways AHRQ and other stakeholders can contribute to a collaborative approach to improving diagnostic performance, as well as identify the research and evidence, tools and training, and data and measures that are needed to improve diagnostic performance.

An article in the June 2017 issue of Diagnosis, authored by members of AHRQ's patient safety team, builds upon themes from the summit by outlining key challenges and areas for potential future research and improvement related to diagnostic errors. Among them are: more robust engagement of patients as an integral part of their health care team; a deeper understanding of diagnostic errors and how to most effectively measure them; successful use of health information technology (IT) to prevent diagnostic error; and structures that optimize how organizations operate and enable better diagnoses for patients.

Studies

AHRQ has funded several recent studies on diagnostic error:

  • Outpatient diagnostic errors affect 1 in 20 U.S. adults. This study used data from three previous studies of errors in general primary care diagnosis, colorectal cancer diagnosis, and lung cancer diagnosis. The authors estimated that about half of the diagnostic errors they found could have severely harmed patients.
  • Pediatricians self-report an appreciable number of diagnostic errors. This study also finds that pediatricians are most interested in preventing high-frequency, non-life-threatening errors. A third (36%) reported no help in diagnostic error reduction from their electronic health record.
  • Additional studies and resources can be found by visiting AHRQ's Patient Safety Network and searching for diagnostic error.

Grants Related to Diagnostic Errors

Grants Awarded in Fiscal Year 2019

Recognizing that all Americans can be affected by diagnostic errors, Congress authorized $2 million in fiscal year 2019 for AHRQ to initiate a research agenda to understand and solve the problem. AHRQ has awarded 4 grants that will more precisely define the scope of diagnostic errors. As stated in the fiscal year 2019 request for applications, AHRQ has three key areas of interest:

  • Quantifying the incidence of diagnostic errors.
  • Understanding what contributes to these errors.
  • Learning more about the link between diagnostic errors and outcomes, including adverse events.
Grants Awarded in Fiscal Year 2022

In fiscal year 2022, Congress authorized funding to support AHRQ's research to address failures in the diagnostic process, which may include the establishment of Research Centers of Diagnostic Excellence to develop systems, measures, and new technology solutions to improve diagnostic safety and quality. In response, AHRQ awarded 10 grants to establish Diagnostic Safety Centers of Excellence. As stated in the fiscal year 2022 request for application, AHRQ specified the four following areas of interest:

  • Two areas of focus aligned with frontline diagnostician support:
    • Safety-I error detection and prevention and Safety-II resilience for safe practice.
  • Two additional areas of focus aligned with improving diagnostic systems:
    • Improving diagnostic precision through consensus and Improving "truth" or diagnostic reference standards.

Separate grant funding from AHRQ has also supported other diagnostic safety research, including conference grants focused on improving diagnostic safety and quality.

AHRQ tools to reduce diagnostic errors include:

Calibrate Dx is a self-evaluation tool for clinicians to improve their diagnostic decision making. This resource provides structured exercises and tools to help clinicians learn from reviewing their clinical practice. Anyone whose scope of practice includes medical diagnosis can use Calibrate Dx.

Diagnostic Safety Supplemental Items for the Surveys on Patient Safety Culture (SOPS) Medical Office Survey. These supplemental items are designed to be used in conjunction with the core SOPS Medical Office Survey to help medical offices assess the extent to which their organizations support the diagnostic process, accurate diagnoses, and communication around diagnoses.

Guide to Patient and Family Engagement in Hospital Quality and Safety. This guide encourages hospital patients and family members to be involved in their care. It focuses on four primary strategies for promoting patient/family engagement in hospital safety and quality of care:

  • Encourage patients and family members to participate as advisors.
  • Promote better communication among patients, family members, and health care professionals from the point of admission.
  • Implement safe continuity of care by keeping the patient and family informed through nurse bedside change-of-shift reports.
  • Engage patients and families in discharge planning throughout the hospital stay.

Learn more about the importance of patient and family engagement with this infographic (PDF, 392 KB).

Guide to Improving Patient Safety in Primary Care Settings by Engaging Patients and Families offers four interventions and four case studies designed to improve patient safety by meaningfully engaging patients and families in their care.

Improving Your Laboratory Testing Process: A Step-by-Step Guide for Rapid-Cycle Patient Safety and Quality Improvement About 40 percent of patient encounters in primary care offices involve some form of medical test. Studies of primary care offices consistently show that the process for managing tests is a significant source of error and patient harm. This toolkit helps ensure that diagnostic lab tests are accurately managed and shared with patients and clinicians in a timely manner. The tools help examine how tests are managed in the office, from the moment tests are ordered until the patient is notified of the test results and the appropriate follow up is determined.

Measure Dx: A Resource To Identify, Analyze, and Learn From Diagnostic Safety Events is a resource to help healthcare organizations detect, analyze, and learn from diagnostic safety events. Measure Dx can be used by any healthcare organization interested in promoting diagnostic excellence and reducing harm from diagnostic safety events. Potential users include clinicians, quality and safety professionals, risk management professionals, health system leaders, and clinical managers.

Questions Are the Answer: Asking questions about a diagnosis or other aspects of care is a step that patients can take to make care safer. Talking with your doctor builds trust and leads to better results, quality, safety, and satisfaction. One of the best ways to communicate with your doctor and health care team is by asking questions. Because time is limited during medical appointments, you will feel less rushed if you prepare your questions before your appointment. These AHRQ resources demonstrate how asking questions can improve care with tips on how to communicate with clinicians.

