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AHRQ: Agency for Healthcare Research and Quality

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Total Results: 585 records

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  1. Swiss Cheese Model | PSNet

    psnet.ahrq.gov/glossary/swiss-cheese-model
    September 13, 2021 - Swiss Cheese Model September 13, 2021 Anonymous (not verified) Reason developed the "Swiss cheese model" to illustrate how analyses of major accidents and catastrophic systems failures tend to reveal multiple, smaller failures leading up to the actual hazard. In the model, each slice of cheese represents a safe…

  2. Triaging Interhospital Transfers | PSNet

    psnet.ahrq.gov/web-mm/triaging-interhospital-transfers
    April 12, 2023 - existing protocols that the transfer center may have had (i.e., communication guidelines that may have correctly

  3. Pharmacist's Role in Medication Safety | PSNet

    psnet.ahrq.gov/primer/pharmacists-role-medication-safety
    March 14, 2018 - Pharmacist's Role in Medication Safety Citation Text: The Pharmacist's Role in Medication Safety. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2019. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML EndNote 7…

  4. Speak Up Video Series. | PSNet

    psnet.ahrq.gov/issue/speak-video-series
    November 27, 2018 - Audiovisual Speak Up Video Series. Citation Text: Speak Up Video Series. Oakbrook Terrace, IL: Joint Commission.   Copy Citation Save Save to your library Print Download PDF Share Facebook Twitter Linkedin Copy UR…

  5. National Patient Safety Goals | PSNet

    psnet.ahrq.gov/primer/national-patient-safety-goals
    January 16, 2025 - National Patient Safety Goals Citation Text: Shaikh U. National Patient Safety Goals. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2024. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML EndNote 7 XML Endnote…

  6. Cancer diagnoses delayed among prisoners in Washington state. | PSNet

    psnet.ahrq.gov/issue/cancer-diagnoses-delayed-among-prisoners-washington-state
    March 24, 2021 - Newspaper/Magazine Article Cancer diagnoses delayed among prisoners in Washington state. Citation Text: Cancer diagnoses delayed among prisoners in Washington state. Medscape Medical News. May 12, 2021. Copy Citation Save Save to your library Print Dow…

  7. Black or 'other'? Doctors may be relying on race to make decisions about your health. | PSNet

    psnet.ahrq.gov/issue/black-or-other-doctors-may-be-relying-race-make-decisions-about-your-health
    September 15, 2021 - Newspaper/Magazine Article Black or 'other'? Doctors may be relying on race to make decisions about your health. Citation Text: Black or 'other'? Doctors may be relying on race to make decisions about your health. Smith J, Spodak C. CNN. April 25, 2021. Copy Citation …

  8. The Top Five: A Review of Post-Pandemic Patient Safety Priorities. | PSNet

    psnet.ahrq.gov/issue/top-five-review-post-pandemic-patient-safety-priorities
    July 10, 2024 - Book/Report The Top Five: A Review of Post-Pandemic Patient Safety Priorities. Citation Text: The Top Five: A Review of Post-Pandemic Patient Safety Priorities. Sacramento, CA: Hospital Quality Institute; 2024. Copy Citation Save Save to your library Print…

  9. Getting Started with a Communication and Resolution Program (CRP) Policy or Commitment Statement to CR. | PSNet

    psnet.ahrq.gov/issue/getting-started-communication-and-resolution-program-crp-policy-or-commitment-statement-cr
    February 28, 2024 - Tools/Toolkit Getting Started with a Communication and Resolution Program (CRP) Policy or Commitment Statement to CR. Citation Text: Getting Started with a Communication and Resolution Program (CRP) Policy or Commitment Statement to CR. Collaborative for Accountability and Improvement Po…

  10. Haste Makes Care Unsafe | PSNet

    psnet.ahrq.gov/web-mm/haste-makes-care-unsafe
    January 07, 2015 - Haste Makes Care Unsafe Citation Text: Eichhorn JH. Haste Makes Care Unsafe. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2015. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML EndNote 7 XML Endnote tagged P…

  11. Stranded in the ER, seniors await hospital care and suffer avoidable harm. | PSNet

    psnet.ahrq.gov/issue/stranded-er-seniors-await-hospital-care-and-suffer-avoidable-harm
    December 05, 2018 - Newspaper/Magazine Article Stranded in the ER, seniors await hospital care and suffer avoidable harm. Citation Text: Stranded in the ER, seniors await hospital care and suffer avoidable harm. Graham J. KFF Health News. May 6, 2024. Copy Citation Save Save to your …

