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psnet.ahrq.gov/issue/teamwork-and-team-performance-multidisciplinary-cancer-teams-development-and-evaluation
August 11, 2010 - Study
Teamwork and team performance in multidisciplinary cancer teams: development and evaluation of an observational assessment tool.
Citation Text:
Lamb BW, Vincent CA, Green JSA, et al. Teamwork and team performance in multidisciplinary cancer teams: development and evaluation of an…
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psnet.ahrq.gov/issue/physician-led-chart-audit-engaging-providers-fortifying-culture-safety
November 20, 2013 - Study
The "physician-led chart audit": engaging providers in fortifying a culture of safety.
Citation Text:
Gitkind MJ, Perla RJ, Manno M, et al. The "physician-led chart audit: " engaging providers in fortifying a culture of safety. J Patient Saf. 2014;10(1):72-9. doi:10.1097/PTS.0000…
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psnet.ahrq.gov/issue/incorporating-medication-indications-prescribing-process
May 01, 2019 - Commentary
Emerging Classic
Incorporating medication indications into the prescribing process.
Citation Text:
Kron K, Myers S, Volk LA, et al. Incorporating medication indications into the prescribing process. Am J Health-syst Pharm. 2018;75(11):774-783. doi:10.…
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psnet.ahrq.gov/issue/canadian-association-university-surgeons-annual-symposium-surgical-simulation-solution-safe
March 09, 2022 - Review
Canadian Association of University Surgeons' Annual Symposium. Surgical simulation: the solution to safe training or a promise unfulfilled?
Citation Text:
Brindley PG, Jones DB, Grantcharov T, et al. Canadian Association of University Surgeons' Annual Symposium. Surgical simulat…
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psnet.ahrq.gov/issue/patient-safetys-missing-link-using-clinical-expertise-recognize-respond-and-reduce-risks
May 08, 2017 - Commentary
Patient safety's missing link: using clinical expertise to recognize, respond to and reduce risks at a population level.
Citation Text:
Hibbert PD, Healey F, Lamont T, et al. Patient safety's missing link: using clinical expertise to recognize, respond to and reduce risks at a…
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psnet.ahrq.gov/issue/structured-judgement-method-enhance-mortality-case-note-review-development-and-evaluation
May 27, 2011 - Study
A structured judgement method to enhance mortality case note review: development and evaluation.
Citation Text:
Hutchinson A, Coster JE, Cooper KL, et al. A structured judgement method to enhance mortality case note review: development and evaluation. BMJ Qual Saf. 2013;22(12). do…
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psnet.ahrq.gov/issue/idea-safety-training-improve-critical-thinking-individuals-and-teams
May 25, 2016 - Commentary
An IDEA: safety training to improve critical thinking by individuals and teams.
Citation Text:
Browne AM, Deutsch ES, Corwin K, et al. An IDEA: Safety Training to Improve Critical Thinking by Individuals and Teams. Am J Med Qual. 2019;34(6):569-576. doi:10.1177/106286061882068…
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psnet.ahrq.gov/issue/contribution-prescription-chart-design-and-familiarity-prescribing-error-prospective
March 20, 2024 - Study
The contribution of prescription chart design and familiarity to prescribing error: a prospective, randomised, cross-over study.
Citation Text:
Tallentire VR, Hale RL, Dewhurst NG, et al. The contribution of prescription chart design and familiarity to prescribing error: a prospe…
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psnet.ahrq.gov/issue/stories-clinicians-tell-achieving-high-reliability-and-improving-patient-safety
April 24, 2018 - Commentary
The stories clinicians tell: achieving high reliability and improving patient safety.
Citation Text:
Cohen DL, Stewart KO. The Stories Clinicians Tell: Achieving High Reliability and Improving Patient Safety. Perm J. 2016;20(1):85-90. doi:10.7812/TPP/15-039.
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psnet.ahrq.gov/issue/duty-hours-restriction-and-their-effect-resident-education-and-academic-departments-american
November 16, 2022 - Review
Duty hours restriction and their effect on resident education and academic departments: the American perspective.
Citation Text:
Swide CE, Kirsch JR. Duty hours restriction and their effect on resident education and academic departments: the American perspective. Curr Opin Anaes…
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psnet.ahrq.gov/issue/seen-through-patients-eyes-safety-chronic-illness-care
May 16, 2018 - Study
Seen through the patients' eyes: safety of chronic illness care.
