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1. NURS FPX 4035 Assessment 1 Enhancing Quality and Safety
Student Name
Capella University
NURS-FPX4035
Professor’s Name
Submission Date
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NURS FPX 4025 Assessment 3

2. Enhancing Quality and Safety
Diagnostic errors represent one of the most critical threats to healthcare quality, often resulting in
adverse patient outcomes and significant clinical consequences. Errors in diagnosis may occur at
various stages of the care process, including patient history-taking, interpretation of results, and
clinical decision-making. Contributing factors often include excessive workload, insufficient
staffing, communication breakdowns, and limited access to diagnostic tools (Newman-Toker et
al., 2024).
These challenges require a multidimensional approach involving evidence-based practices,
technology integration, and interprofessional collaboration. This paper discusses diagnostic
errors and presents evidence-based measures to mitigate them while highlighting the vital role of
nurses and other stakeholders in promoting diagnostic accuracy and patient safety.
Factors Contributing to Patient Safety Risks
Diagnostic inaccuracies are frequently linked to complex patient conditions, particularly when
individuals present with multiple comorbidities that mask or overlap symptoms. Alharbi et al.
(2025) found that nearly one-fifth of emergency department patients in the United States
experience diagnostic errors, revealing the widespread nature of the problem.
High workloads and chronic understaffing exacerbate these risks, often leading to fatigue,
decreased focus, and impaired clinical judgment. Newman-Toker et al. (2024) estimate that
diagnostic errors result in approximately 795,000 permanent disabilities or deaths annually in the
United States, demonstrating their profound implications for patient safety.
Another major factor contributing to diagnostic errors is inadequate communication and
insufficient training. The absence of continuous education on new diagnostic tools or systems
may lead clinicians to overlook subtle indicators of disease. Furthermore, poor communication
among physicians, nurses, and specialists leads to fragmented care, increasing the likelihood of
diagnostic delays or omissions.
Electronic health record (EHR) system failures also contribute to diagnostic inaccuracies. Krevat
et al. (2023) found that 61.3% of diagnostic errors were related to EHR factors. This emphasizes
the need for optimized digital systems to support accuracy, communication, and coordination in
patient care.
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3. Utilizing Standards to Illustrate Safety Risks
Diagnostic inaccuracies pose substantial threats to patient safety and are recognized by global
health organizations as preventable sources of harm. The Joint Commission includes accurate
diagnosis and effective communication as key National Patient Safety Goals (Arnetz, 2022).
Similarly, the World Health Organization (2021) identifies diagnostic safety as a global priority
requiring structured intervention.
Implementation of standard protocols, continuous monitoring, and a culture of transparency can
help identify and correct risks early. Regular incident reporting, compliance audits, and
adherence to safety frameworks help build an institutional culture focused on quality
improvement. Aligning healthcare policies with internationally recognized standards enhances
patient safety, reduces avoidable harm, and strengthens overall care delivery.
Evidence-Based Solutions for Patient Safety
Evidence-based strategies improve patient outcomes by strengthening diagnostic accuracy and
minimizing human error. The integration of computerized provider order entry (CPOE) systems
with clinical decision support systems (CDSS) alerts clinicians about potential errors, missing
information, or misinterpretations (Olakotan & Yusof, 2021).
Standardized communication frameworks, such as the SBAR (Situation, Background,
Assessment, Recommendation) model, ensure clear information exchange during care transitions
and reduce the risk of miscommunication (Azmi et al., 2025). Additionally, simulation-based
learning and periodic training refine clinical reasoning, allowing healthcare professionals to
enhance diagnostic precision and maintain current knowledge.
Encouraging a non-punitive culture of error reporting promotes transparency and organizational
learning. Interdisciplinary collaboration and consistent professional development foster
accountability and enable teams to identify and correct errors before they impact patients. Proper
utilization of EHRs and CDSS tools can significantly improve data accuracy, expedite clinical
decisions, and prevent diagnostic mistakes.
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4. Nurse-Led Coordination and Cost Reduction
Nurses play a pivotal role in care coordination, directly influencing diagnostic accuracy and
reducing related healthcare costs. Their involvement in patient monitoring, test result evaluation,
and documentation ensures that critical diagnostic steps are not missed (Iula et al., 2020).
Through vigilant assessment and communication, nurses can identify discrepancies or
incomplete data that might lead to misdiagnosis or delayed intervention. Additionally, nurse-led
patient education encourages individuals to accurately report symptoms, improving diagnostic
clarity. By collaborating with physicians and other healthcare providers, nurses streamline care
delivery and minimize redundant procedures.
Furthermore, nurses enhance patient outcomes by leveraging technology such as EHRs to track
test results, identify trends, and monitor patient progress efficiently (Iula et al., 2020). Their
leadership in multidisciplinary teams supports real-time information sharing, continuity of care,
and cost-effective healthcare delivery.
