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psnet.ahrq.gov/issue/hospital-sequelae-injurious-falls-24-medicalsurgical-units-four-hospitals-united-states
December 12, 2012 - Study
In-hospital sequelae of injurious falls in 24 medical/surgical units in four hospitals in the United States.
Citation Text:
Hill A-M, Jacques A, Chandler M, et al. In-Hospital Sequelae of Injurious Falls in 24 Medical/Surgical Units in Four Hospitals in the United States. Jt Comm J…
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psnet.ahrq.gov/issue/patterns-errors-contributing-trauma-mortality-lessons-learned-2594-deaths
March 24, 2021 - Study
Patterns of errors contributing to trauma mortality: lessons learned from 2,594 deaths.
Citation Text:
Gruen RL, Jurkovich GJ, McIntyre LK, et al. Patterns of Errors Contributing to Trauma Mortality. Transactions of the .. Meeting of the American Surgical Association. 2006;124. d…
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psnet.ahrq.gov/issue/guidance-patient-safety-ophthalmology-royal-college-ophthalmologists
November 12, 2014 - Review
Guidance on patient safety in ophthalmology from the Royal College of Ophthalmologists.
Citation Text:
Kelly SP, Ophthalmologists RC of. Guidance on patient safety in ophthalmology from the Royal College of Ophthalmologists. Eye (Lond). 2009;23(12):2143-51. doi:10.1038/eye.2009.…
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psnet.ahrq.gov/issue/point-care-testing-error-sources-and-amplifiers-taxonomy-prevention-strategies-and-detection
January 08, 2016 - Study
Point-of-care testing error: sources and amplifiers, taxonomy, prevention strategies, and detection monitors.
Citation Text:
Meier FA, Jones BA. Point-of-care testing error: sources and amplifiers, taxonomy, prevention strategies, and detection monitors. Arch Pathol Lab Med. 2005…
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psnet.ahrq.gov/issue/accuracy-adverse-drug-event-reports-collected-using-automated-dispensing-system
April 06, 2022 - Study
Accuracy of adverse-drug-event reports collected using an automated dispensing system.
Citation Text:
Romero A, Malone DC. Accuracy of adverse-drug-event reports collected using an automated dispensing system. Am J Health Syst Pharm. 2005;62(13):1375-80.
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psnet.ahrq.gov/issue/web-based-incident-reporting-system-and-multidisciplinary-collaborative-projects-patient
October 27, 2010 - Study
A web-based incident reporting system and multidisciplinary collaborative projects for patient safety in a Japanese hospital.
Citation Text:
Nakajima K, Kurata Y, Takeda H. A web-based incident reporting system and multidisciplinary collaborative projects for patient safety in a …
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psnet.ahrq.gov/issue/lessons-unexpected-increased-mortality-after-implementation-commercially-sold-computerized
April 29, 2018 - Commentary
Lessons from "unexpected increased mortality after implementation of a commercially sold computerized physician order entry system."
Citation Text:
Sittig DF, Ash JS, Zhang J, et al. Lessons from "Unexpected increased mortality after implementation of a commercially sold com…
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psnet.ahrq.gov/issue/how-well-do-we-communicate-comparison-intraoperative-diagnoses-listed-pathology-reports-and
May 29, 2019 - Study
How well do we communicate? A comparison of intraoperative diagnoses listed in pathology reports and operative notes.
Citation Text:
Talmon G, Horn A, Wedel W, et al. How well do we communicate?: a comparison of intraoperative diagnoses listed in pathology reports and operative no…
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psnet.ahrq.gov/issue/limited-health-literacy-barrier-medication-reconciliation-ambulatory-care
March 24, 2010 - Study
Limited health literacy is a barrier to medication reconciliation in ambulatory care.
Citation Text:
Persell SD, Osborn CY, Richard R, et al. Limited health literacy is a barrier to medication reconciliation in ambulatory care. J Gen Intern Med. 2007;22(11):1523-6.
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psnet.ahrq.gov/issue/getting-underuse-interpreters-resident-physicians
February 21, 2018 - Study
Getting by: underuse of interpreters by resident physicians.
Citation Text:
Diamond LC, Schenker Y, Curry LA, et al. Getting by: underuse of interpreters by resident physicians. J Gen Intern Med. 2009;24(2):256-62. doi:10.1007/s11606-008-0875-7.
