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  1. Using four-phased unit-based patient safety walkrounds to uncover correctable system flaws. | PSNet

    psnet.ahrq.gov/issue/using-four-phased-unit-based-patient-safety-walkrounds-uncover-correctable-system-flaws
    October 05, 2022 - Study Using four-phased unit-based patient safety walkrounds to uncover correctable system flaws. Citation Text: Taylor AM, Chuo J, Figueroa-Altmann A, et al. Using four-phased unit-based patient safety walkrounds to uncover correctable system flaws. Jt Comm J Qual Patient Saf. 2013;39…

  2. Enhancing patient safety and quality of care by improving the usability of electronic health record systems: recommendations from AMIA. | PSNet

    psnet.ahrq.gov/issue/enhancing-patient-safety-and-quality-care-improving-usability-electronic-health-record
    March 04, 2011 - Commentary Enhancing patient safety and quality of care by improving the usability of electronic health record systems: recommendations from AMIA. Citation Text: Middleton B, Bloomrosen M, Dente MA, et al. Enhancing patient safety and quality of care by improving the usability of electro…

  3. Out-of-hospital medication errors among young children in the United States, 2002–2012. | PSNet

    psnet.ahrq.gov/issue/out-hospital-medication-errors-among-young-children-united-states-2002-2012
    June 14, 2017 - Study Out-of-hospital medication errors among young children in the United States, 2002–2012. Citation Text: Smith MD, Spiller HA, Casavant MJ, et al. Out-of-hospital medication errors among young children in the United States, 2002-2012. Pediatrics. 2014;134(5):867-76. doi:10.1542/peds.…

  4. Section 3. Appendix | Agency for Healthcare Research and Quality

    www.ahrq.gov/cpi/centers/ockt/kt/tools/impuspstf/impuspstf3.html
    October 01, 2014 - Section 3. Appendix Additional Prevention Materials and Resources from AHRQ When you use The Guide to Clinical Preventive Services 2009 in the classroom or in practice, here are some additional products AHRQ developed based on the recommendations that you may find helpful. These items can be printed from yo…

  5. In-house, overnight physician staffing: a cross-sectional survey of Canadian adult and pediatric intensive care units. | PSNet

    psnet.ahrq.gov/issue/house-overnight-physician-staffing-cross-sectional-survey-canadian-adult-and-pediatric
    December 04, 2015 - Study In-house, overnight physician staffing: a cross-sectional survey of Canadian adult and pediatric intensive care units. Citation Text: Parshuram CS, Kirpalani H, Mehta S, et al. In-house, overnight physician staffing: a cross-sectional survey of Canadian adult and pediatric intens…

  6. Identifying opportunities for quality improvement in surgical site infection prevention. | PSNet

    psnet.ahrq.gov/issue/identifying-opportunities-quality-improvement-surgical-site-infection-prevention
    June 14, 2017 - Study Identifying opportunities for quality improvement in surgical site infection prevention. Citation Text: Gagliardi AR, Eskicioglu C, McKenzie M, et al. Identifying opportunities for quality improvement in surgical site infection prevention. Am J Infect Control. 2009;37(5):398-402.…

  7. National costs of the medical liability system. | PSNet

    psnet.ahrq.gov/issue/national-costs-medical-liability-system
    May 20, 2015 - Study Classic National costs of the medical liability system. Citation Text: Mello MM, Chandra A, Gawande AA, et al. National costs of the medical liability system. Health Aff (Millwood). 2010;29(9):1569-1577. doi:10.1377/hlthaff.2009.0807. Copy Citation F…

  8. Fatigue and safety in paramedicine. | PSNet

    psnet.ahrq.gov/issue/fatigue-and-safety-paramedicine
    December 16, 2020 - Study Fatigue and safety in paramedicine. Citation Text: Donnelly EA, Bradford P, Davis M, et al. Fatigue and Safety in Paramedicine. CJEM. 2019;21(6):762-765. doi:10.1017/cem.2019.380. Copy Citation Format: DOI Google Scholar BibTeX EndNote X3 XML EndNote 7 XML Endnote tag…

  9. Nonpayment for harms resulting from medical care: catheter-associated urinary tract infections. | PSNet

    psnet.ahrq.gov/issue/nonpayment-harms-resulting-medical-care-catheter-associated-urinary-tract-infections
    December 19, 2017 - Commentary Nonpayment for harms resulting from medical care: catheter-associated urinary tract infections. Citation Text: Wald HL, Kramer AM. Nonpayment for harms resulting from medical care: catheter-associated urinary tract infections. JAMA. 2007;298(23):2782-4. doi:10.1001/jama.298.…

  10. Rates of Patient Safety Indicators in Belgian hospitals were low but generally higher than in US hospitals, 2016-18. | PSNet

    psnet.ahrq.gov/issue/rates-patient-safety-indicators-belgian-hospitals-were-low-generally-higher-us-hospitals-2016
    September 13, 2023 - Study Rates of Patient Safety Indicators in Belgian hospitals were low but generally higher than in US hospitals, 2016-18. Citation Text: Van Wilder A, Bruyneel L, Cox B, et al. Rates of Patient Safety Indicators in Belgian hospitals were low but generally higher than in US hospitals, 20…

