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  1. effectivehealthcare.ahrq.gov/sites/default/files/related_files/mhs-IV-patient-family-engagement.pdf
    July 01, 2023 - EHC Protocol: Addressing Social Isolation To Improve Health of Older Adults: A Rapid Evidence Review Evidence-based Practice Center Rapid Response Protocol Project Title: Making Healthcare Safer IV: Patient and Family Engagement Review Questions 1. What is the frequency and severity of harms addre…
  2. psnet.ahrq.gov/innovation/verification-screen-includes-prominent-patient-photograph-significantly-reduces-errors
    October 30, 2024 - Verification Screen That Includes Prominent Patient Photograph Significantly Reduces Errors Caused by Orders Placed in Wrong Chart Save Save to your library Print Download PDF Share Facebook Twitter Linkedin Copy URL June 12, 2020 …
  3. www.ahrq.gov/sites/default/files/2024-12/moyer-report.pdf
    January 01, 2024 - Final Progress Report: Crossing an Invisible Quality Chasm: From NICU to Ambulatory Care AHRQ Grant Final Progress Report Title: Crossing An Invisible Quality Chasm: From NICU to Ambulatory Care Principal Investigator: Virginia A. Moyer, MD, MPH Team Members: Papile, Lucille A., MD, Co-Investigator Guillory, Char…
  4. www.ahrq.gov/sites/default/files/2024-04/baernholdt-report.pdf
    January 01, 2024 - Final Progress Report: Care Interventions and Quality of Care in Rural and Urban Nursing Units Title of Project: Care Interventions and Quality of Care in Rural and Urban Nursing Units Principal Investigator and Team Members: PI: Marianne Baernholdt, PhD, MPH, RN, Virginia Commonwealth University, School of N…
  5. hcup-us.ahrq.gov/db/nation/nass/nasschecklist.jsp
    November 01, 2024 - Checklist for Working with the NASS An official website of the Department of Health & Human Services Search All AHRQ Websites Careers Contact Us Espanol FAQs Email Updates …
  6. www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol4/Arroyo.pdf
    June 11, 2003 - A Nonpunitive, Computerized System for Improved Reporting of Medical Occurrences 71 A Nonpunitive, Computerized System for Improved Reporting of Medical Occurrences Dale A. Arroyo Abstract To improve the patient safety program at the Naval Hospital at Oak Harbor, the facility instituted a new computerized s…
  7. psnet.ahrq.gov/issue/devil-detail-how-closed-loop-documentation-system-iv-infusion-administration-contributes-and
    February 12, 2020 - Study The devil is in the detail: how a closed-loop documentation system for IV infusion administration contributes to and compromises patient safety. Citation Text: Furniss D, Dean Franklin B, Blandford A. The devil is in the detail: how a closed-loop documentation system for IV infusi…
  8. psnet.ahrq.gov/issue/designing-distractions-human-factors-approach-decreasing-interruptions-centralised-medication
    July 27, 2018 - Study Designing for distractions: a human factors approach to decreasing interruptions at a centralised medication station. Citation Text: Colligan L, Guerlain S, Steck SE, et al. Designing for distractions: a human factors approach to decreasing interruptions at a centralised medication…
  9. psnet.ahrq.gov/issue/evaluation-problem-specific-sbar-tool-improve-after-hours-nurse-physician-phone-communication
    December 30, 2014 - Study Evaluation of a problem-specific SBAR tool to improve after-hours nurse-physician phone communication: a randomized trial. Citation Text: Joffe E, Turley JP, Hwang KO, et al. Evaluation of a problem-specific SBAR tool to improve after-hours nurse-physician phone communication: a ra…
  10. psnet.ahrq.gov/issue/effect-electronic-transmission-prescriptions-dispensing-errors-and-prescription-enhancements
    December 16, 2020 - Study The effect of the electronic transmission of prescriptions on dispensing errors and prescription enhancements made in English community pharmacies: a naturalistic stepped wedge study. Citation Text: Franklin BD, Reynolds M, Sadler S, et al. The effect of the electronic transmission…