Citation Text:
Desmedt M, Petrovic M, Bergs J, et al. Seen through the patients' eyes: Safety of chronic illness care. Int J Qual Health Care. 2017;29(7):916-921. doi:10.1093/intqhc/mzx137.
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psnet.ahrq.gov/issue/empirically-derived-taxonomy-factors-affecting-physicians-willingness-disclose-medical-errors
February 15, 2011 - Review
An empirically derived taxonomy of factors affecting physicians' willingness to disclose medical errors.
Citation Text:
Kaldjian LC, Jones EW, Rosenthal GE, et al. An empirically derived taxonomy of factors affecting physicians’ willingness to disclose medical errors. J Gen Inter…
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psnet.ahrq.gov/issue/levels-reflective-thinking-and-patient-safety-investigation-mechanisms-impact-student
January 30, 2013 - Study
Levels of reflective thinking and patient safety: an investigation of the mechanisms that impact on student learning in a single cohort over a 5 year curriculum.
Citation Text:
Ambrose LJ, Ker J. Levels of reflective thinking and patient safety: an investigation of the mechanisms t…
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psnet.ahrq.gov/issue/how-organisations-contribute-improving-quality-healthcare
June 25, 2014 - Commentary
How organisations contribute to improving the quality of healthcare.
Citation Text:
Fulop NJ, Ramsay AIG. How organisations contribute to improving the quality of healthcare. BMJ. 2019;365:l1773. doi:10.1136/bmj.l1773.
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www.ahrq.gov/news/newsroom/case-studies/202301.html
October 01, 2024 - Ohio Veterans’ Facility Relied on AHRQ Resource to Develop Diabetes Initiative
Search All Impact Case Studies
March 2023
The Dayton (Ohio) Veterans Affairs (VA) Medical Center facility has adopted AHRQ’s SHARE Approach as part of the U.S. Department of Veterans Affairs' national Hypoglycemic Safety Initia…
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psnet.ahrq.gov/issue/undermining-and-bullying-surgical-training-review-and-recommendations-association-surgeons
July 25, 2018 - Review
Undermining and bullying in surgical training: a review and recommendations by the Association of Surgeons in Training.
Citation Text:
Wild JRL, Ferguson HJM, McDermott FD, et al. Undermining and bullying in surgical training: a review and recommendations by the Association of Sur…
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digital.ahrq.gov/technology/pharmacy-information-system
January 01, 2023 - Pharmacy Information System
CancelRx case study: Implications for clinic and community pharmacy work systems.
Citation
Watterson TL, Stone JA, Kleinschmidt PC, Chui MA. CancelRx case study: Implications for clinic and community pharmacy work systems. BMC Health Serv Res. 2023 …
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psnet.ahrq.gov/issue/diagnostic-safety-needs-assessment-and-informed-curriculum-academic-childrens-hospital
June 28, 2023 - Study
Diagnostic safety: needs assessment and informed curriculum at an academic children's hospital.
Citation Text:
Congdon M, Rasooly IR, Toto RL, et al. Diagnostic safety: needs assessment and informed curriculum at an academic children's hospital. Pediatr Qual Saf. 2024;9(6):e773. do…
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psnet.ahrq.gov/issue/tiered-daily-huddles-power-teamwork-managing-large-healthcare-organisations
December 09, 2020 - Commentary
Tiered daily huddles: the power of teamwork in managing large healthcare organisations.
Citation Text:
Mihaljevic T. Tiered daily huddles: the power of teamwork in managing large healthcare organisations. BMJ Qual Saf. 2020;29(12):1050-1052. doi:10.1136/bmjqs-2019-010575.
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www.ahrq.gov/sites/default/files/wysiwyg/hai/tools/mrsa-2/056-patient-instructions-chg-shower.docx
April 01, 2025 - AHRQ Safety Program for MRSA Prevention: Targeting SSI
Patient Instructions: Showering With CHG
Surgical Services
For: Cardiac, Hip and Knee Joint Replacement, and Spinal Fusion Surgeries
What Is Decolonization?
Preoperative Decolonization =
Preemptive treatment to kill bacteria on your body BEFORE surgery,
to reduce …