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  1. www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol1/Duthie.pdf
    January 01, 2004 - Quantitative and Qualitative Analysis of Medication Errors: The New York Experience 131 Quantitative and Qualitative Analysis of Medication Errors: The New York Experience Elizabeth Duthie, Barbara Favreau, Angelo Ruperto, Janet Mannion, Ellen Flink, Ruth Leslie Abstract Objectives: In June 2000, the New Yo…
  2. www.ahrq.gov/sites/default/files/wysiwyg/research/findings/making-healthcare-safer/mhs3/patient-id-errors-1.pdf
    March 01, 2020 - Making Healthcare Safer Practices: 11. Patient Identification Errors in the Operating Room Patient Identification Errors in the Operating Room 11-1 11. Patient Identification Errors in the Operating Room Authors: Cori Sheedy, Ph.D., and Sonja Richard, M.P.H. Introduction In the first Making Health Care Safer …
  3. www.ahrq.gov/sites/default/files/wysiwyg/research/findings/nhqrdr/2018qdr-mepsmethods.pdf
    January 01, 2020 - 2018 National Healthcare Quality and Disparities Report Detailed Methods for the Medical Expenditure Panel Survey 2018 NATIONAL HEALTHCARE QUALITY AND DISPARITIES REPORT DETAILED METHODS FOR THE MEDICAL EXPENDITURE PANEL SURVEY U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Agency for Health…
  4. www.ahrq.gov/sites/default/files/2025-07/fenton2-report.pdf
    January 01, 2025 - Final Progress Report: Watchful Waiting as a Strategy for Reducing Low-value Spinal Imaging Watchful Waiting as a Strategy for Reducing Low-value Spinal Imaging Principal Investigator: Joshua J. Fenton, MD, MPH Team Members: Anthony Jerant. MD Camille Cipri, BS Melissa Gosdin, PhD Daniel Tancredi, PhD Guibo Xing, P…
  5. www.ahrq.gov/news/events/nac/2020-07-nac/nacmtg071420-minutes.html
    November 01, 2020 - Meeting Minutes, July 2020 National Advisory Council Minutes from the July 14, 2020, meeting of the Agency for Healthcare Research and Quality's National Advisory Council. ( Virtual Meeting ) Contents Summary Call to Order and Approval of March 26, 2020, Meeting Summary Overview and Recent Accomplis…
  6. www.ahrq.gov/sites/default/files/wysiwyg/news/events/nac/2020-07-nac/nacminutes-071420.pdf
    January 01, 2020 - National Advisory Council Meeting, July 14, 2020: Minutes National Advisory Council, July 14, 2020 Page 1 Agency for Healthcare Research and Quality National Advisory Council Meeting (Virtual Meeting) July 14, 2020 SUMMARY NAC Members Present Tina M. Hernandez-Boussard, Ph.D., M.…
  7. www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol2/Behara.pdf
    January 01, 2004 - A Conceptual Framework for Studying the Safety of Transitions in Emergency Care 309 A Conceptual Framework for Studying the Safety of Transitions in Emergency Care Ravi Behara, Robert L. Wears, Shawna J. Perry, Eric Eisenberg, Lexa Murphy, Mary Vanderhoef, Marc Shapiro, Christopher Beach, Pat Croskerry, Ka…
  8. www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol3/Harper.pdf
    March 01, 2004 - Identifying Barriers to the Success of a Reporting System 167 Identifying Barriers to the Success of a Reporting System Michelle L. Harper, Robert L. Helmreich Abstract Spurred by a controversial report from the Institute of Medicine on the prevalence of medical error, To Err Is Human, the medical profe…
  9. www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol3/Graham.pdf
    April 14, 2004 - Institutional Review Board Approval of Practice-based Research Network Patient Safety Studies 453 Institutional Review Board Approval of Practice-based Research Network Patient Safety Studies Deborah G. Graham, Wilson Pace, Jennifer Kappus, Sherry Holcomb, James M. Galliher, Christine W. Duclos, Aaron J. B…
