Diagnostic safety in the policy landscape - a comparative policy document analysis of Australian and Aotearoa New Zealand vs US health care and research policy

Diagnostic safety, a subset of patient safety, ensures safe, high-quality care in the diagnostic process e.g. through reporting and evaluating near-misses and errors. It involves healthcare policy (e.g. incident reporting guidelines) and research policy (e.g. research funding). To date, policy attention to diagnostic safety has been limited. Across United States (US) versus Australian and Aotearoa New Zealand (AUS/AoNZ) policy contexts, we systematically identified relevant policy documents from national health quality organisations and Emergency Medicine (EM) specialist colleges and compared the development and integration of diagnostic safety into policy. We adopted a directed policy document analytical approach (READ (Ready materials, Extract data, Analyse data, Distil findings) to develop comparative frameworks for diagnostic safety policy and embedded a case study on Emergency Medicine guidelines. We identified 237 publicly available, written policy documents (AUS/AoNZ: n = 151; US: n = 86) and 36 EM guidelines AUS/AoNZ: n = 16; US: n = 20) from national US and AUS/AoNZ health quality organisations and EM specialist colleges. The majority of policy documents (55%) were published between 2019 and 2023. US policy documents had a greater dedicated diagnostic safety focus (n = 58, 67%) compared to a generic patient safety focus (n = 28; 33%) and had higher emphasis on research compared to diseases. AUS/AoNZ documents focused more on generic patient safety (n = 102, 68%) than diagnostic safety (n = 49, 32%) and concentrated more on diseases than research. The majority of EM guidelines (AUS/AoNZ: 81%, US: 75%) contained diagnostic safety comments, but overall 20% focused on treatment rather than diagnosis. US EM guidelines showed greater legal considerations. Awareness of diagnostic safety as reflected in healthcare and research policy is growing. Identifying country-specific differences can inform future strategic policy development and target areas that have received limited attention.