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5281. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/41047/psn-pdf
      November 26, 2014 - Failure to follow-up test results for ambulatory patients: a systematic review. November 26, 2014 Callen JL, Westbrook JI, Georgiou A, et al. Failure to Follow-Up Test Results for Ambulatory Patients: A Systematic Review. J Gen Intern Med. 2011;27(10):1334-1348. doi:10.1007/s11606-011-1949-5. https://psnet.ahrq.go…

5282. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/72572/psn-pdf
      January 01, 2021 - "At home, with care": lessons from New York City home- based primary care practices managing COVID-19. December 16, 2020 Franzosa E, Gorbenko K, Brody AA, et al. "At home, with care": lessons from New York City home-based primary care practices managing COVID-19. J Am Geriatr Soc. 2021;69(2):300-306. doi:10.1111/j…

5283. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/43514/psn-pdf
      April 25, 2016 - A qualitative analysis of physician perspectives on missed and delayed outpatient diagnosis: the focus on system-related factors. April 25, 2016 Sarkar U, Simchowitz B, Bonacum D, et al. A Qualitative Analysis of Physician Perspectives on Missed and Delayed Outpatient Diagnosis: The Focus on System-Related Factors…

5284. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/40236/psn-pdf
      March 23, 2012 - The safety implications of missed test results for hospitalised patients: a systematic review. March 23, 2012 Callen J, Georgiou A, Li J, et al. The safety implications of missed test results for hospitalised patients: a systematic review. BMJ Qual Saf. 2011;20(2):194-199. doi:10.1136/bmjqs.2010.044339. https://ps…

5285. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/41413/psn-pdf
      September 26, 2012 - The effects of a 'discharge time-out' on the quality of hospital discharge summaries. September 26, 2012 Mohta N, Vaishnava P, Liang C, et al. The effects of a 'discharge time-out' on the quality of hospital discharge summaries. BMJ Qual Saf. 2012;21(10):885-90. https://psnet.ahrq.gov/issue/effects-discharge-time-…

5286. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/844549/psn-pdf
      February 15, 2023 - Preventable harm because of outpatient medication errors among children with leukemia and lymphoma: a multisite longitudinal assessment. February 15, 2023 Wong CI, Vannatta K, Gilleland Marchak J, et al. Preventable harm because of outpatient medication errors among children with leukemia and lymphoma: a multisite…

5287. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/60176/psn-pdf
      April 01, 2020 - Health and social care-associated harm amongst vulnerable children in primary care: mixed methods analysis of national safety reports. April 1, 2020 Omar A, Rees P, Cooper A, et al. Health and social care-associated harm amongst vulnerable children in primary care: mixed methods analysis of national safety reports…

5288. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/37771/psn-pdf
      June 29, 2011 - Effect of crew resource management training in a multidisciplinary obstetrical setting. June 29, 2011 Haller G, Garnerin P, Morales M-A, et al. Effect of crew resource management training in a multidisciplinary obstetrical setting. Int J Qual Health Care. 2008;20(4):254-63. doi:10.1093/intqhc/mzn018. https://psnet…

5289. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/42803/psn-pdf
      February 13, 2014 - Pilot testing of a model for insurer-driven, large-scale multicenter simulation training for operating room teams. February 13, 2014 Arriaga AF, Gawande AA, Raemer D, et al. Pilot testing of a model for insurer-driven, large-scale multicenter simulation training for operating room teams. Ann Surg. 2014;259(3):403-1…

5290. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/852746/psn-pdf
      August 23, 2023 - Common contributing factors of diagnostic error: a retrospective analysis of 109 serious adverse event reports from Dutch hospitals. August 23, 2023 Hooftman J, Dijkstra AC, Suurmeijer I, et al. Common contributing factors of diagnostic error: a retrospective analysis of 109 serious adverse event reports from Dutc…

5291. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/42223/psn-pdf
      August 15, 2013 - Development of a checklist of safe discharge practices for hospital patients. August 15, 2013 Soong C, Daub S, Lee J, et al. Development of a checklist of safe discharge practices for hospital patients. J Hosp Med. 2013;8(8):444-9. doi:10.1002/jhm.2032. https://psnet.ahrq.gov/issue/development-checklist-safe-disch…

