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psnet.ahrq.gov/node/41527/psn-pdf
July 18, 2012 - Improving Transitions of Care: Hand-off Communications.
July 18, 2012
Oakbrook Terrace, IL: Joint Commission Center for Transforming Healthcare; June 2012.
https://psnet.ahrq.gov/issue/improving-transitions-care-hand-communications
This tool describes factors that contribute to incomplete handoffs and recommends ta…
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psnet.ahrq.gov/node/41980/psn-pdf
January 16, 2013 - Handoff Communication Tools.
January 16, 2013
Landrigan CP, Lyons A, Gannon P, et al. FIRST Do No Harm. December 2012;1-8.
https://psnet.ahrq.gov/issue/handoff-communication-tools
This newsletter issue highlights initiatives and tools developed to improve handoff communication in
Massachusetts.
https://psnet.ahrq…
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psnet.ahrq.gov/node/60269/psn-pdf
April 29, 2020 - The Emergency Medicine attending did not communicate the
EGS attending’s refusal to see the patient
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psnet.ahrq.gov/web-mm/empty-handoff
August 01, 2017 - evolve over time for necessary human and organizational reasons; and that high performing teams often communicate
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psnet.ahrq.gov/node/49501/psn-pdf
February 03, 2006 - A variety of methods are used in the ED and across health care to communicate important information such
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cdsic.ahrq.gov/sites/default/files/2025-06/TPC%20Topic%20Highlight%20Patient%20Preferences.pdf
January 01, 2025 - action over others; or (3) prioritize particular aspects or outcomes of healthcare.2 When
patients communicate
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psnet.ahrq.gov/node/39666/psn-pdf
April 16, 2018 - Teamwork and Communication.
April 16, 2018
Pa Patient Saf Advis. June 2010;7(suppl 2):1-16.
https://psnet.ahrq.gov/issue/teamwork-and-communication
Articles in this special supplement outline tactics to improve communication including crew resource
management, chain-of-command policies, and teamwork training.
htt…
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psnet.ahrq.gov/node/838067/psn-pdf
September 14, 2022 - The Psychological Safety Scale of the Safety,
Communication, Operational, Reliability, and Engagement
(SCORE) survey: a brief, diagnostic, and actionable
metric for the ability to speak up in healthcare settings.
September 14, 2022
Adair KC, Heath A, Frye MA, et al. The Psychological Safety Scale of the Safety, Co…
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psnet.ahrq.gov/node/46309/psn-pdf
December 22, 2018 - Effects of the I-PASS nursing handoff bundle on
communication quality and workflow.
December 22, 2018
Starmer AJ, Schnock KO, Lyons A, et al. Effects of the I-PASS Nursing Handoff Bundle on communication
quality and workflow. BMJ Qual Saf. 2017;26(12):949-957. doi:10.1136/bmjqs-2016-006224.
https://psnet.ahrq.gov/…
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psnet.ahrq.gov/node/44179/psn-pdf
November 20, 2015 - Routine failures in the process for blood testing and the
communication of results to patients in primary care in
the UK: a qualitative exploration of patient and provider
perspectives.
November 20, 2015
Litchfield I, Bentham L, Hill A, et al. Routine failures in the process for blood testing and the communication…
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psnet.ahrq.gov/node/837967/psn-pdf
September 01, 2022 - Free-text computerized provider order entry orders used
as workaround for communicating medication
information.
September 1, 2022
Kandaswamy S, Grimes J, Hoffman D, et al. Free-text computerized provider order entry orders used as
workaround for communicating medication information. J Patient Saf. 2022;18(5):430-4…
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www.ahrq.gov/patient-safety/resources/learning-lab/neonatal-interfacility-transfers-long-desc.html
January 01, 2025 - Patient Safety Learning Laboratory to Enhance the Value and Safety of Neonatal Interfacility Transfers in a Regional Care Network
Principal Investigator: Rachel Umoren, M.B.B.Ch., M.S., University of Washington, Seattle, WA AHRQ Grant No.: HS027259 Project Period : 09/03/19-08/31/23 Description: The lab’s…
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psnet.ahrq.gov/node/35388/psn-pdf
February 24, 2011 - Preventing communication errors in telephone medicine.
February 24, 2011
Reisman AB, Brown KE. Preventing communication errors in telephone medicine. J Gen Intern Med.
2005;20(10):959-63.
https://psnet.ahrq.gov/issue/preventing-communication-errors-telephone-medicine
The authors use case scenarios to illustrate po…
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psnet.ahrq.gov/node/37493/psn-pdf
December 27, 2014 - Patient Safety Through Teamwork and Communication
Toolkit.
December 27, 2014
Denver Health.
https://psnet.ahrq.gov/issue/patient-safety-through-teamwork-and-communication-toolkit
Part of the AHRQ-funded PIPS program, this module provides educational materials for health care
workers regarding teamwork and communi…
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psnet.ahrq.gov/node/36098/psn-pdf
July 12, 2006 - Getting Results: Reliably Communicating and Acting on
Critical Test Results.
July 12, 2006
Schiff G, ed. Oakbrook Terrace IL: Joint Commission Resources; 2006. ISBN: 9781599400013.
https://psnet.ahrq.gov/issue/getting-results-reliably-communicating-and-acting-critical-test-results
This book is a collection of arti…
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psnet.ahrq.gov/node/35359/psn-pdf
November 28, 2016 - Being open: communicating patient safety incidents with
patients and their carers.
November 28, 2016
National Patient Safety Agency.
https://psnet.ahrq.gov/issue/being-open-communicating-patient-safety-incidents-patients-and-their-carers
This Web site provides the United Kingdom's set of disclosure guidelines for …
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psnet.ahrq.gov/issue/new-horizons-patient-safety-safe-communication-evidence-based-core-competencies-case-studies
November 19, 2018 - Book/Report
New Horizons in Patient Safety. Safe Communication: Evidence-based Core Competencies with Case Studies from Nursing.
Citation Text:
New Horizons in Patient Safety. Safe Communication: Evidence-based Core Competencies with Case Studies from Nursing. Hannawa AF, Wendt AL, Day L…
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psnet.ahrq.gov/issue/confronting-medical-errors-oncology-and-disclosing-them-cancer-patients
September 01, 2018 - Commentary
Confronting medical errors in oncology and disclosing them to cancer patients.
Citation Text:
Surbone A, Rowe M, Gallagher TH. Confronting medical errors in oncology and disclosing them to cancer patients. J Clin Oncol. 2007;25(12):1463-7.
Copy Citation
Format:
…
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psnet.ahrq.gov/issue/do-you-hear-what-i-hear-communication-practices-about-medications-between-physicians-and
August 02, 2016 - Study
Do you hear what I hear? Communication practices about medications between physicians and clients with chronic illness in Canada.
Citation Text:
Do you hear what I hear? Communication practices about medications between physicians and clients with chronic illness in Canada. Sears…
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patientsafetyculture/asc/ascwebinar/tinsleyslides.pdf
September 01, 2015 - Underwood Surgery Center: Slide Presentation
50
50
Underwood Surgery Center
Orlando, Florida
Terry Tinsley R.N., B.A.
Clinical Nurse Manager
51
51
Underwood Surgery Center (USC)
• Physician owned multi-specialty surgery center
• Performs endoscopic procedures, surgeries
involving colon and rectal, …