  11. Registration errors among patients receiving blood transfusions: a national analysis from 2008 to 2017. | PSNet

    psnet.ahrq.gov/issue/registration-errors-among-patients-receiving-blood-transfusions-national-analysis-2008-2017
    March 18, 2020 - Study Registration errors among patients receiving blood transfusions: a national analysis from 2008 to 2017. Citation Text: Vijenthira S, Armali C, Downie H, et al. Registration errors among patients receiving blood transfusions: a national analysis from 2008 to 2017. Vox Sang. 2021;116…

  12. Is physician mentorship associated with the occurrence of adverse patient safety events? | PSNet

    psnet.ahrq.gov/issue/physician-mentorship-associated-occurrence-adverse-patient-safety-events
    February 11, 2015 - Study Is physician mentorship associated with the occurrence of adverse patient safety events? Citation Text: Harrison R, Sharma A, Lawton R, et al. Is Physician Mentorship Associated With the Occurrence of Adverse Patient Safety Events? J Patient Saf. 2021;17(8):e1633-e1637. doi:10.1097…

  13. Artificial lung ventilation tube connected to the patient in the bed (doc file)

    www.ahrq.gov/sites/default/files/wysiwyg/hai/tools/mrsa/044-vap-prevention-essential.docx
    October 01, 2024 - Ventilator-Associated Pneumonia (VAP) Prevention Essential Practices1 Avoid intubation if possible.2-3 Consider alternative strategies, such as, high flow O2 or noninvasive positive pressure ventilation. Consider each patient’s clinical scenario to determine the most appropriate strategy. Minimize sedation.2-5 Determ…

  14. Implementation Guide | Agency for Healthcare Research and Quality

    www.ahrq.gov/hai/tools/ambulatory-surgery/sections/implementation/implementation-guide.html
    May 01, 2017 - Implementation Guide The Implementation Guide discusses the importance of using the safe surgery checklist as a teamwork and communication tool to improve patient safety. Implementation Guide ( PDF , 441 KB; Text Version ) Appendixes Appendix A. Facility Spreadsheet for One-on-One Conversations ( Word …

  15. Surgical patient safety outcomes in critical access hospitals: how do they compare? | PSNet

    psnet.ahrq.gov/issue/surgical-patient-safety-outcomes-critical-access-hospitals-how-do-they-compare
    June 05, 2019 - Study Surgical patient safety outcomes in critical access hospitals: how do they compare? Citation Text: Natafgi N, Baloh J, Weigel P, et al. Surgical Patient Safety Outcomes in Critical Access Hospitals: How Do They Compare? J Rural Health. 2016;33(2):117-126. doi:10.1111/jrh.12176. C…

  16. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/33653/psn-pdf
    June 01, 2007 - In response to "Failure to Report" (March 2007) June 1, 2007 Paparella S, Vaida AJ, Spath P. In response to "Failure to Report" (March 2007). PSNet [internet]. 2007. https://psnet.ahrq.gov/perspective/response-failure-report-march-2007 In response to "Failure to Report" (March 2007) Letter To the editors: Dr. Sp…

  17. Evaluating ambulatory practice safety: the PROMISES Project administrators and practice staff surveys. | PSNet

    psnet.ahrq.gov/issue/evaluating-ambulatory-practice-safety-promises-project-administrators-and-practice-staff
    August 14, 2017 - Study Evaluating ambulatory practice safety: the PROMISES Project administrators and practice staff surveys. Citation Text: Singer SJ, Nieva HR, Brede N, et al. Evaluating ambulatory practice safety: the PROMISES project administrators and practice staff surveys. Med Care. 2015;53(2):141…

  18. Clinical and economic outcomes attributable to health care–associated sepsis and pneumonia. | PSNet

    psnet.ahrq.gov/issue/clinical-and-economic-outcomes-attributable-health-care-associated-sepsis-and-pneumonia
    December 09, 2015 - Study Clinical and economic outcomes attributable to health care–associated sepsis and pneumonia. Citation Text: Eber MR, Laxminarayan R, Perencevich E, et al. Clinical and economic outcomes attributable to health care-associated sepsis and pneumonia. Arch Intern Med. 2010;170(4):347-53.…

  19. Opportunities and Challenges Ahead | Agency for Healthcare Research and Quality

    www.ahrq.gov/diagnostic-safety/resources/issue-briefs/dxsafety-dx-stewardship8.html
    August 01, 2024 - Diagnostic Stewardship as a Model To Improve the Quality and Safety of Diagnosis Opportunities and Challenges Ahead Previous Page Next Page Table of Contents Diagnostic Stewardship as a Model To Improve the Quality and Safety of Diagnosis Introduction Background Diagnostic Error in the Testi…

  20. Reducing Unecessary Urinary catheter Use in the Emergency Department: How to Implement the Process (ppt file)

    www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/cauti-tools/archived-webinars/integrating-teamwork-tools-cusp-efforts.ppt
    June 02, 2025 - Reducing Unecessary Urinary catheter Use in the Emergency Department: How to Implement the Process Integrating Teamwork Tools into CUSP Efforts Shannon Davila, RN, MSN, CIC, CPQH New Jersey Hospital Association Slides adapted from original source: Barbara Edson, RN, MBA, MHA VP, Clinical Quality, Health Research &…
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