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psnet.ahrq.gov/issue/adverse-event-reporting-priorities-integrative-review
March 10, 2021 - Review
Adverse event reporting priorities: an integrative review.
Citation Text:
Falcone ML, Van Stee SK, Tokac U, et al. Adverse event reporting priorities: an integrative review. J Patient Saf. 2022;18(4):e727-e740. doi:10.1097/pts.0000000000000945.
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psnet.ahrq.gov/issue/improving-patient-handoffs-and-transitions-through-adaptation-and-implementation-i-pass
September 23, 2020 - Study
Improving patient handoffs and transitions through adaptation and implementation of I-PASS across multiple handoff settings.
Citation Text:
Blazin LJ, Sitthi-Amorn J, Hoffman JM, et al. Improving patient handoffs and transitions through adaptation and implementation of I-PASS acros…
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psnet.ahrq.gov/issue/scoping-review-patients-attitudes-about-their-role-and-behaviours-ensure-safe-care-direct
May 19, 2021 - Review
Scoping review of patients' attitudes about their role and behaviours to ensure safe care at the direct care level.
Citation Text:
Duhn L, Godfrey C, Medves J. Scoping review of patients’ attitudes about their role and behaviours to ensure safe care at the direct care level. Healt…
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psnet.ahrq.gov/issue/encouraging-patients-speak-about-problems-cancer-care
March 11, 2013 - Study
Encouraging patients to speak up about problems in cancer care.
Citation Text:
Mazor KM, Kamineni A, Roblin DW, et al. Encouraging patients to speak up about problems in cancer care. J Patient Saf. 2021;17(8):e1278-e1284. doi:10.1097/pts.0000000000000510.
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psnet.ahrq.gov/issue/critical-incident-technique
January 07, 2015 - Study
Classic
The critical incident technique.
Citation Text:
FLANAGAN JC. The critical incident technique. Psychol Bull. 1954;51(4):327-358.
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psnet.ahrq.gov/issue/analyzing-and-mitigating-risks-patient-harm-during-operating-room-intensive-care-unit-patient
October 05, 2022 - Commentary
Analyzing and mitigating the risks of patient harm during operating room to intensive care unit patient handoffs.
Citation Text:
Martins NRS, Martinez EZ, Simões CM, et al. Analyzing and mitigating the risks of patient harm during operating room to intensive care unit patient …
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psnet.ahrq.gov/issue/analysis-structure-and-content-dashboards-used-monitor-patient-safety-inpatient-setting
March 09, 2022 - Study
An analysis of the structure and content of dashboards used to monitor patient safety in the inpatient setting.
Citation Text:
Kuznetsova M, Frits ML, Dulgarian S, et al. An analysis of the structure and content of dashboards used to monitor patient safety in the inpatient setting.…
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psnet.ahrq.gov/issue/improving-departmental-psychological-safety-through-medical-school-wide-initiative
July 19, 2023 - Study
Improving departmental psychological safety through a medical school-wide initiative
Citation Text:
Porter-Stransky KA, Horneffer-Ginter KJ, Bauler LD, et al. Improving departmental psychological safety through a medical school-wide initiative. BMC Med Educ. 2024;24(1):800. doi:10.…
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psnet.ahrq.gov/issue/referrals-infection-control-breaches-public-health-authorities-ambulatory-care-settings
December 09, 2020 - Study
Referrals of infection control breaches to public health authorities: ambulatory care settings experience, 2017.
Citation Text:
Braun B, Chitavi SO, Perkins KM, et al. Referrals of infection control breaches to public health authorities: ambulatory care settings experience, 2017. J…
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psnet.ahrq.gov/issue/enhancing-psychological-safety-mental-health-services
May 12, 2021 - Commentary
Classic
Enhancing psychological safety in mental health services.
Citation Text:
Hunt DF, Bailey J, Lennox BR, et al. Enhancing psychological safety in mental health services. Int J Ment Health Syst. 2021;15(1):33. doi:10.1186/s13033-021-00439-1.