Reducing Diagnostic Errors in Primary Care Pediatrics Toolkit aims to assist primary care practice teams with a systematic approach to reduce diagnostic errors among children in three important areas: elevated blood pressure, adolescent depression, and actionable pediatric diagnostic tests. This toolkit walks teams through the measurement, screening, recognition, diagnosis, follow-up, and reduction of diagnostic errors in these areas. It is based on clinical evidence, best practices, and a compilation of resources from the project, which involved over 100 primary care physicians and their care teams working across the United States to improve care for children.

Resources To Facilitate Communication Between Patients and Clinicians: From the IOM report, "Improving Diagnosis in Health Care," this toolkit includes a checklist and other resources to help patients understand what they can to do prevent diagnostic error.

TeamSTEPPS for Diagnosis Improvement: TeamSTEPPS® is an evidence-based program built on a framework composed of four teachable, learnable skills-communication, leadership, situation monitoring, and mutual support. The TeamSTEPPS® for Diagnosis Improvement Course applies the TeamSTEPPS® framework to the specific problem of diagnostic error. When implementing TeamSTEPPS® for Diagnosis Improvement, teams will learn about the four skills and how improved communication among all members of the care team can help lead to safer, more accurate, and more timely diagnosis in all healthcare settings.

The Toolkit for Engaging Patients To Improve Diagnostic Safety is designed to promote enhanced communication and information sharing within the patient-provider encounter to help patients, families, and health professionals work together as partners to improve diagnostic safety.

AHRQ Papers on Diagnostic Safety Topics

AHRQ is developing a series of papers on different diagnostic safety issues. Some papers will be posted on the AHRQ website as Issue Briefs while others will be submitted for publication in peer-reviewed journals.

Issue Briefs

Journal Articles

AHRQ Views Blogs

AHRQ's Patient Safety Network (PSNet)

PSNet highlights the latest patient safety literature, news, and expert commentary, including weekly updates, Web M&M, Patient Safety Primers, and more. You can search diagnostic error to find related studies and resources.

Common Formats for Event Reporting - Diagnostic Safety (CFER-DS)

Background

In 2015, The National Academies of Sciences, Engineering, and Medicine published a report titled Improving Diagnosis in Health Care. This report was a continuation of two previously published reports from the Institute of Medicine: To Err Is Human: Building a Safer Health System (2000) and Crossing the Quality Chasm: A New Health System for the 21st Century (2001). These reports bring attention to the specific problem of diagnostic errors and their effect on the quality and safety of healthcare.

In Improving Diagnosis, NASEM outlined eight goals to reduce diagnostic error and improve diagnosis. Goal 8 is to provide dedicated funding for research on the diagnostic process and diagnostic errors. A recommendation for meeting this goal is for Federal agencies to develop a coordinated research agenda on the diagnostic process and diagnostic errors and to commit dedicated funding to implementing this research agenda.

Following the NASEM report, Senate Report 115-150 requested that AHRQ convene a cross-agency work group to address the lack of dedicated research into improving medical diagnosis and in particular, diagnostic failures that lead to patient harm. The Federal Interagency Workgroup on Improving Diagnostic Safety and Quality in Healthcare was established in response to the Senate Report.

Members

The Workgroup includes members (PDF, 127 KB) from different operating divisions under the U.S. Department of Health and Human Services, as well as representatives from the Department of Defense and the Department of Veterans Affairs.

Meetings

Diagnostic Safety Issue Briefs

Strategies for Improving Clinician Psychological Safety in Reporting and Discussing Diagnostic Error (PDF, 1 MB)

Pediatric Diagnostic Safety: State of the Science and Future Directions (PDF, 1.5 MB)

Reimagining Healthcare Teams: Leveraging the Patient-Clinician-AI Triad To Improve Diagnostic Safety (PDF, 1.7 MB)

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

Patient Experience as a Source for Understanding the Origins, Impact, and Remediation of Diagnostic Errors. Vol. 2: Eliciting Patient Narratives (PDF, 1 MB)

Diagnostic Safety Across Transitions of Care Throughout the Healthcare System: Current State and a Call to Action (PDF, 2 MB)

Reinforcing the Value and Roles of Nurses in Diagnostic Safety: Pragmatic Recommendations for Nurse Leaders and Educators (PDF, 1.2 MB)

Improved Diagnostic Accuracy Through Probability-Based Diagnosis (PDF, 976 KB)

Distributed Cognition and the Role of Nurses in Diagnostic Safety in the Emergency Department (PDF, 1.5 MB)

Improving Education—A Key to Better Diagnostic Outcomes (PDF, 2 MB)

The Contribution of Diagnostic Errors to Maternal Morbidity and Mortality During and Immediately After Childbirth: State of the Science (PDF, 1.4 MB)

Leadership To Improve Diagnosis: A Call to Action (PDF, 2.4 MB)

Health Information Technology for Engaging Patients in Diagnostic Decision Making in Emergency Departments
(PDF, 2.6 MB)

Evidence on Use of Clinical Reasoning Checklists for Diagnostic Error Reduction (PDF, 971 KB)

Telediagnosis for Acute Care: Implications for the Quality and Safety of Diagnosis (PDF, 1 MB)

Operational Measurement of Diagnostic Safety: State of the Science (PDF, 2 MB)

Grants Related to Diagnostic Errors

Diagnostic Safety Grants Awarded in FY 2022

Diagnostic Safety Grants Awarded in FY 2019

Diagnostic Safety Fact Sheet

Improving Diagnosis (PDF, 333 KB)