Stakeholder Involvement in Quality Enhancement
Improving diagnostic safety is a collective responsibility involving nurses, physicians, laboratory
and imaging specialists, administrators, IT professionals, patients, and families. Nurses work
closely with physicians to ensure that test results, clinical warnings, and patient symptoms are
promptly communicated. Collaboration with laboratory and imaging personnel ensures accurate
and timely data collection, which is vital to diagnosis (Alhawsawi et al., 2023).
Patients and their families serve as essential stakeholders by providing accurate information and
participating actively in care decisions. Administrators and IT specialists play critical roles in
supporting healthcare professionals with adequate staffing, technological resources, and system
optimization to prevent data-related errors.
Active nurse participation in Quality Improvement (QI) initiatives enhances the diagnostic
process by identifying procedural gaps and introducing corrective measures. This teamwork
fosters accountability, transparency, and mutual respect across the healthcare continuum,
ultimately strengthening the culture of safety.
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5. Potential and Relevance
The participation of nurses in diagnostic accuracy efforts has far-reaching implications for
healthcare quality and patient safety. Nurses are integral to the early identification of risks,
timely interpretation of test results, and monitoring of clinical changes (Iula et al., 2020).
Engaging patients and families in the diagnostic process fosters trust and ensures complete
symptom reporting. Administrators and IT teams support these initiatives by providing access to
advanced diagnostic technologies and training. Effective collaboration with technology
specialists helps sustain robust data systems and continuous process improvement (Olakotan &
Yusof, 2021).
These combined efforts promote a culture of precision, communication, and accountability,
which directly translates to improved safety outcomes and reduced healthcare inefficiencies.
Conclusion
Diagnostic errors present a critical challenge to healthcare systems, yet they are largely
preventable through evidence-based practices and interdisciplinary collaboration. The integration
of CDSS, standardized communication methods, and ongoing professional training enhances
diagnostic accuracy and mitigates patient harm.
Nurses, as frontline coordinators of care, play a crucial role in safeguarding diagnostic processes
through careful assessment, documentation, and teamwork. Success in this domain depends on
collaboration among physicians, nurses, laboratory personnel, IT experts, administrators, and
patients. Collectively, these efforts nurture a strong culture of safety, elevate healthcare quality,
and optimize patient outcomes across all care settings.
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6. References
Alhawsawi, A. N., Muhammed, W. M., Almaimony, A. G., Alraffaa, Y. A., Jeadi, M. A.,
Aldossari, W. H., Sofy, A. J., Almutairi, F. M., Abdullah, A., Alzaagi, B. S., Alghamdi, L. M.,
Ali, M., Alenazy, S. M., & Alanazi, A. R. (2023). Exploring interprofessional communication
and collaboration among pharmacists, nurses, and laboratory staff enhances patient safety and
healthcare outcomes. International Journal of Health Sciences (IJHS), 7(S1).
https://doi.org/10.53730/ijhs.v7ns1.14703
Arnetz, J. E. (2022). The Joint Commission’s new and revised workplace violence prevention
standards for hospitals: A major step forward toward improved quality and safety. The Joint
Commission Journal on Quality and Patient Safety, 48(4).
https://doi.org/10.1016/j.jcjq.2022.02.001
Azmi, N., Priambodo, A. P., & Nuraeni, A. (2025). Analysis of handoff communication using
SBAR (Situation, Background, Assessment, Recommendation) in emergency department and
intensive care unit: A scoping review. Journal of Health and Nutrition Research, 4(2), 464–473.
https://doi.org/10.56303/jhnresearch.v4i2.400
Krevat, S. A., Samuel, S., Boxley, C., Mohan, V., Siegel, D., Gold, J. A., & Ratwani, R. M.
(2023). Journal of the American Medical Association Network, 6(4), e238399–e238399.
https://doi.org/10.1001/jamanetworkopen.2023.8399
Newman-Toker, D. E., Nassery, N., Schaffer, A. C., Yu-Moe, C. W., Clemens, G. D., Wang, Z.,
Zhu, Y., Tehrani, A. S. S., Fanai, M., Hassoon, A., & Siegel, D. (2024). Burden of serious harms
from diagnostic error in the USA. BMJ Quality & Safety, 33(2). https://doi.org/10.1136/bmjqs-
2021-014130
Olakotan, O. O., & Yusof, M. M. (2021). The appropriateness of clinical decision support
systems alerts in supporting clinical workflows: A systematic review. Health Informatics
Journal, 27(2), 1–22. https://doi.org/10.1177/14604582211007536
World Health Organization. (2021). Global patient safety action plan 2021–2030.
https://books.google.com/books?id=csZqEAAAQBAJ
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