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psnet.ahrq.gov/node/47547/psn-pdf
February 13, 2019 - Prevention of prescription opioid misuse and projected
overdose deaths in the United States.
February 13, 2019
Chen Q, Larochelle MR, Weaver DT, et al. Prevention of Prescription Opioid Misuse and Projected
Overdose Deaths in the United States. JAMA Netw Open. 2019;2(2):e187621.
doi:10.1001/jamanetworkopen.2018.76…
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psnet.ahrq.gov/node/46361/psn-pdf
May 23, 2018 - Inadequate hand-off communication.
May 23, 2018
Inadequate hand-off communication. Sentinel event alert. 2017;58(58):1-6.
https://psnet.ahrq.gov/issue/inadequate-hand-communication
The Joint Commission publishes sentinel event alerts to draw attention to pressing or emerging safety
issues and provide guidelines fo…
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psnet.ahrq.gov/node/41369/psn-pdf
May 29, 2015 - Cognitive interventions to reduce diagnostic error: a
narrative review.
May 29, 2015
Graber ML, Kissam S, Payne VL, et al. Cognitive interventions to reduce diagnostic error: a narrative
review. BMJ Qual Saf. 2012;21(7):535-557. doi:10.1136/bmjqs-2011-000149.
https://psnet.ahrq.gov/issue/cognitive-interventions-re…
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psnet.ahrq.gov/node/45461/psn-pdf
January 03, 2017 - Operating room–to-ICU patient handovers: a
multidisciplinary human-centered design approach.
January 3, 2017
Segall N, Bonifacio AS, Barbeito A, et al. Operating Room-to-ICU Patient Handovers: A Multidisciplinary
Human-Centered Design Approach. Jt Comm J Qual Patient Saf. 2016;42(9):400-14.
https://psnet.ahrq.gov/…
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psnet.ahrq.gov/node/40473/psn-pdf
July 02, 2011 - A systematic review of failures in handoff communication
during intrahospital transfers.
July 2, 2011
Ong M-S, Coiera E. A systematic review of failures in handoff communication during intrahospital transfers.
Jt Comm J Qual Patient Saf. 2011;37(6):274-284.
https://psnet.ahrq.gov/issue/systematic-review-failures-h…
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www.ahrq.gov/takeheart/assessing/evaluation-report/index.html
August 01, 2023 - Hybrid Cardiac Rehabilitation Workgroup Evaluation Report
Evaluation Report
Implementing PCOR To Increase Referral, Enrollment, and Retention in Cardiac Rehabilitation Through Automatic Referral With Care Coordination
Overview
Although interest in nontraditional models of care in cardiac rehab…
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psnet.ahrq.gov/node/43533/psn-pdf
August 28, 2017 - Organizational, cultural, and psychological determinants
of smart infusion pump work arounds: a study of 3 U.S.
health systems.
August 28, 2017
Dunford BB, Perrigino M, Tucker SJ, et al. Organizational, Cultural, and Psychological Determinants of
Smart Infusion Pump Work Arounds: A Study of 3 U.S. Health Systems. …
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www.ahrq.gov/sites/default/files/wysiwyg/ncepcr/research/pcph-stakeholder-report.pdf
September 01, 2022 - Person-Centered Preventive Healthcare: Gathering Stakeholder Input on Evidence and Implementation
Person-Centered Preventive Healthcare:
Gathering Stakeholder Input on
Evidence and Implementation
Clinical preventive services (CPS), such as vaccinations and cancer screenings, can help individuals live
longer, heal…
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psnet.ahrq.gov/node/48061/psn-pdf
June 12, 2019 - Interventions to reduce burnout and improve resilience:
impact on a health system's outcomes.
June 12, 2019
Moffatt-Bruce SD, Nguyen MC, Steinberg B, et al. Interventions to Reduce Burnout and Improve
Resilience: Impact on a Health System's Outcomes. Clin Obstet Gynecol. 2019;62(3):432-443.
doi:10.1097/GRF.0000000…
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psnet.ahrq.gov/node/38288/psn-pdf
February 03, 2011 - Hospital-wide code rates and mortality before and after
implementation of a rapid response team.