5292. Section 1: Overview of Key Concepts and Tools | Agency for Healthcare Research and Quality
      www.ahrq.gov/teamstepps-program/curriculum/intro/overview.html
      July 01, 2023 - Section 1: Overview of Key Concepts and Tools This section provides an overview of the key concepts in the Introduction. More extensive explanations and illustrations are provided in section 2 ; methods for teaching the introduction's concepts are in section 3 . Each of the four modules that follow also inclu…

5293. New AHRQ SOPS® Workplace Safety Supplemental Items for Hospitals - Ginsberg (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/sops/events/webinar/02-new-sops-workplace-safety-ginsberg.pdf
      June 02, 2025 - New AHRQ SOPS® Workplace Safety Supplemental Items for Hospitals - Ginsberg AHRQ’s Surveys on Patient Safety Culture™ (SOPS®) Program Caren Ginsberg, Ph.D. Center for Quality Improvement and Patient Safety, AHRQ 6 AHRQ’s SOPS Program • Initiated and funded by AHRQ since 2001 to advance the understanding, measu…

5294. Gap Analysis Facilitator's Guide: Appendix E | Agency for Healthcare Research and Quality
      www.ahrq.gov/patient-safety/settings/hospital/candor/modules/facguide3/ape.html
      August 01, 2022 - Gap Analysis Facilitator's Guide: Appendix E Gap Analysis Report Template The purpose of the Gap Analysis report is to call attention to common themes among the groups, as well as variations among the groups in their perceptions and degree of commitment to CANDOR principles. Findings should be used for target…

5295. Exhibit 2.15. Major Factors that Inhibited Lean Success at Central | Agency for Healthcare Research and Quality
      www.ahrq.gov/practiceimprovement/systemdesign/leancasestudies/lean-exhibit2-15.html
      November 01, 2014 - Improving Care Delivery Through Lean: Implementation Case Studies Exhibit 2.15. Major Factors that Inhibited Lean Success at Central Previous Page Next Page Table of Contents Improving Care Delivery Through Lean: Implementation Case Studies Introduction to the Case Studies Case 1. Lakeview Healt…

5296. Sustainability | Agency for Healthcare Research and Quality
      www.ahrq.gov/hai/cauti-tools/phys-championsgd/section6.html
      October 01, 2015 - Resident Physicians as Champions in Preventing Device-Associated Infections Sustainability Previous Page Next Page Table of Contents Resident Physicians as Champions in Preventing Device-Associated Infections Preamble and Summary Epidemiology of Invasive Devices and Complications Examples of P…

5297. Exhibit 4.19. Major Factors that Inhibit Lean Success | Agency for Healthcare Research and Quality
      www.ahrq.gov/practiceimprovement/systemdesign/leancasestudies/lean-exhibit4-19.html
      November 01, 2014 - Improving Care Delivery Through Lean: Implementation Case Studies Exhibit 4.19. Major Factors that Inhibit Lean Success Previous Page Next Page Table of Contents Improving Care Delivery Through Lean: Implementation Case Studies Introduction to the Case Studies Case 1. Lakeview Healthcare Case …

5298. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/37290/psn-pdf
      February 15, 2011 - Medical errors involving trainees: a study of closed malpractice claims from 5 insurers. February 15, 2011 Singh H, Thomas EJ, Petersen L, et al. Medical errors involving trainees: a study of closed malpractice claims from 5 insurers. Arch Intern Med. 2007;167(19):2030-6. https://psnet.ahrq.gov/issue/medical-error…

5299. Personalized Medicine | Digital Healthcare Research
      digital.ahrq.gov/health-care-theme/personalized-medicine
      January 01, 2023 - Personalized Medicine Precision Emergency Medicine: Setting a Research Agenda Description This research will use a consensus conference format during the 2023 Society for Academic Emergency Medicine conference to develop and publish an actionable research agenda for precision …

5300. SOPS Action Planning Tool Template (doc file)
      www.ahrq.gov/sites/default/files/wysiwyg/sops/sops-action-planning-tool-template.docx
      June 02, 2025 - SOPS Action Planning Tool Template Facility name: Date last updated: Action Plan for the AHRQ Surveys on Patient Safety Culture 1. Identifying Areas to Improve 1a. What areas do you want to focus on for improvement? 1b. What are your “SMART” goals? Notes or Comments Facility name: Date last…