Co…
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-family-engagement/pfeprimarycare/warm-handoff-guide-for-clinicians.pdf
June 02, 2025 - Warm Handoffs: A Guide for Clinicians
Why is it important?
Communication breakdowns can result in
medical errors. Warm handoffs can help
address communication issues and:
■ Engage patients and families and
encourage them to ask questions.
■ Allow patients to clarify or correct the
information exchanged.
■…
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psnet.ahrq.gov/issue/why-do-people-sue-doctors-study-patients-and-relatives-taking-legal-action
August 04, 2021 - Study
Classic
Why do people sue doctors? A study of patients and relatives taking legal action.
Citation Text:
Vincent C, Young M, Phillips A. Why do people sue doctors? A study of patients and relatives taking legal action. Lancet. 1994;343(8913):1609-1613.
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digital.ahrq.gov/2018-year-review/research-dissemination/journals
January 01, 2018 - AHRQ-Funded Researchers Disseminate in High-Impact Journals
In 2018, AHRQ-funded researchers published over 100 research articles in peer-reviewed journals and book chapters, including the following:
Development and Dissemination of a Novel Quality Improvement Framework to Improve Care…
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psnet.ahrq.gov/issue/champ-model-building-center-support-health-care-worker-well-being-after-experiencing-adverse
January 18, 2023 - Commentary
CHaMP: A model for building a center to support health care worker well-being after experiencing an adverse event.
Citation Text:
McIntosh MS, Garvan C, Kalynych CJ, et al. CHaMP: A model for building a center to support health care worker well-being after experiencing an adve…
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psnet.ahrq.gov/issue/there-role-patients-and-their-relatives-escalating-clinical-deterioration-hospital-systematic
March 08, 2023 - Review
Is there a role for patients and their relatives in escalating clinical deterioration in hospital? A systematic review.
Citation Text:
Albutt AK, O'Hara JK, Conner MT, et al. Is there a role for patients and their relatives in escalating clinical deterioration in hospital? A syste…
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psnet.ahrq.gov/issue/it-rational-pursue-zero-suicides-among-patients-health-care
October 18, 2023 - Commentary
Is it rational to pursue zero suicides among patients in health care?
Citation Text:
Mokkenstorm JK, Kerkhof AJFM, Smit JH, et al. Is It Rational to Pursue Zero Suicides Among Patients in Health Care? Suicide Life Threat Behav. 2018;48(6):745-754. doi:10.1111/sltb.12396.
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www.ahrq.gov/news/blog/ahrqviews/diagnostic-safety-tops-the-list.html
March 01, 2024 - AHRQ Views: Blog posts from AHRQ leaders
When It Comes to High-Quality Healthcare, Diagnostic Safety Tops the List
MAR
12
2024
By
Robert Otto Valdez, Ph.D., M.H.S.A., and
Stephen Raab, M.D.
As we celebrate Patient Safety Awareness Week 2024 , AHRQ again places particular em…
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psnet.ahrq.gov/issue/patient-safety-issues-information-overload-electronic-medical-records
May 04, 2022 - Review
Patient safety issues from information overload in electronic medical records.
Citation Text:
Nijor S, Rallis G, Lad N, et al. Patient safety issues from information overload in electronic medical records. J Patient Saf. 2022;18(6):e999-e1003. doi:10.1097/pts.0000000000001002.
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www.ahrq.gov/policy/electronic/plain-writing/index.html
July 01, 2025 - Plain Language at AHRQ
The Plain Writing Act of 2010 requires federal agencies to write clear Government communication that the public can understand and use. This page explains what plain language is and how the Agency for Healthcare Research and Quality (AHRQ) is implementing the Act.
What is Plain Language…
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www.ahrq.gov/news/blog/ahrqviews/focus-diagnostic-safety.html
March 01, 2023 - AHRQ Views: Blog posts from AHRQ leaders
In the Spirit of Patient Safety Awareness Week, AHRQ Sharpens Its Focus on Diagnostic Safety
MAR
15
2023
By
Robert Otto
Valdez,
Ph.D., M.H.S.A.
Robert Otto Valdez, Ph.D., M.H.S.A.
In 2023, the American healthcare system rem…