February 3, 2011
Chan PS, Khalid A, Longmore LS, et al. Hospital-wide code rates and mortality before and after
implementation of a rapid response team. JAMA. 2008;300(21):2506-13. doi:10.1001/jama.2008.715.
https://ps…
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www.ahrq.gov/ncepcr/communities/pbrn/registry/ambulatory-research-community-health-network.html
February 07, 2019 - Ambulatory Research Community Health Network
Status:
Active
Registered Date:
February 7, 2019
PBRN Acronym:
ARCHNet
PBRN Type:
Family Medicine Network (at least 75% are Family Medicine Clinicians)
Network Category:
Established
Street Address:
937 Morrison Ave.
…
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www.ahrq.gov/ncepcr/communities/pbrn/registry/building-investigative-practices-better-health-outcomes-research-network.html
January 01, 2012 - Building Investigative Practices for Better Health Outcomes Research Network
Status:
Active
Registered Date:
January 1, 2012
PBRN Acronym:
BIGHORN
PBRN Type:
Family Medicine Network (at least 75% are Family Medicine Clinicians)
Network Category:
Established
Street Add…
-
psnet.ahrq.gov/node/863747/psn-pdf
March 06, 2024 - "Good care is slow enough to be able to pay attention":
primary care time scarcity and patient safety.
March 6, 2024
Satterwhite S, Nguyen M-LT, Honcharov V, et al. "Good care is slow enough to be able to pay attention":
primary care time scarcity and patient safety. J Gen Intern Med. 2024;39(9):1575-1582.
doi:10.…
-
www.ahrq.gov/ncepcr/communities/pbrn/registry/colorado-childrens-outcomes-network.html
January 01, 2012 - Colorado Children's Outcomes Network
Status:
Active
Registered Date:
January 1, 2012
PBRN Acronym:
COCONet
PBRN Type:
Pediatric Network (at least 75% are pediatricians or specialize in child health)
Network Category:
Established
Street Address:
1890 N Revere Ct, Thi…
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www.ahrq.gov/antibiotic-use/long-term-care/safety/index.html
January 01, 2024 - Create a Culture of Safety Around Antibiotic Prescribing
For information on how the materials below can be integrated into institutional efforts to improve antibiotic use, read the Implementation Guide for Long-Term Care Antibiotic Stewardship Programs (PDF, 402 KB).
Presentations
Improving antibi…
-
psnet.ahrq.gov/node/39063/psn-pdf
December 17, 2009 - Safety and risk management interventions in hospitals: a
systematic review of the literature.
December 17, 2009
Dückers M, Faber M, Cruijsberg J, et al. Safety and risk management interventions in hospitals: a
systematic review of the literature. Med Care Res Rev. 2009;66(6 Suppl):90S-119S.
doi:10.1177/10775587093…
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www.ahrq.gov/hai/tools/clabsi-cauti-icu/overcome/functioning.html
April 01, 2022 - Team Functioning
From your first team convening where you set your unit's goals for preventing infections, to celebrating and spreading successful strategies with other units, team functioning is essential to creating and sustaining a culture of safety. Common challenges addressed by these tools are how to stru…
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www.ahrq.gov/sites/default/files/wysiwyg/policymakers/chipra/overview/background/measures-AC-17.pdf
December 16, 2010 - MEASURE SUMMARY (CHIPRA Core Set Candidate Measures) - Control #: AC-17
Completed by:
Page 1 12/16/2010
MEASURE SUMMARY
CHIPRA Core Set Candidate Measures
A. Control #: AC-17
B. Measure Name: Otitis Media with Effusion (OME): Systemic antimicrobials – Avoidance of inappropriate
use
C. Measure Defini…
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psnet.ahrq.gov/node/40450/psn-pdf
December 21, 2014 - Unit-based care teams and the frequency and quality of
physician–nurse communications.
December 21, 2014
Gordon M, Melvin P, Graham DA, et al. Unit-based care teams and the frequency and quality of physician-
nurse communications. Arch Pediatr Adolesc Med. 2011;165(5):424-8. doi:10.1001/archpediatrics.2011.54.
htt…
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psnet.ahrq.gov/node/39873/psn-pdf
January 22, 2017 - A proactive risk avoidance system using failure mode and
effects analysis for "same-name" physician orders.
January 22, 2017
Tarpey K, Schaaf E, Lakhani U, et al. A proactive risk avoidance system using failure mode and effects
analysis for "same-name" physician orders. Jt Comm J Qual Patient Saf. 2010;36(10):461-7…