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psnet.ahrq.gov/web-mm/privacy-or-safety
December 01, 2011 - achieve a more value-based, patient-centered, learning health care system create new opportunities for … health care system—is considered research, and the patient's prior consent is needed unless a Privacy … engaged in by health care providers. … not necessary—and providers and health care delivery systems should consult with their privacy officer … Paving the regulatory road to the "learning health care system."
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psnet.ahrq.gov/node/859647/psn-pdf
January 04, 2024 - How Healthcare Systems Can Mitigate Their Contribution to Climate Change
Worldwide, the healthcare industry … Sustainable and
resilient health care in the face of a changing climate. … Health care pollution and
public health damage in the United States: an update: Study examines health … Institute of Medicine (US) Committee on Quality of Health Care in America. … Bringing environmental sustainability into the quality agenda: time to act on
reducing health care pollution
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psnet.ahrq.gov/issue/complexity-medication-related-verbal-orders
November 17, 2010 - dispensing and administration in critical access hospitals. … September 22, 2010
Enabling a learning healthcare system with automated computer protocols … care system: use of medication administration record and bar code scanning technology. … March 18, 2010
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Hospitals
Health … Care Providers
Quality and Safety Professionals
Information Professionals
Hospital Pharmacy
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psnet.ahrq.gov/web-mm/mistaken-dose-naloxone
March 21, 2009 - To mitigate this risk, there have been increasing efforts to expand access to naloxone, an opioid antagonist … decrease overdose deaths. 3 Prescribers and pharmacists play important roles in increasing access to … One strategy to aid healthcare professionals in achieving important clinical interventions is to use … Healthcare systems and providers should use multi-layered education to inform patients about appropriate … naloxone use. 14,15
Individual providers and healthcare systems need to do a better job of identifying
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psnet.ahrq.gov/perspective/conversation-alison-holmes-md-mph
March 01, 2014 - If you were in charge of the health care system in the United States would you build in such targets … But in terms of prioritization it will depend on what health care systems can offer. … ensure the safety of patients in the health care system. … system. … Public reporting of health care–associated surveillance data: recommendations from the Healthcare Infection
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psnet.ahrq.gov/perspective/pharmacist-role-patient-safety
June 29, 2020 - opioid use, access to medications, medication adherence, readmission reductions, and medication safety … developed a pharmacist-led prior authorization drug request program with the goal of ensuring timely access … However, pharmacist review and approval of prescriptions before nurses can access a medicine is critical … Related Resources From the Same Author(s)
Perspective
Health … Care Delivery and Pharmacists During the COVID-19 Pandemic
June 29, 2020
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psnet.ahrq.gov/periodic-issue/periodic-issue-460
October 30, 2024 - Errors typically occur due to lack of access to the appropriate knowledge, and neither system is essential … In this study, people who have used community-based mental health care, carers, and providers shared … Commentary
From theory to policy in resilient health care: policy recommendations … improve resilience in health care, including the role of patients and caregivers, creating a culture … Newspaper/Magazine Article
How America’s health care system fails women in pain
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psnet.ahrq.gov/issue/patient-safety-and-quality-improvement-act-2005-hhs-guidance-regarding-patient-safety-work
December 24, 2008 - Agency for Healthcare Research and Quality. Fed Regist. 2016;81(100);32655-32660. … May 19, 2021
Request for Information: Creating a National Healthcare System Action Alliance … November 30, 2016
Medicare and Medicaid Programs; Hospital and Critical Access Hospital … Medicaid program; payment adjustment for provider-preventable conditions including health … care–acquired conditions.
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psnet.ahrq.gov/issue/there-role-patients-and-their-relatives-escalating-clinical-deterioration-hospital-systematic
March 08, 2023 - March 8, 2023
Patient and public co-creation of healthcare safety and healthcare system … April 13, 2022
Impact of providing patients access to electronic health records on quality … in healthcare improvement. … October 10, 2012
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Hospitals
Health … Care Providers
Medicine
Active Errors
Provider-Patient Communication
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psnet.ahrq.gov/issue/10-patient-safety-tips-hospitals
December 09, 2009 - Rockville, MD: Agency for Healthcare Research and Quality; December 2009. … research funded by the Agency for Healthcare Research and Quality. … The tips can be grouped into three areas: 1) reducing health care-acquired infections and retained surgical … instruments through use of specific clinical practices; 2) improving drug safety by ensuring access … July 24, 2013
AHRQ Projects to Prevent Healthcare-Associated Infections, Fiscal Year
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psnet.ahrq.gov/web-mm/crossing-line
December 01, 2012 - Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services … Due to poor peripheral IV access, a central venous catheter (CVC) was inserted by the attending physician … To implement these changes with the greatest chances of success, health care systems should: (i) make … Gould, MD, MS Research Associate and Staff Physician, VA Palo Alto Health Care System Assistant Professor … A sonographically guided technique for central venous access.
