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2281. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/47414/psn-pdf
      May 01, 2019 - Impact of teamwork improvement training on communication and teamwork climate in ambulatory reproductive health care. May 1, 2019 Dodge LE, Nippita S, Hacker MR, et al. Impact of teamwork improvement training on communication and teamwork climate in ambulatory reproductive health care. J Healthc Risk Manag. 2019;3…

2282. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/46854/psn-pdf
      June 20, 2018 - FDA Safety Communication: recommendations to reduce surgical fires and related patient injury. June 20, 2018 MedWatch Safety Alert. Silver Spring, MD: US Food and Drug Administration. May 29, 2018. https://psnet.ahrq.gov/issue/fda-safety-communication-recommendations-reduce-surgical-fires-and-related- patient-inju…

2283. Miscommunication in the OR Leads to Anticoagulation Mishap | PSNet
      psnet.ahrq.gov/web-mm/miscommunication-or-leads-anticoagulation-mishap
      May 08, 2019 - Miscommunication in the OR Leads to Anticoagulation Mishap Citation Text: Solsky I, Haynes AB. Miscommunication in the OR Leads to Anticoagulation Mishap. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2017. Copy Citation Forma…

2284. Labor and Delivery Unit Safety: Umbilical Cord Prolapse | Agency for Healthcare Research and Quality
      www.ahrq.gov/patient-safety/settings/labor-delivery/perinatal-care/modules/strategies/labor-delivery-unit/tool-cord-prolapse.html
      July 01, 2023 - Labor and Delivery Unit Safety: Umbilical Cord Prolapse AHRQ Safety Program for Perinatal Care Purpose of the tool: This tool describes the key perinatal safety elements that support safe umbilical cord prolapse management. The key safety elements are presented within the framework of the Compreh…

2285. Creating a foundation for the design of culturally-informed health IT - 2010 | Digital Healthcare Research
      digital.ahrq.gov/ahrq-funded-projects/creating-foundation-design-culturally-informed-health-it/annual-summary/2010
      January 01, 2010 - Creating a foundation for the design of culturally-informed health IT - 2010 Project Name Creating a Foundation for the Design of Culturally-Informed Health Information Technology Principal Investigator Valdez, Rupa Sheth Organization University of Wisconsin - Madison …

2286. Impact of simulation-based closed-loop communication training on medical errors in a pediatric emergency department. | PSNet
      psnet.ahrq.gov/issue/impact-simulation-based-closed-loop-communication-training-medical-errors-pediatric-emergency
      July 22, 2020 - Study Impact of simulation-based closed-loop communication training on medical errors in a pediatric emergency department. Citation Text: Diaz MCG, Dawson K. Impact of Simulation-Based Closed-Loop Communication Training on Medical Errors in a Pediatric Emergency Department. Am J Med Qual…

2287. A look into the nature and causes of human errors in the intensive care unit. | PSNet
      psnet.ahrq.gov/issue/look-nature-and-causes-human-errors-intensive-care-unit
      June 29, 2009 - Study Classic A look into the nature and causes of human errors in the intensive care unit. Citation Text: Donchin Y, Gopher D, Olin M, et al. A look into the nature and causes of human errors in the intensive care unit. Crit Care Med. 1995;23(2):294-300. Co…

2288. Failure to debrief after critical events in anesthesia is associated with failures in communication during the event. | PSNet
      psnet.ahrq.gov/issue/failure-debrief-after-critical-events-anesthesia-associated-failures-communication-during
      September 24, 2018 - Study Emerging Classic Failure to debrief after critical events in anesthesia is associated with failures in communication during the event. Citation Text: Arriaga AF, Sweeney RE, Clapp JT, et al. Failure to Debrief after Critical Events in Anesthesia Is Associa…

2289. Peers without fears? Barriers to effective communication among primary care physicians and oncologists about diagnostic delays in cancer. | PSNet
      psnet.ahrq.gov/issue/peers-without-fears-barriers-effective-communication-among-primary-care-physicians-and
      October 27, 2021 - Study Peers without fears? Barriers to effective communication among primary care physicians and oncologists about diagnostic delays in cancer. Citation Text: Lipitz-Snyderman A, Kale M, Robbins L, et al. Peers without fears? Barriers to effective communication among primary care physici…

2290. "The patient is awake and we need to stay calm": reconsidering indirect communication in the face of medical error and professionalism lapses. | PSNet
      psnet.ahrq.gov/issue/patient-awake-and-we-need-stay-calm-reconsidering-indirect-communication-face-medical-error
      October 11, 2023 - Study "The patient is awake and we need to stay calm": reconsidering indirect communication in the face of medical error and professionalism lapses. Citation Text: Taylor T, Columbus L, Banner H, et al. “The patient is awake and we need to stay calm”: reconsidering indirect communication…

