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digital.ahrq.gov/sites/default/files/docs/publication/r01hs016759-ralston-final-report-2012_0.pdf
January 01, 2012 - Contact medium if email wasn’t available MyGH Web survey
How well doctors communicate CAHPS Clinician … helping me remember what I’m
supposed to do and when
• The patient website helps me connect and communicate
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psnet.ahrq.gov/node/46361/psn-pdf
May 23, 2018 - Inadequate hand-off communication.
May 23, 2018
Inadequate hand-off communication. Sentinel event alert. 2017;58(58):1-6.
https://psnet.ahrq.gov/issue/inadequate-hand-communication
The Joint Commission publishes sentinel event alerts to draw attention to pressing or emerging safety
issues and provide guidelines fo…
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psnet.ahrq.gov/node/45435/psn-pdf
August 24, 2016 - Pharmacist–physician communications in a highly
computerised hospital: sign-off and action of electronic
review messages.
August 24, 2016
Pontefract SK, Hodson J, Marriott JF, et al. Pharmacist-Physician Communications in a Highly
Computerised Hospital: Sign-Off and Action of Electronic Review Messages. PLoS One.
…
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psnet.ahrq.gov/node/50384/psn-pdf
September 25, 2019 - Safety and communication in the operating room: a safety
questionnaire after the implementation of a blood-borne
pathogen exposure checkpoint in the surgical safety
checklist preprocedure time-out.
September 25, 2019
Kane P, Marley R, Daney B, et al. Safety and Communication in the Operating Room: A Safety
Questi…
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psnet.ahrq.gov/node/46624/psn-pdf
November 29, 2017 - Empowerment failure: how shortcomings in physician
communication unwittingly undermine patient autonomy.
November 29, 2017
Ubel PA, Scherr KA, Fagerlin A. Empowerment Failure: How Shortcomings in Physician Communication
Unwittingly Undermine Patient Autonomy. Am J Bioeth. 2017;17(11):31-39.
doi:10.1080/15265161.20…
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www.ahrq.gov/sites/default/files/wysiwyg/patient-safety/resources/diagnostic-toolkit/09-diagnostic-safety-practice-orientation.pptx
November 24, 2020 - failure to (a) establish and accurate and timely explanation of the patient’s health problem(s) or (b) communicate
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psnet.ahrq.gov/node/861881/psn-pdf
January 31, 2024 - I need to figure out a better way that we can communicate among
providers and teams.”
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psnet.ahrq.gov/node/49473/psn-pdf
March 01, 2005 - On O.R. Off?
March 1, 2005
Leonard M. On O.R. Off? PSNet [internet]. 2005.
https://psnet.ahrq.gov/web-mm/or
The Case
An elderly man was admitted to the vascular surgery service with rest pain in his leg. Angiography
demonstrated peripheral artery disease with anatomy suitable for revascularization. A consulting
…
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www.ahrq.gov/hai/cusp/modules/apply/sl-cusp.html
December 01, 2012 - Presentation Slides
CUSP Toolkit, Apply CUSP
The Apply CUSP module of the CUSP Toolkit introduces Just Culture principles, which emphasize shared accountability and attitudes towards risk. This module also summarizes the concepts and activities of the other six modules in the CUSP Toolkit, including TeamSTEPP…
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psnet.ahrq.gov/issue/interruptions-and-miscommunications-surgery-observational-study
August 11, 2021 - Study
Interruptions and miscommunications in surgery: an observational study.
Citation Text:
Gillespie BM, Chaboyer W, Fairweather N. Interruptions and miscommunications in surgery: an observational study. AORN J. 2012;95(5):576-90. doi:10.1016/j.aorn.2012.02.012.
Copy Citation
For…
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psnet.ahrq.gov/issue/communication-and-teamwork-patient-care-how-much-can-we-learn-aviation
August 12, 2019 - Review
Communication and teamwork in patient care: how much can we learn from aviation?
