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3421. Using the Targeted Solutions Tool® to improve emergency department handoffs in a community hospital. | PSNet
      psnet.ahrq.gov/issue/using-targeted-solutions-toolr-improve-emergency-department-handoffs-community-hospital
      April 13, 2022 - Study Using the Targeted Solutions Tool® to improve emergency department handoffs in a community hospital. Citation Text: Benjamin MF, Hargrave S, Nether K. Using the Targeted Solutions Tool® to Improve Emergency Department Handoffs in a Community Hospital. Jt Comm J Qual Patient Saf. 2…

3422. Differences in safety climate among hospital anesthesia departments and the effect of a realistic simulation-based training program. | PSNet
      psnet.ahrq.gov/issue/differences-safety-climate-among-hospital-anesthesia-departments-and-effect-realistic
      October 19, 2022 - Study Differences in safety climate among hospital anesthesia departments and the effect of a realistic simulation-based training program. Citation Text: Cooper JB, Blum RH, Carroll JS, et al. Differences in safety climate among hospital anesthesia departments and the effect of a reali…

3423. A steep increase in domestic fatal medication errors with use of alcohol and/or street drugs. | PSNet
      psnet.ahrq.gov/issue/steep-increase-domestic-fatal-medication-errors-use-alcohol-andor-street-drugs
      September 20, 2011 - Study A steep increase in domestic fatal medication errors with use of alcohol and/or street drugs. Citation Text: Phillips DP, Barker GEC, Eguchi MM. A steep increase in domestic fatal medication errors with use of alcohol and/or street drugs. Arch Intern Med. 2008;168(14):1561-6. doi:1…

3424. Intervention study for the reduction of medication errors in elderly trauma patients. | PSNet
      psnet.ahrq.gov/issue/intervention-study-reduction-medication-errors-elderly-trauma-patients
      December 18, 2019 - Study Intervention study for the reduction of medication errors in elderly trauma patients. Citation Text: Parro Martín M de los Á, Muñoz García M, Delgado Silveira E, et al. Intervention study for the reduction of medication errors in elderly trauma patients. J Eval Clin Pract. 2021;27(…

3425. | Agency for Healthcare Research and Quality
      www.ahrq.gov/es/tools/index.html?page=0
      December 01, 2015 - Comprehensive Unit-based Safety Program (CUSP) The CUSP toolkit includes training tools to make care safer. More The SHARE Approach Five-step process for clinicians and their patients More EvidenceNOW Tools for Change Helping practices implement evidence More Tools The …

3426. U.S. compounding pharmacy-related outbreaks, 2001--2013: public health and patient safety lessons learned. | PSNet
      psnet.ahrq.gov/issue/us-compounding-pharmacy-related-outbreaks-2001-2013-public-health-and-patient-safety-lessons
      August 24, 2022 - Review U.S. compounding pharmacy-related outbreaks, 2001--2013: public health and patient safety lessons learned. Citation Text: Shehab N, Brown MN, Kallen AJ, et al. U.S. compounding pharmacy-related outbreaks, 2001--2013: public health and patient safety lessons learned. J Patient Saf.…

3427. Disclosure of hospital adverse events and its association with patients' ratings of the quality of care. | PSNet
      psnet.ahrq.gov/issue/disclosure-hospital-adverse-events-and-its-association-patients-ratings-quality-care
      December 29, 2014 - Study Disclosure of hospital adverse events and its association with patients' ratings of the quality of care. Citation Text: López L, Weissman JS, Schneider EC, et al. Disclosure of hospital adverse events and its association with patients' ratings of the quality of care. Arch Intern Me…

3428. AHRQ Evidence Reviews: Catalysts for Practice Change | Agency for Healthcare Research and Quality
      www.ahrq.gov/news/blog/ahrqviews/epc-program-evidence-reviews.html
      January 01, 2022 - AHRQ Views: Blog posts from AHRQ leaders AHRQ Evidence Reviews: Catalysts for Practice Change JAN 19 2022 By Lionel Bañez, M.D., and David Meyers, M.D. Lionel Bañez, M.D. Medical research keeps advancing while clinicians are busy taking care of patients. It is a const…

3429. Evaluating serial strategies for preventing wrong-patient orders in the NICU. | PSNet
      psnet.ahrq.gov/issue/evaluating-serial-strategies-preventing-wrong-patient-orders-nicu
      November 03, 2015 - Study Evaluating serial strategies for preventing wrong-patient orders in the NICU. Citation Text: Adelman JS, Aschner JL, Schechter CB, et al. Evaluating Serial Strategies for Preventing Wrong-Patient Orders in the NICU. Pediatrics. 2017;139(5). doi:10.1542/peds.2016-2863. Copy Citati…

3430. Impact of an original methodological tool on the identification of corrective and preventive actions after root cause analysis of adverse events in health care facilities: results of a randomized controlled trial. | PSNet
      psnet.ahrq.gov/issue/impact-original-methodological-tool-identification-corrective-and-preventive-actions-after
      March 15, 2017 - Study Impact of an original methodological tool on the identification of corrective and preventive actions after root cause analysis of adverse events in health care facilities: results of a randomized controlled trial. Citation Text: Vacher A, El Mhamdi S, dʼHollander A, et al. Impact o…

