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5861. To Err Is Human: Building a Safer Health System. | PSNet
      psnet.ahrq.gov/issue/err-human-building-safer-health-system
      July 08, 2016 - Book/Report Classic To Err Is Human: Building a Safer Health System. Citation Text: To Err Is Human: Building a Safer Health System. Kohn KT, Corrigan JM, Donaldson MS, eds. Washington, DC: Committee on Quality Health Care in America, Institute of Medicine: Nati…

5862. Patient Engagement | Digital Healthcare Research
      digital.ahrq.gov/health-care-theme/patient-engagement
      January 01, 2023 - Patient Engagement Bedside Notes: A Multicenter Trial to Improve Family Clinical Note Access and Outcomes for Hospitalized Children Description This research will evaluate the effectiveness of Bedside Notes, a digital health solution designed to provide caregivers with real-ti…

5863. Toolkit for Engaging Patients To Improve Diagnostic Safety  | Agency for Healthcare Research and Quality
      www.ahrq.gov/diagnostic-safety/tools/engaging-patients-improve.html
      April 01, 2025 - Toolkit for Engaging Patients To Improve Diagnostic Safety  Diagnostic errors occur in all care settings and one in three patients will experience a diagnostic error firsthand. Research suggests that communication breakdowns during the patient-provider encounter are a leading contributor to diagnostic errors. …

5864. The National Quality Strategy: Fact Sheet | Agency for Healthcare Research and Quality
      www.ahrq.gov/workingforquality/about/nqs-fact-sheets/nqs-fact-sheet-0214.html
      November 01, 2016 - The National Quality Strategy: Fact Sheet About the National Quality Strategy How the National Quality Strategy Works Who Is Responsible for the National Quality Strategy? What You Can Do The National Quality Strategy is a national effort to align public- and private-sector stakeholders to achieve…

5865. Trends in adverse event rates in hospitalized patients, 2010-2019. | PSNet
      psnet.ahrq.gov/issue/trends-adverse-event-rates-hospitalized-patients-2010-2019
      June 22, 2022 - Study Trends in adverse event rates in hospitalized patients, 2010-2019. Citation Text: Eldridge N, Wang Y, Metersky M, et al. Trends in adverse event rates in hospitalized patients, 2010-2019. JAMA. 2022;328(2):173-183. doi:10.1001/jama.2022.9600. Copy Citation Format: DOI…

5866. A systematic review of patient-report safety climate measures in health care. | PSNet
      psnet.ahrq.gov/issue/systematic-review-patient-report-safety-climate-measures-health-care
      September 15, 2021 - Review A systematic review of patient-report safety climate measures in health care. Citation Text: Madden C, Lydon S, O’Dowd E, et al. A systematic review of patient-report safety climate measures in health care. J Patient Saf. 2022;18(1):e51-e60. doi:10.1097/pts.0000000000000705. Cop…

5867. Communication failure: analysis of prescribers' use of an internal free-text field on electronic prescriptions. | PSNet
      psnet.ahrq.gov/issue/communication-failure-analysis-prescribers-use-internal-free-text-field-electronic
      May 20, 2019 - Study Communication failure: analysis of prescribers' use of an internal free-text field on electronic prescriptions. Citation Text: Ai A, Wong A, Amato MG, et al. Communication failure: analysis of prescribers’ use of an internal free-text field on electronic prescriptions. J Am Med Inf…

5868. Measuring team hierarchy during high-stakes clinical decision making: development and validation of a new behavioral observation method. | PSNet
      psnet.ahrq.gov/issue/measuring-team-hierarchy-during-high-stakes-clinical-decision-making-development-and
      April 05, 2023 - Study Measuring team hierarchy during high-stakes clinical decision making: development and validation of a new behavioral observation method. Citation Text: Johansson AC, Manago B, Sell J, et al. Measuring team hierarchy during high-stakes clinical decision making: development and valid…

5869. Assessment of fidelity in interventions to improve hand hygiene of healthcare workers: a systematic review. | PSNet
      psnet.ahrq.gov/issue/assessment-fidelity-interventions-improve-hand-hygiene-healthcare-workers-systematic-review
      June 02, 2019 - Review Assessment of fidelity in interventions to improve hand hygiene of healthcare workers: a systematic review. Citation Text: Musuuza JS, Barker A, Ngam C, et al. Assessment of Fidelity in Interventions to Improve Hand Hygiene of Healthcare Workers: A Systematic Review. Infect Contro…

5870. Improving resident engagement in quality improvement and patient safety initiatives at the bedside: the Advocate for Clinical Education (ACE). | PSNet
      psnet.ahrq.gov/issue/improving-resident-engagement-quality-improvement-and-patient-safety-initiatives-bedside
      December 21, 2017 - Study Improving resident engagement in quality improvement and patient safety initiatives at the bedside: the Advocate for Clinical Education (ACE). Citation Text: Schleyer AM, Best JA, McIntyre LK, et al. Improving resident engagement in quality improvement and patient safety initiati…