Citation Text:
Lyndon A. Communication and teamwork in patient care: how much can we learn from aviation? J Obstet Gynecol Neonatal Nurs. 2006;35(4):538-46.
Copy Citation
Format:
Googl…
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www.ahrq.gov/patient-safety/patients-families/engagingfamilies/strategy2/index.html
December 01, 2017 - Strategy 2: Communicating to Improve Quality
Research shows that when patients are engaged in their health care, it can lead to measurable improvements in safety and quality. To promote stronger engagement, Agency for Healthcare Research and Quality developed the Guide to Patient and Family Engagement in Hospit…
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www.ahrq.gov/sites/default/files/2025-07/catchpole-report.pdf
January 01, 2025 - Participants indicated
the same level of confidence when asked about their ability to communicate effectively … Total themes identified = 12
• Work together to ensure safety is a priority – complete
timeout, communicate … The role-reversal room
emphasized the importance of speaking loudly and clearly to communicate needs
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psnet.ahrq.gov/node/44938/psn-pdf
September 28, 2017 - Walking the tightrope: communicating overdiagnosis in
modern healthcare.
September 28, 2017
McCaffery KJ, Jansen J, Scherer LD, et al. Walking the tightrope: communicating overdiagnosis in modern
healthcare. BMJ. 2016;352:i348. doi:10.1136/bmj.i348.
https://psnet.ahrq.gov/issue/walking-tightrope-communicating-over…
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psnet.ahrq.gov/node/34602/psn-pdf
February 17, 2009 - Disclosure of unanticipated events: the next step in better
communication with patients (part 1 of 3).
February 17, 2009
Chicago, IL; American Society of Healthcare Risk Management: 2003.
https://psnet.ahrq.gov/issue/disclosure-unanticipated-events-next-step-better-communication-patients-part-
1-3
The change in t…
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psnet.ahrq.gov/node/39572/psn-pdf
January 03, 2017 - The tangible handoff: a team approach for advancing
structured communication in labor and delivery.
January 3, 2017
Block M, Ehrenworth JF, Cuce VM, et al. The tangible handoff: a team approach for advancing structured
communication in labor and delivery. Jt Comm J Qual Patient Saf. 2010;36(6):282-287, 241.
https:…
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psnet.ahrq.gov/node/866567/psn-pdf
August 21, 2024 - A daily dose of communication to improve quality and
safety outcomes.
August 21, 2024
Halm MA. A daily dose of communication to improve quality and safety outcomes. Am J Crit Care.
2024;33(4):305-310. doi:10.4037/ajcc2024318.
https://psnet.ahrq.gov/issue/daily-dose-communication-improve-quality-and-safety-outcomes…
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psnet.ahrq.gov/node/41152/psn-pdf
June 19, 2012 - The ins and outs of change of shift handoffs between
nurses: a communication challenge.
June 19, 2012
Carroll JS, Williams M, Gallivan TM. The ins and outs of change of shift handoffs between nurses: a
communication challenge. BMJ Qual Saf. 2012;21(7):586-93. doi:10.1136/bmjqs-2011-000614.
https://psnet.ahrq.gov/i…
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psnet.ahrq.gov/node/40248/psn-pdf
June 20, 2011 - Achieving quality improvement in the nursing home:
influence of nursing leadership on communication and
teamwork.
June 20, 2011
Vogelsmeier A, Scott-Cawiezell J. Achieving quality improvement in the nursing home: influence of nursing
leadership on communication and teamwork. J Nurs Care Qual. 2011;26(3):236-42.
d…
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psnet.ahrq.gov/node/42825/psn-pdf
December 18, 2013 - Primary care physician communication at hospital
discharge reduces medication discrepancies.
December 18, 2013
Lindquist LA, Yamahiro A, Garrett A, et al. Primary care physician communication at hospital discharge
reduces medication discrepancies. J Hosp Med. 2013;8(12):672-7. doi:10.1002/jhm.2098.
https://psnet.a…