  11. psnet.ahrq.gov/issue/diagnostic-discrepancies-between-antemortem-clinical-diagnosis-and-autopsy-findings-pediatric
    July 28, 2021 - Study Diagnostic discrepancies between antemortem clinical diagnosis and autopsy findings in pediatric cancer patients. Citation Text: Raghuram N, Alodan K, Bartels U, et al. Diagnostic discrepancies between antemortem clinical diagnosis and autopsy findings in pediatric cancer patients.…
  12. digital.ahrq.gov/ahrq-funded-projects/best-practices-integrating-clinical-decision-support-clinical-workflow
    January 01, 2023 - Best Practices For Integrating Clinical Decision Support Into Clinical Workflow Project Final Report ( PDF , 513.15 KB) Disclaimer Disclaimer The findings and conclusions in this document are those of the author(s), who are responsible for its content, and do not necessarily re…
  13. psnet.ahrq.gov/issue/fall-prevention-smart-socks-system-reduces-hospital-fall-rates
    September 09, 2020 - Study Fall prevention with the Smart Socks System reduces hospital fall rates. Citation Text: Moore T, Kline D, Palettas M, et al. Fall prevention with the Smart Socks System reduces hospital fall rates. J Nurs Care Qual. 2023;38(1):55-60. doi:10.1097/ncq.0000000000000653. Copy Citatio…
  14. digital.ahrq.gov/principal-investigator/casale-cecilia
    January 01, 2023 - Casale, Cecilia Health information technology and quality of health care: strategies for reducing disparities in underresourced settings. Citation Millery M, Kukafka R. Health information technology and quality of health care: strategies for reducing disparities in underresour…
  15. psnet.ahrq.gov/issue/reducing-risk-delayed-colorectal-cancer-diagnoses-through-ambulatory-safety-net-collaborative
    February 28, 2011 - Study Reducing the risk of delayed colorectal cancer diagnoses through an ambulatory safety net collaborative. Citation Text: Moyal-Smith R, Elam M, Boulanger J, et al. Reducing the risk of delayed colorectal cancer diagnoses through an ambulatory safety net collaborative. Jt Comm J Qual…
  16. psnet.ahrq.gov/issue/identifying-barriers-and-opportunities-telehealth-implementation-amidst-covid-19-pandemic
    July 07, 2021 - Commentary Identifying barriers to and opportunities for telehealth implementation amidst the COVID-19 pandemic by using a human factors approach: a leap into the future of health care delivery? Citation Text: Zhang T, Mosier J, Subbian V. Identifying barriers to and opportunities for te…
  17. psnet.ahrq.gov/issue/safety-pediatric-hospice-and-palliative-care-qualitative-study
    September 02, 2020 - Study Safety in pediatric hospice and palliative care: a qualitative study. Citation Text: Pestian T, Thienprayoon R, Grossoehme D, et al. Safety in pediatric hospice and palliative care: a qualitative study. Pediatr Qual Saf. 2020;5(4):e328. doi:10.1097/pq9.0000000000000328. Copy Cit…
  18. psnet.ahrq.gov/issue/unintended-consequences-online-consultations-qualitative-study-uk-primary-care
    November 16, 2022 - Study Unintended consequences of online consultations: a qualitative study in UK primary care. Citation Text: Turner A, Morris R, Rakhra D, et al. Unintended consequences of online consultations: a qualitative study in UK primary care. Br J Gen Pract. 2021;72(715):e128-e137. doi:10.3399/…
  19. psnet.ahrq.gov/issue/observational-study-how-patients-are-identified-medication-administrations-medical-and
    June 24, 2020 - Study An observational study of how patients are identified before medication administrations in medical and surgical wards. Citation Text: Härkänen M, Kervinen M, Ahonen J, et al. An observational study of how patients are identified before medication administrations in medical and surg…
  20. psnet.ahrq.gov/issue/patient-participation-patient-safety-still-missing-patient-safety-experts-views
    February 13, 2019 - Study Patient participation in patient safety still missing: patient safety experts' views. Citation Text: Sahlström M, Partanen P, Rathert C, et al. Patient participation in patient safety still missing: Patient safety experts' views. Int J Nurs Pract. 2016;22(5):461-469. doi:10.1111/ij…