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psnet.ahrq.gov/issue/health-literacy-research-current-status-and-future-directions
October 07, 2015 - Copy Citation
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Save to your library
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Share … December 23, 2011
Patient Safety in Dialysis Access. … December 17, 2014
Human Factors and Ergonomics in Healthcare Delivery: A Special Issue … April 8, 2011
Language Barriers in Health Care. … February 22, 2011
The Science of Simulation in Healthcare: Defining and Developing Clinical
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psnet.ahrq.gov/node/60330/psn-pdf
May 05, 2020 - Particularly in rural
healthcare, advances in telehealth have spurred increased patient access to services … Healthcare System Address
COVID-19 Patient Surge. … www.cms.gov/newsroom/press-releases/trump-
administration-makes-sweeping-regulatory-changes-help-us-healthcare-system-address-covid … /www.cms.gov/newsroom/press-releases/trump-administration-makes-sweeping-regulatory-changes-help-us-healthcare-system-address-covid … /www.cms.gov/newsroom/press-releases/trump-administration-makes-sweeping-regulatory-changes-help-us-healthcare-system-address-covid
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psnet.ahrq.gov/node/867652/psn-pdf
February 26, 2025 - When an adverse event
occurs in health care, it is critical to understand why and implement measures … Despite the importance of RCA, its implementation in health care can be challenging.1 RCA effectiveness … However, the healthcare system is highly complex, with
many interdependent parts and processes that … RCA History and Challenges
RCA has a longstanding role in health care, particularly since 1997 when … The challenges of undertaking root cause analysis in health care: a
qualitative study.
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psnet.ahrq.gov/issue/still-not-safe-patient-safety-and-middle-managing-american-medicine
June 26, 2019 - This book surveys the evolution of the collective error reduction effort in health care. … January 27, 2021
Listening for What Matters: Avoiding Contextual Errors in Health Care … Managing Moral Problems in Health Care Systems. … July 17, 2019
Closing Death’s Door: Legal Innovations to End the Epidemic of Healthcare … January 29, 2014
Resilient Health Care Series.
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psnet.ahrq.gov/perspective/patient-safety-primary-care
January 31, 2020 - challenges by increasing provider access to patient information. … more thoughtful design, the exponential growth in the amount of information and data providers have access … to may actually make matters worse, as clinicians struggle to a) maintain awareness and access the totality … Stewardship in Dentistry
December 7, 2020
Perspective
Health … Care Delivery and Pharmacists During the COVID-19 Pandemic
June 29, 2020
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psnet.ahrq.gov/node/851657/psn-pdf
July 26, 2023 - Weight stigma and barriers to effective obesity care.
July 26, 2023
Puhl RM. … Weight stigma and barriers to effective obesity care. … weight-stigma-and-barriers-effective-obesity-care
Implicit biases and stigma can impede the delivery of safe, high-quality healthcare … The authors propose several strategies to reduce weight stigma in health
care, including stigma-reduction … psnet.ahrq.gov/issue/weight-stigma-and-barriers-effective-obesity-care
https://psnet.ahrq.gov/issue/stigma-and-healthcare-access-among-transgender-and-gender-diverse-people-qualitative-meta
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psnet.ahrq.gov/issue/unacceptable-behaviours-between-healthcare-workers-just-tip-patient-safety-iceberg
February 16, 2022 - Commentary
Unacceptable behaviours between healthcare workers: just the tip of the … Disruptive behaviors are discouragingly present in health care. … May 12, 2021
Impact of providing patients access to electronic health records on quality … August 29, 2011
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Health Care Providers … Health Care Executives and Administrators
Psychological and Social Complications
Latent Errors
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psnet.ahrq.gov/innovation/us-department-veterans-affairs-medical-center-houston-tx-and-baylor-college-medicine
February 26, 2025 - Access to comprehensive electronic health records (progress notes, tests, referrals) and a shared understanding … diagnostic error. 13 Other potential factors may relate to the healthcare system and care team, the … Int J Quality Health Care. 2020; 32(6):405-411. doi:10.1093/intqhc/mzaa066
Grants to enable diagnostic … Int J Quality Health Care. 2020;32(6):405-411. doi:10.1093/intqhc/mzaa066
Saleh Velez FG, Alvarado-Dyer … https://www.geisinger.edu/research/research-at-geisinger/learning-healthcare-system/safer-dx
Saber
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psnet.ahrq.gov/node/49738/psn-pdf
August 21, 2015 - achieve a more value-based, patient-
centered, learning health care system create new opportunities … health care
system—is considered research, and the patient's prior consent is needed unless a Privacy … likely not necessary—and providers and health care delivery systems should
consult with their privacy … Paving the regulatory road to the "learning health care system." … onc-ehr-adoption-hospitals-has-tripled-hitech
https://www.stanfordlawreview.org/online/privacy-paradox/learning-health-care-system