  10. www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety-2/vol2/Advances-Stalhandske2_70.pdf
    March 01, 2006 - VHA’s National Falls Collaborative and Prevention Programs VHA’s National Falls Collaborative and Prevention Programs Erik Stalhandske, MPP, MHSA; Peter Mills, PhD; Pat Quigley, PhD, ARNP, CRRN, FAAN; Julia Neily, MS, MPH; James P. Bagian, MD, PE Abstract Falls are a high-volume, high-cost problem in he…
  11. www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety-2/vol1/Advances-Aydin_2.pdf
    January 01, 2021 - Beyond Nursing Quality Measurement: The Nation’s First Regional Nursing Virtual Dashboard rds Beyond Nursing Quality Measurement: The Nation’s First Regional Nursing Virtual Dashboard Carolyn E. Aydin, PhD; Linda Burnes Bolton, DrPH, RN, FAAN; Nancy Donaldson, DNSc, RN, FAAN; Diane Storer Brown, PhD, RN, FN…
  12. www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol4/Kizer2.pdf
    December 01, 2000 - Serious Reportable Adverse Events in Health Care 339 Serious Reportable Adverse Events in Health Care Kenneth W. Kizer, Melissa B. Stegun Abstract Health care errors resulting in patient harm are a leading cause of morbidity and mortality in the United States, although there is no national reporting of such…
  13. www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol4/Snow.pdf
    January 01, 2010 - A Clinical Assessment Program to Evaluate the Safety of Patient Care 57 A Clinical Assessment Program to Evaluate the Safety of Patient Care Richard J. Snow, Martin S. Levine, Dwain L. Harper, Sharon L. McGill, George Thomas, Joseph P. McNerney Abstract The American Osteopathic Association’s Clinical Asses…
  14. www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety-2/vol2/Advances-Baker_107.pdf
    March 30, 2008 - Analysis of Patient Safety: Converting Complex Pediatric Chemotherapy Ordering Processes from Paper to Electronic Systems Analysis of Patient Safety: Converting Complex Pediatric Chemotherapy Ordering Processes from Paper to Electronic Systems Donald K. Baker, PharmD; James M. Hoffman, PharmD; Gregory A. Hal…
  15. www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/nicu_toolkit/nicupacket.pdf
    December 01, 2013 - There are no right or wrong answers, and often the first answer that comes to mind is best.
  16. www.ahrq.gov/sites/default/files/wysiwyg/patient-safety/settings/hospitals/nicupacket.pdf
    December 01, 2013 - There are no right or wrong answers, and often the frst answer that comes to mind is best.
  17. www.ahrq.gov/sites/default/files/wysiwyg/topics/ed-boarding-summit-report.pdf
    March 01, 2025 - AHRQ Summit to Address Emergency Department Boarding 2 AHRQ Summit to Address Emergency Department Boarding Technical Report e AHRQ Summit to Address Emergency Department Boarding Technical Report Prepared by Robin M. Weinick, PhD Resonant, LLC Sean Bruna, PhD, MA, MA Agen…
  18. www.ahrq.gov/sites/default/files/wysiwyg/patient-safety/highlights/ps-project-highlights-pfe.pdf
    January 01, 2023 - AHRQ-Funded Patient Safety Project Highlights AHRQ-Funded Patient Safety Project Highlights Improving Healthcare Safety by Engaging Patients and Families Overview Research has shown that involving patients, as well as their families and caregivers, in the planning, delivery, and evaluation of their healthcare c…
  19. www.ahrq.gov/sites/default/files/publications/files/universalicu.pdf
    September 01, 2013 - that includes the decolonization protocol, a training module, visual aids and skills assessment, and answers
  20. www.ahrq.gov/ncepcr/reports/primary-care-research/results.html
    January 01, 2024 - " - RAND interviewee While the EPC program focuses on providing relevant and timely answers to

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