2291. Improving communication with primary care physicians at the time of hospital discharge. | PSNet
      psnet.ahrq.gov/issue/improving-communication-primary-care-physicians-time-hospital-discharge
      November 16, 2022 - Study Improving communication with primary care physicians at the time of hospital discharge. Citation Text: Destino LA, Dixit A, Pantaleoni JL, et al. Improving Communication with Primary Care Physicians at the Time of Hospital Discharge. Jt Comm J Qual Patient Saf. 2017;43(2):80-88. do…

2292. Effects of a communication-and-resolution program on hospitals' malpractice claims and costs. | PSNet
      psnet.ahrq.gov/issue/effects-communication-and-resolution-program-hospitals-malpractice-claims-and-costs
      October 11, 2017 - Study Effects of a communication-and-resolution program on hospitals' malpractice claims and costs. Citation Text: Kachalia A, Sands K, Van Niel M, et al. Effects Of A Communication-And-Resolution Program On Hospitals' Malpractice Claims And Costs. Health Aff (Millwood). 2018;37(11):1836…

2293. Risk-adjusted morbidity in teaching hospitals correlates with reported levels of communication and collaboration on surgical teams but not with scale measures of teamwork climate, safety climate, or working conditions. | PSNet
      psnet.ahrq.gov/issue/risk-adjusted-morbidity-teaching-hospitals-correlates-reported-levels-communication-and
      July 12, 2010 - Study Classic Risk-adjusted morbidity in teaching hospitals correlates with reported levels of communication and collaboration on surgical teams but not with scale measures of teamwork climate, safety climate, or working conditions. Citation Text: Davenport DL…

2294. Predictors of likelihood of speaking up about safety concerns in labour and delivery. | PSNet
      psnet.ahrq.gov/issue/predictors-likelihood-speaking-about-safety-concerns-labour-and-delivery
      October 19, 2022 - Study Predictors of likelihood of speaking up about safety concerns in labour and delivery. Citation Text: Lyndon A, Sexton B, Simpson KR, et al. Correction. BMJ Qual Saf. 2011;22(2):791-799. doi:10.1136/bmjqs.2010.050211. Copy Citation Format: DOI Google Scholar BibTeX E…

2295. Cusp Patient Family Engagement Facilitator Notes (doc file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/education/curriculum-tools/cusptoolkit/modules/patfamilyengagement/CUSP_Patient_Family_Engagement_Facilitator_Notes.docx
      June 02, 2025 - SAY: The Patient and Family Engagement module of the Comprehensive Unit-based Safety Program (or CUSP) Toolkit focuses on an important topic: Making sure patients and their family members understand what is happening during the patient’s hospital stay, are active participants in the patient’s care, and are prepared for…

2296. Executive Summary | Agency for Healthcare Research and Quality
      www.ahrq.gov/patient-safety/settings/hospital/candor/demo-program/grants/summary.html
      August 01, 2022 - Demonstration Grants Final Evaluation Report Executive Summary Previous Page Next Page Table of Contents Demonstration Grants Final Evaluation Report Executive Summary Detailed Findings Evaluation Issues Contributions to Patient Safety and Medical Liability Lessons Learned From Implement…

2297. Safe Medication Administration: Facilitator Guide | Agency for Healthcare Research and Quality
      www.ahrq.gov/patient-safety/settings/labor-delivery/perinatal-care/modules/strategies/medication/safe-medication-fac-guide.html
      July 01, 2023 - Safe Medication Administration: Facilitator Guide AHRQ Safety Program for Perinatal Care Slide 1: Safe Medication Administration Say: The Safe Medication Administration bundle provides information on high-alert medications commonly used in labor and delivery (L&D) units, and discusses the importance of …

2298. Safemed Facguide (doc file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/perinatal-care/modules/strategies/medication/safemed_facguide.docx
      May 01, 2017 - AHRQ Safety Program for Perinatal Care Safe Medication Administration Safe Medication Administration SAY: The Safe Medication Administration bundle provides information on high-alert medications commonly used in labor and delivery (L&D) units, and discusses the importance of implementing safeguards for their administ…

2299. Empty Handoff | PSNet
      psnet.ahrq.gov/web-mm/empty-handoff
      August 01, 2017 - Commission issued National Patient Safety Goal 2E which requires a "standardized approach to handoff communications

2300. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/853773/psn-pdf
      September 27, 2023 - Assessment, and Recommendation/Request tool represents a useful starting point to ensure that team communications