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psnet.ahrq.gov/issue/surgical-never-events-how-common-are-adverse-occurrences
November 16, 2022 - Commentary
Surgical 'never events': how common are adverse occurrences?
Citation Text:
West JC. Surgical ‘never events’: How common are adverse occurrences? Journal of Healthcare Risk Management. 2009;26(1). doi:10.1002/jhrm.5600260105.
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psnet.ahrq.gov/issue/disclosure-unanticipated-outcomes-care-and-medical-errors-what-does-mean-anesthesiologists
August 21, 2024 - Review
The disclosure of unanticipated outcomes of care and medical errors: what does this mean for anesthesiologists?
Citation Text:
Souter KJ, Gallagher TH. The Disclosure of Unanticipated Outcomes of Care and Medical Errors. Anesth Analg. 2011;114(3):615-621. doi:10.1213/ane.0b013e3…
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www.ahrq.gov/hai/cusp/clabsi-final-companion/clabsicomp4b.html
January 01, 2013 - Eliminating CLABSI, A National Patient Safety Imperative: Final Report Companion Guide
Pediatric Units
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Table of Contents
Eliminating CLABSI, A National Patient Safety Imperative: Final Report Companion Guide
Preface
Methods
Participation
Outcomes
Adult Non-ICUs
Pe…
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psnet.ahrq.gov/issue/review-educational-philosophies-applied-radiation-safety-training-medical-institutions
May 31, 2017 - Commentary
A review of educational philosophies as applied to radiation safety training at medical institutions.
Citation Text:
Dauer LT, St Germain J. A review of educational philosophies as applied to radiation safety training at medical institutions. Health Phys. 2006;90(5 Suppl):S6…
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psnet.ahrq.gov/issue/next-act-patient-safety
September 03, 2011 - Commentary
A next act for patient safety.
Citation Text:
Viola AF, Kallem C, Bronnert J. A next act for patient safety. J AHIMA. 2009;80(4):30-5; quiz 37-8.
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psnet.ahrq.gov/issue/2021-john-m-eisenberg-patient-safety-and-quality-awards
August 02, 2023 - Award Recipient
The 2021 John M. Eisenberg Patient Safety and Quality Awards.
Citation Text:
The 2021 John M. Eisenberg Patient Safety and Quality Awards. Jt Comm J Qual Patient Saf. 2022;48(8):365-424.
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psnet.ahrq.gov/issue/creating-culture-safety-emergency-department-value-teamwork-training
October 14, 2020 - Study
Creating a culture of safety in the emergency department: the value of teamwork training.
Citation Text:
Jones F, Podila P, Powers C. Creating a culture of safety in the emergency department: the value of teamwork training. J Nurs Adm. 2013;43(4):194-200. doi:10.1097/NNA.0b013e318…
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www.ahrq.gov/diagnostic-safety/resources/issue-briefs/dxsafety-culture-survey-brazil-actions.html
August 01, 2024 - Learning from AHRQ's Diagnostic Safety Culture Survey at a Tertiary Care Health System in Brazil: A Case Study
Actions Based on Survey Results
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Table of Contents
Learning from AHRQ's Diagnostic Safety Culture Survey at a Tertiary Care Health System in Brazil: A Case Study
In…
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www.ahrq.gov/patient-safety/resources/simulation-issue-brief4.html
July 01, 2024 - Simulation To Improve Patient Safety: Getting Started
Use Simulation To Adopt and Adapt Best Practices
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Table of Contents
Simulation To Improve Patient Safety: Getting Started
Introduction
Leverage Patient Safety Infrastructure
Use Simulation To Adopt and Adapt Best Prac…
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psnet.ahrq.gov/issue/alliance-between-society-and-medicine-publics-stake-medical-professionalism
November 16, 2022 - Commentary
Alliance between society and medicine: the public's stake in medical professionalism.
Citation Text:
Cohen JJ, Cruess S, Davidson C. Alliance between society and medicine: the public's stake in medical professionalism. JAMA. 2007;298(6):670-3.
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www.ahrq.gov/sites/default/files/wysiwyg/pqmp/toolkits/healthplan-key-drive-diagram.pdf
June 02, 2025 - Transcranial Doppler Screening for Children with Sickle Cell Anemia: Health Plan - Key Driver Diagram
Transcranial Doppler Screening for Children with Sickle Cell Anemia
Health Plan - Key Driver Diagram
Key Drivers
Strateg…
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psnet.ahrq.gov/issue/4-days-hospital-thought-he-had-just-pneumonia-it-was-coronavirus
November 29, 2023 - Newspaper/Magazine Article
For 4 days, the hospital thought he had just pneumonia. It was coronavirus.
Citation Text:
Goldstein J, Salcedo A. For 4 days, the hospital thought he had just pneumonia. It was coronavirus. New York Times. 2020;March 10.
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/clinicians-providers/iadapt/gurwitz.pdf
January 01, 2014 - Off-Label Use of Atypical Antipsychotics in the Nursing Home
Research to Help Underserved Populations
Innovative Adaptation and Dissemination of AHRQ Comparative Effectiveness
Research Products
Off-Label Use of Atypical Antipsychotics in the Nursing Home
Description
The prevalence of off-label use of atypi…
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psnet.ahrq.gov/issue/moving-patient-safety-ambulatory-settings-and-beyond
October 02, 2019 - Commentary
Moving patient safety into ambulatory settings and beyond.
Citation Text:
Ricciardi R, Shofer M. Moving Patient Safety Into Ambulatory Settings and Beyond. J Nurs Care Qual. 2018;33(3):195-199. doi:10.1097/NCQ.0000000000000329.
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psnet.ahrq.gov/issue/evaluating-effectiveness-health-care-teams
September 20, 2023 - Review
Evaluating the effectiveness of health care teams.
Citation Text:
Mickan SM. Evaluating the effectiveness of health care teams. Aust Health Rev. 2005;29(2):211-7.
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psnet.ahrq.gov/issue/surgical-simulation-systematic-review
June 15, 2011 - Review
Surgical simulation: a systematic review.
Citation Text:
Sutherland LM, Middleton PF, Anthony A, et al. Surgical simulation: a systematic review. Ann Surg. 2006;243(3):291-300.
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www.ahrq.gov/hai/tools/surgery/tools/applying-cusp/or-briefing-audit.html
December 01, 2017 - Operating Room Briefing and Debriefing Audit Tool
AHRQ Safety Program for Surgery
Introduction
Problem Statement
One of the strongest determinants of safety culture is whether local and hospital leadership respond to staff patient safety concerns. Frontline providers understand patient safety …
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www.ahrq.gov/pqmp/publications/search.html?page=4
January 01, 2014 - All Publications
The following list presents materials published as a result of the AHRQ-CMS Pediatric Quality Measures Program (PQMP).
Results
101 - 107 of 107 Publications
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Advancing Child…
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psnet.ahrq.gov/issue/need-systems-integration-health-care
July 01, 2017 - Commentary
The need for systems integration in health care.
Citation Text:
Mathews SC, Pronovost P. The need for systems integration in health care. JAMA. 2011;305(9):934-5. doi:10.1001/jama.2011.237.
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psnet.ahrq.gov/issue/eight-year-experience-neurosurgical-checklist
September 27, 2023 - Study
Eight-year experience with a neurosurgical checklist.
Citation Text:
Lyons MK. Eight-year experience with a neurosurgical checklist. Am J Med Qual. 2010;25(4):285-8. doi:10.1177/1062860610363305.
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