  12. Advancing safety with closed-loop communication of test results. | PSNet

    psnet.ahrq.gov/issue/advancing-safety-closed-loop-communication-test-results
    November 13, 2019 - Newspaper/Magazine Article Advancing safety with closed-loop communication of test results. Citation Text: Advancing safety with closed-loop communication of test results. Quick Safety. December 17, 2019;(52):1-3. Copy Citation Save Save to your library …

  13. Getting to the Root of the Matter | PSNet

    psnet.ahrq.gov/web-mm/getting-root-matter
    September 01, 2005 - SPOTLIGHT CASE Getting to the Root of the Matter Citation Text: Saint S, Flanders S. Getting to the Root of the Matter. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2005. Copy Citation Format: Google Schola…

  14. Beyond the Data: Understanding the Impact of COVID-19 on BAME Groups. | PSNet

    psnet.ahrq.gov/issue/beyond-data-understanding-impact-covid-19-bame-groups
    January 13, 2021 - Book/Report Classic Beyond the Data: Understanding the Impact of COVID-19 on BAME Groups. Citation Text: Beyond the Data: Understanding the Impact of COVID-19 on BAME Groups. Public Health England. London, UK: Crown Copyright; 2020. Copy Citation …

  15. How insight contributes to diagnostic excellence. | PSNet

    psnet.ahrq.gov/issue/how-insight-contributes-diagnostic-excellence
    June 08, 2022 - Commentary How insight contributes to diagnostic excellence. Citation Text: Shimizu T, Graber ML. How insight contributes to diagnostic excellence. Diagnosis (Berl). 2022;9(3):311-315. doi:10.1515/dx-2022-0007. Copy Citation Format: DOI Google Scholar BibTeX EndNote X3 XML …

  16. Evidence on Use of Clinical Reasoning Checklists for Diagnostic Error Reduction. | PSNet

    psnet.ahrq.gov/issue/evidence-use-clinical-reasoning-checklists-diagnostic-error-reduction
    October 06, 2021 - Book/Report Evidence on Use of Clinical Reasoning Checklists for Diagnostic Error Reduction. Citation Text: Evidence on Use of Clinical Reasoning Checklists for Diagnostic Error Reduction. Zwaan L, Staal J. Rockville, MD: Agency for Healthcare Research and Quality; September 2020. A…

  17. Organizing Patient Safety: Failsafe Fantasies and Pragmatic Practices. | PSNet

    psnet.ahrq.gov/issue/organizing-patient-safety-failsafe-fantasies-and-pragmatic-practices
    August 01, 2018 - Book/Report Organizing Patient Safety: Failsafe Fantasies and Pragmatic Practices. Citation Text: Organizing Patient Safety: Failsafe Fantasies and Pragmatic Practices. Pedersen KZ. London, United Kingdom: Palgrave Macmillan; 2018. ISBN: 9781137537850. Copy Citation Sav…

  18. Caregiver and clinician perspectives on discharge medication counseling: a qualitative study. | PSNet

    psnet.ahrq.gov/issue/caregiver-and-clinician-perspectives-discharge-medication-counseling-qualitative-study
    January 31, 2024 - Study Caregiver and clinician perspectives on discharge medication counseling: a qualitative study. Citation Text: Carroll AR, Schlundt D, Bonnet K, et al. Caregiver and clinician perspectives on discharge medication counseling: a qualitative study. Hosp Pediatr. 2023;13(4):325-342. doi:…

  19. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49565/psn-pdf
    July 01, 2008 - Wrong Route for Nutrients July 1, 2008 Scott-Cawiezell JR. Wrong Route for Nutrients. PSNet [internet]. 2008. https://psnet.ahrq.gov/web-mm/wrong-route-nutrients The Case An 82-year-old man living in a skilled nursing facility (SNF) had not been eating or drinking well for about 6 months. He had lost weight and d…

  20. Teamwork Toolkit. | PSNet

    psnet.ahrq.gov/issue/teamwork-toolkit
    July 21, 2021 - Toolkit Teamwork Toolkit. Citation Text: Teamwork Toolkit. Durham, NC: Duke Center for Healthcare Safety and Quality; June 2019. Copy Citation Save Save to your library Print Download PDF Share Facebook Twitter Linkedin Copy…
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