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www.ahrq.gov/patient-safety/settings/long-term-care/resource/hcbs/findings/tab19e.html
March 01, 2023 - Assessing the Health and Welfare of the HCBS Population
Table 19E: SMI Subpopulation
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Table of Contents
Assessing the Health and Welfare of the HCBS Population
Introduction
HCBS Population
Availability and Use of State Medicaid HCBS
Outcome Indicators for the HCBS Popu…
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psnet.ahrq.gov/issue/how-often-do-physicians-review-medication-charts-ward-rounds
September 23, 2020 - Study
How often do physicians review medication charts on ward rounds?
Citation Text:
Looi KL, Black PN. How often do physicians review medication charts on ward rounds? BMC Clin Pharmacol. 2008;8:9. doi:10.1186/1472-6904-8-9.
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DOI Google Scholar PubM…
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www.ahrq.gov/sites/default/files/wysiwyg/evidencenow/heart-health/strategies-to-better-manage-lipids.pptx
November 01, 2016 - Strategies to Better Manage Lipids – Statin Pearls
Strategies to Better Manage Lipids – Statin Pearls
Alex Krist MD MPH
Family Physician
Virginia Commonwealth University
Member, US Preventive Services Task Force
ahkrist@vcu.edu
‹#›
5/24/2018
1
Disclaimer
Although I am a member of the U.S. Preventive Services Tas…
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psnet.ahrq.gov/issue/human-factors-engineering-tool-medical-device-evaluation-hospital-procurement-decision-making
June 28, 2017 - Study
Human factors engineering: a tool for medical device evaluation in hospital procurement decision-making.
Citation Text:
Ginsburg G. Human factors engineering: a tool for medical device evaluation in hospital procurement decision-making. J Biomed Inform. 2005;38(3):213-9.
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psnet.ahrq.gov/issue/distraction-and-interruption-anaesthetic-practice
May 18, 2022 - Study
Distraction and interruption in anaesthetic practice.
Citation Text:
Campbell G, Arfanis K, Smith AF. Distraction and interruption in anaesthetic practice. Br J Anaesth. 2012;109(5):707-715. doi:10.1093/bja/aes219.
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DOI Google Scholar PubMed BibTe…
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www.ahrq.gov/sites/default/files/wysiwyg/sops/events/webinar/03-gray-sops-action-planning-tool.pdf
June 02, 2025 - Action Planning for the SOPS Surveys-Introducing SOPS
10
Introducing the SOPS Action
Planning Tool
Laura Gray, MPH
Senior Study Director,
User Network for the AHRQ Surveys on Patient Safety Culture
(SOPS)
Westat
11
AHRQ Surveys on Patient Safety Culture
Surveys of clinicians and staff about the extent to
w…
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psnet.ahrq.gov/issue/medical-malpractice-reflected-forensic-evaluation-4450-autopsies
September 02, 2009 - Study
Medical malpractice as reflected by the forensic evaluation of 4450 autopsies.
Citation Text:
Madea B, Preuss J. Medical malpractice as reflected by the forensic evaluation of 4450 autopsies. Forensic Sci Int. 2009;190(1-3):58-66. doi:10.1016/j.forsciint.2009.05.013.
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www.ahrq.gov/patient-safety/settings/long-term-care/resource/hcbs/findings/tab19b.html
March 01, 2023 - Assessing the Health and Welfare of the HCBS Population
Table 19B: Dually Eligible HCBS Participants
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Table of Contents
Assessing the Health and Welfare of the HCBS Population
Introduction
HCBS Population
Availability and Use of State Medicaid HCBS
Outcome Indicators f…
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psnet.ahrq.gov/issue/excess-cost-and-length-stay-associated-voluntary-patient-safety-event-reports-hospitals
October 19, 2022 - Study
Excess cost and length of stay associated with voluntary patient safety event reports in hospitals.
Citation Text:
Paradis AR, Stewart VT, Bayley KB, et al. Excess Cost and Length of Stay Associated With Voluntary Patient Safety Event Reports in Hospitals. American Journal of M…
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www.ahrq.gov/patient-safety/settings/long-term-care/resource/hcbs/findings/tab19c.html
March 01, 2023 - Assessing the Health and Welfare of the HCBS Population
Table 19C: Medicaid-Only HCBS Participants
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Table of Contents
Assessing the Health and Welfare of the HCBS Population
Introduction
HCBS Population
Availability and Use of State Medicaid HCBS
Outcome Indicators for…