3431. Prescribing discrepancies likely to cause adverse drug events after patient transfer. | PSNet
      psnet.ahrq.gov/issue/prescribing-discrepancies-likely-cause-adverse-drug-events-after-patient-transfer
      December 08, 2010 - Study Prescribing discrepancies likely to cause adverse drug events after patient transfer. Citation Text: Boockvar KS, Liu S, Goldstein N, et al. Prescribing discrepancies likely to cause adverse drug events after patient transfer. Qual Saf Health Care. 2009;18(1):32-6. doi:10.1136/qshc…

3432. Workarounds in electronic health record systems and the revised Sociotechnical Electronic Health Record Workaround Analysis Framework: scoping review. | PSNet
      psnet.ahrq.gov/issue/workarounds-electronic-health-record-systems-and-revised-sociotechnical-electronic-health
      October 05, 2022 - Review Workarounds in electronic health record systems and the revised Sociotechnical Electronic Health Record Workaround Analysis Framework: scoping review. Citation Text: Blijleven V, Hoxha F, Jaspers MWM. Workarounds in electronic health record systems and the revised sociotechnical E…

3433. Job Aid: Joy in Work (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/ncepcr/resources/job-aid-joy-in-work.pdf
      June 02, 2025 - Job Aid: Joy in Work Primary Care Practice Facilitator Training Series 1 Job Aid: Joy in Work Joy in work is one of three categories of common goals practices have for improvement. Joy in work is central to good patient care and in recognition of this, the national triple aim has been expanded to…

3434. Job Aid: Standardized Quality Measures (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/ncepcr/resources/job-aid-standardized-quality-measures.pdf
      June 02, 2025 - Job Aid: Standardized Quality Measures Primary Care Practice Facilitator Training Series 1 Job Aid: Standardized Quality Measures Familiarity with the standardized quality measures that payers and regulatory groups use is an important part of a practice facilitator's core knowledge. Standar…

3435. Job Aid: Practice Assessments and Surveys (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/ncepcr/resources/job-aid-practice-assessments.pdf
      June 02, 2025 - Job Aid: Practice Assessments and Surveys Primary Care Practice Facilitator Training Series 1 Job Aid: Practice Assessments and Surveys Overview Practice assessments and surveys are simple and non-threatening ways for a practice to gather information, generate ideas for improvements, and test and…

3436. Interventions to improve team effectiveness within health care: a systematic review of the past decade. | PSNet
      psnet.ahrq.gov/issue/interventions-improve-team-effectiveness-within-health-care-systematic-review-past-decade
      March 05, 2010 - Review Classic Interventions to improve team effectiveness within health care: a systematic review of the past decade. Citation Text: Buljac-Samardzic M, Doekhie KD, van Wijngaarden JDH. Interventions to improve team effectiveness within health care: a systemati…

3437. Seen through their eyes: residents' reflections on the cognitive and contextual components of diagnostic errors in medicine. | PSNet
      psnet.ahrq.gov/issue/seen-through-their-eyes-residents-reflections-cognitive-and-contextual-components-diagnostic
      November 18, 2013 - Study Seen through their eyes: residents' reflections on the cognitive and contextual components of diagnostic errors in medicine. Citation Text: Ogdie AR, Reilly JB, Pang WG, et al. Seen through their eyes: residents' reflections on the cognitive and contextual components of diagnostic…

3438. Unscheduled returns to the emergency department: an outcome of medical errors? | PSNet
      psnet.ahrq.gov/issue/unscheduled-returns-emergency-department-outcome-medical-errors
      November 12, 2014 - Study Unscheduled returns to the emergency department: an outcome of medical errors? Citation Text: Nuñez S, Hexdall A, Aguirre-Jaime A. Unscheduled returns to the emergency department: an outcome of medical errors? Qual Saf Health Care. 2006;15(2):102-8. Copy Citation Format: …

3439. Effect of the World Health Organization checklist on patient outcomes: a stepped wedge cluster randomized controlled trial. | PSNet
      psnet.ahrq.gov/issue/effect-world-health-organization-checklist-patient-outcomes-stepped-wedge-cluster-randomized
      June 03, 2020 - Study Classic Effect of the World Health Organization checklist on patient outcomes: a stepped wedge cluster randomized controlled trial. Citation Text: Haugen AS, Søfteland E, Almeland SK, et al. Effect of the World Health Organization checklist on patient outc…

3440. 149-Cusp-Tip-Sheet-Assembling-Team (doc file)
      www.ahrq.gov/sites/default/files/wysiwyg/hai/tools/mrsa/149-cusp-tip-sheet-assembling-team.docx
      October 01, 2024 - AHRQ Safety Program for MRSA Prevention CUSP Tip Sheet: Assembling the CUSP Team ICU & Non-ICU Purpose Teamwork and interprofessional collaboration are important to high-quality patient care. A culture of teamwork and learning from mistakes helps improve patient safety. The Comprehensive Unit-based Safety Program (CUS…