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psnet.ahrq.gov/issue/safety-management-within-scope-teaching-practical-clinical-skills-framing-errors
December 21, 2022 - September 18, 2024
Cognitive tests predict real-world errors: the relationship between
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psnet.ahrq.gov/issue/indication-alerts-intercept-drug-name-confusion-errors-during-computerized-entry-medication
August 28, 2019 - August 28, 2019
Cognitive tests predict real-world errors: the relationship between drug
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psnet.ahrq.gov/issue/challenger-launch-decision-risky-technology-culture-and-deviance-nasa
November 18, 2015 - normalization of deviance ,” a phenomenon that shares many features with the “status quo bias” discussed in cognitive
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psnet.ahrq.gov/issue/efficiency-and-thoroughness-trade-offs-high-volume-organisational-routines-ethnographic-study
June 14, 2017 - September 1, 2016
Cognitive tests predict real-world errors: the relationship between
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psnet.ahrq.gov/issue/developing-resilience-combat-nurse-burnout
May 01, 2019 - March 20, 2019
Peer training using cognitive rehearsal to promote a culture of safety
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psnet.ahrq.gov/issue/doctors-quest-piece-together-american-health-care
October 05, 2022 - March 6, 2024
The Cognitive Autopsy: A Root Cause Analysis of Medical Decision Making
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psnet.ahrq.gov/issue/missed-diagnosis-cancer-primary-care-insights-malpractice-claims-data
March 15, 2017 - April 9, 2013
Cognitive errors and logistical breakdowns contributing to missed and delayed
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psnet.ahrq.gov/issue/5th-national-audit-project-nap5-accidental-awareness-during-general-anaesthesia-patient
October 01, 2014 - January 28, 2010
No simple fix for fixation errors: cognitive processes and their clinical
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psnet.ahrq.gov/issue/fair-and-reliable-medical-justice-act
March 06, 2005 - December 30, 2014
Minnesota hospitals are testing ways to reduce return trips.
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psnet.ahrq.gov/issue/making-healthcare-safe-story-patient-safety-movement
January 20, 2021 - October 12, 2022
Cognitive Errors and Diagnostic Mistakes: A Case-Based Guide to Critical
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psnet.ahrq.gov/issue/toolkit-engaging-patients-improve-diagnostic-safety
October 19, 2022 - Tools/Toolkit
Toolkit for Engaging Patients to Improve Diagnostic Safety.
Citation Text:
Toolkit for Engaging Patients to Improve Diagnostic Safety. Rockville, MD: Agency for Healthcare Research and Quality; August 2021. AHRQ Publication No. 21-0047-2-EF.
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psnet.ahrq.gov/issue/structured-override-reasons-drug-drug-interaction-alerts-electronic-health-records
April 29, 2018 - May 1, 2019
The effect of cognitive load and task complexity on automation bias in electronic
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psnet.ahrq.gov/issue/exploring-situational-awareness-diagnostic-errors-primary-care
September 20, 2011 - August 7, 2013
Cognitive errors and logistical breakdowns contributing to missed and
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psnet.ahrq.gov/web-mm/sleep-deprivation-leads-medication-error-during-spinal-epidural-anesthesia
January 29, 2021 - Background Sleep deprivation impairs cognitive function and adversely affects performance in many occupations … deprivation in resident physicians in hospitals has been associated with impaired psychomotor skills and cognitive … deprived residents have higher levels of inflammatory biomarkers and display greater impulsivity, slower cognitive … processing, and impaired executive function. 14 On psychomotor testing, at least 4 hours of sleep were
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psnet.ahrq.gov/web-mm/diagnostic-overshadowing-dangers
February 12, 2020 - suspicions of malingering or drug-seeking behavior that can result in withholding adequate diagnostic testing … to clinicians' tendency to misattribute symptoms of individuals with learning disabilities to their cognitive … evaluation (e.g., serial electrocardiograms; trending troponin) followed by further diagnostic cardiac testing
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psnet.ahrq.gov/issue/why-are-medical-errors-still-leading-cause-death
September 13, 2017 - December 30, 2014
Minnesota hospitals are testing ways to reduce return trips.
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psnet.ahrq.gov/issue/our-stubborn-quest-diagnostic-certainty
June 21, 2016 - June 21, 2016
Cognitive errors in diagnosis: instantiation, classification, and consequences
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psnet.ahrq.gov/issue/experiences-diagnostic-delay-among-underserved-racial-and-ethnic-patients-systematic-review
November 03, 2015 - system factors included poor organizational health literacy and provider-related factors such as cognitive
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psnet.ahrq.gov/webmm-case-studies
March 25, 2025 - Pharmacy
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Error Types
Active Errors
(414)
Cognitive … importance of imaging in patients with high-risk abdominal pain, and how to mitigate the influence of cognitive … A Cognitive and Communication Blind Spot Contributes to Permanent Paralysis
Garth Utter, MD | … The commentary highlights the cognitive pitfalls associated with managing and processing large volumes
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psnet.ahrq.gov/issue/sent-home-die
April 22, 2020 - August 23, 2023
Pursuit of "endpoint diagnoses" as a cognitive forcing strategy to avoid