5871. Accountability measures—using measurement to promote quality improvement. | PSNet
      psnet.ahrq.gov/issue/accountability-measures-using-measurement-promote-quality-improvement
      January 23, 2012 - Commentary Classic Accountability measures—using measurement to promote quality improvement. Citation Text: Chassin MR, Loeb JM, Schmaltz SP, et al. Accountability measures--using measurement to promote quality improvement. N Engl J Med. 2010;363(7):683-8. doi…

5872. Hospital safety climate and safety outcomes: is there a relationship in the VA? | PSNet
      psnet.ahrq.gov/issue/hospital-safety-climate-and-safety-outcomes-there-relationship-va
      October 14, 2009 - Study Hospital safety climate and safety outcomes: is there a relationship in the VA? Citation Text: Rosen AK, Singer SJ, Zhao S, et al. Hospital safety climate and safety outcomes: is there a relationship in the VA? Med Care Res Rev. 2010;67(5):590-608. doi:10.1177/1077558709356703. …

5873. Putting the "action" in RCA(2): an analysis of intervention strength after adverse events. | PSNet
      psnet.ahrq.gov/issue/putting-action-rca2-analysis-intervention-strength-after-adverse-events
      April 17, 2024 - Study Putting the "action" in RCA(2): an analysis of intervention strength after adverse events. Citation Text: Zerillo JA, Tardiff SA, Flood D, et al. Putting the "action" in RCA(2): an analysis of intervention strength after adverse events. Jt Comm J Qual Patient Saf. 2024;50(7):492-49…

5874. Leadership Support | Agency for Healthcare Research and Quality
      www.ahrq.gov/diagnostic-safety/resources/issue-briefs/dxsafety-sustainability-centers-of-excellence5.html
      April 01, 2025 - Four Pillars for Sustainable Centers of Excellence Leadership Support Previous Page Next Page Table of Contents Four Pillars for Sustainable Centers of Excellence Introduction Center of Excellence Operations Alignment Integration Leadership Support Windows of Opportunity Conclusion A…

5875. Intervening in interruptions: what exactly is the risk we are trying to manage? | PSNet
      psnet.ahrq.gov/issue/intervening-interruptions-what-exactly-risk-we-are-trying-manage
      July 20, 2022 - Review Intervening in interruptions: what exactly is the risk we are trying to manage? Citation Text: Gao J, Rae AJ, Dekker SWA. Intervening in Interruptions: What Exactly Is the Risk We Are Trying to Manage? J Patient Saf. 2021;17(7):e684-e688. doi:10.1097/PTS.0000000000000429. Copy C…

5876. Methodological approaches for analyzing medication error reports in patient safety reporting systems: a scoping review. | PSNet
      psnet.ahrq.gov/issue/methodological-approaches-analyzing-medication-error-reports-patient-safety-reporting-systems
      May 11, 2022 - Review Methodological approaches for analyzing medication error reports in patient safety reporting systems: a scoping review. Citation Text: Tchijevitch O, Hansen SM-B, Hallas J, et al. Methodological approaches for analyzing medication error reports in patient safety reporting systems:…

5877. Implementing patient safety interventions in your hospital: what to try and what to avoid. | PSNet
      psnet.ahrq.gov/issue/implementing-patient-safety-interventions-your-hospital-what-try-and-what-avoid
      June 03, 2010 - Review Implementing patient safety interventions in your hospital: what to try and what to avoid. Citation Text: Ranji SR, Shojania KG. Implementing patient safety interventions in your hospital: what to try and what to avoid. Med Clin North Am. 2008;92(2):275-93, vii-viii. doi:10.1016…

5878. Studying the Accuracy of Symptom-Checker App in Diagnosing Strokes in a Real-World Setting | Digital Healthcare Research
      digital.ahrq.gov/program-overview/research-stories/studying-accuracy-symptom-checker-app-diagnosing-strokes-real
      January 01, 2023 - Studying the Accuracy of Symptom-Checker App in Diagnosing Strokes in a Real-World Setting Theme: Engaging and Empowering Patients and Caregivers Subtheme: Technology Solutions to Engage Patients and Their Families in Care Rigorously evaluating a popular, patient-facing symptom-checker app…

5879. Patient reasoning: patients' and care partners' perceptions of diagnostic accuracy in emergency care. | PSNet
      psnet.ahrq.gov/issue/patient-reasoning-patients-and-care-partners-perceptions-diagnostic-accuracy-emergency-care
      October 23, 2024 - Study Patient reasoning: patients' and care partners' perceptions of diagnostic accuracy in emergency care. Citation Text: Dukhanin V, McDonald KM, Gonzalez N, et al. Patient reasoning: patients' and care partners' perceptions of diagnostic accuracy in emergency care. Med Decis Making. 2…

5880. Adverse drug events after hospital discharge in older adults: types, severity, and involvement of Beers criteria medications. | PSNet
      psnet.ahrq.gov/issue/adverse-drug-events-after-hospital-discharge-older-adults-types-severity-and-involvement
      August 11, 2010 - Study Adverse drug events after hospital discharge in older adults: types, severity, and involvement of Beers criteria medications. Citation Text: Kanaan AO, Donovan JL, Duchin NP, et al. Adverse drug events after hospital discharge in older adults: types, severity, and involvement of …