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  1. psnet.ahrq.gov/issue/exploring-role-communications-quality-improvement-case-study-1000-lives-campaign-nhs-wales
    August 04, 2021 - Study Exploring the role of communications in quality improvement: a case study of the 1000 Lives Campaign in NHS Wales. Citation Text: Cooper A, Gray J, Willson A, et al. Exploring the role of communications in quality improvement: A case study of the 1000 Lives Campaign in NHS Wales. J…
  2. psnet.ahrq.gov/issue/cognitive-biases-and-moral-characteristics-healthcare-workers-and-their-treatment-approach
    March 28, 2018 - Study Cognitive biases and moral characteristics of healthcare workers and their treatment approach for persons with advanced dementia in acute care settings. Citation Text: Erel M, Marcus E-L, DeKeyser Ganz F. Cognitive biases and moral characteristics of healthcare workers and their tr…
  3. www.ahrq.gov/sites/default/files/wysiwyg/hai/tools/mrsa/066-dec-staff-faqs-safety-side-effects.docx
    October 01, 2024 - AHRQ Safety Program for MRSA Prevention Decolonization: Staff Frequently Asked Questions Safety & Side Effects This document provides questions and answers to commonly asked questions. Some questions and answers may not be relevant to your unit. You should remove or edit information to match your unit’s protocols. The…
  4. psnet.ahrq.gov/issue/fatal-consequences-simple-mistake-how-can-patient-be-saved-inadvertent-intrathecal
    January 29, 2020 - Commentary Fatal consequences of a simple mistake: how can a patient be saved from inadvertent intrathecal vincristine? Citation Text: Reddy K, Brown B, Nanda A. Fatal consequences of a simple mistake: how can a patient be saved from inadvertent intrathecal vincristine? Clin Neurol Neu…
  5. psnet.ahrq.gov/issue/taking-detour-positive-and-negative-effects-supervisors-interruptions-during-admission-case
    November 21, 2018 - Study Taking a detour: positive and negative effects of supervisors' interruptions during admission case review discussions. Citation Text: Goldszmidt M, Aziz N, Lingard LA. Taking a detour: positive and negative effects of supervisors' interruptions during admission case review discuss…
  6. psnet.ahrq.gov/issue/rapid-response-team-implementation-and-hospital-mortality
    December 03, 2014 - Study Rapid response team implementation and in-hospital mortality. Citation Text: Salvatierra G, Bindler RC, Corbett CF, et al. Rapid response team implementation and in-hospital mortality*. Crit Care Med. 2014;42(9):2001-6. doi:10.1097/CCM.0000000000000347. Copy Citation Format: …
  7. www.ahrq.gov/teamstepps-program/evidence-base/research.html
    June 01, 2023 - TeamSTEPPS Research and Tools Agency for Healthcare Research and Quality. (2006).  TeamSTEPPS™ Guide to Action: Creating a Safety Net for your Healthcare Organization . AHRQ Publication No. 06-0020-4. Castner, J. (2012). Validity and reliability of the Brief  TeamSTEPPS Teamwork Perceptions Questionnaire.  Jo…
  8. psnet.ahrq.gov/issue/why-july-matters
    October 13, 2018 - Commentary Why July matters. Citation Text: Petrilli CM, Del Valle J, Chopra V. Why July Matters. Acad Med. 2016;91(7):910-912. doi:10.1097/ACM.0000000000001196. Copy Citation Format: DOI Google Scholar PubMed BibTeX EndNote X3 XML EndNote 7 XML Endnote tagged PubMedId RIS …
  9. psnet.ahrq.gov/issue/algorithmic-prediction-failure-modes-healthcare
    September 06, 2023 - Study Algorithmic prediction of failure modes in healthcare. Citation Text: Kobo-Greenhut A, Sharlin O, Adler Y, et al. Algorithmic prediction of failure modes in healthcare. Int J Qual Health Care. 2021;33(1):mzaa151. doi:10.1093/intqhc/mzaa151. Copy Citation Format: DOI G…
  10. psnet.ahrq.gov/issue/medical-error-disclosure-training-evidence-values-based-ethical-environments
    October 15, 2016 - Study Medical error disclosure training: evidence for values-based ethical environments. Citation Text: Rathert C, Phillips W. Medical Error Disclosure Training: Evidence for Values-Based Ethical Environments. Journal of Business Ethics. 2010;97(3). doi:10.1007/s10551-010-0520-3. Cop…
  11. psnet.ahrq.gov/issue/costs-associated-surgical-site-infections-veterans-affairs-hospitals
    June 18, 2014 - Study Costs associated with surgical site infections in Veterans Affairs hospitals. Citation Text: Schweizer ML, Cullen JJ, Perencevich E, et al. Costs Associated With Surgical Site Infections in Veterans Affairs Hospitals. JAMA Surg. 2014;149(6):575-81. doi:10.1001/jamasurg.2013.4663. …
  12. psnet.ahrq.gov/issue/key-considerations-ensuring-safe-regional-telehealth-care-model-systematic-review
    August 25, 2021 - Review Key considerations in ensuring a safe regional telehealth care model: a systematic review. Citation Text: Haveland S, Islam S. Key considerations in ensuring a safe regional telehealth care model: a systematic review. Telemed J E Health. 2022;28(5):602-612. doi:10.1089/tmj.2020.05…
  13. psnet.ahrq.gov/issue/fundamental-use-surgical-energy-fuse-essential-educational-program-operating-room-safety
    June 07, 2018 - Commentary Fundamental Use of Surgical Energy (FUSE): an essential educational program for operating room safety. Citation Text: Jones SB, Munro MG, Feldman LS, et al. Fundamental Use of Surgical Energy (FUSE): An Essential Educational Program for Operating Room Safety. Perm J. 2017;21:1…
  14. psnet.ahrq.gov/issue/patient-safety-culture-transformation-childrens-hospital-interprofessional-approach
    January 16, 2010 - Study Patient safety culture transformation in a children's hospital: an interprofessional approach. Citation Text: Nagelkerk J, Peterson T, Pawl BL, et al. Patient safety culture transformation in a children's hospital: an interprofessional approach. J Interprof Care. 2014;28(4):358-64.…
  15. psnet.ahrq.gov/issue/decoding-laboratory-test-names-major-challenge-appropriate-patient-care
    April 24, 2018 - Study Decoding laboratory test names: a major challenge to appropriate patient care. Citation Text: Passiment E, Meisel JL, Fontanesi J, et al. Decoding laboratory test names: a major challenge to appropriate patient care. J Gen Intern Med. 2013;28(3):453-8. doi:10.1007/s11606-012-2253-8…
  16. psnet.ahrq.gov/issue/silent-treatment-why-safety-tools-and-checklists-arent-enough-save-lives
    April 03, 2009 - Book/Report Classic The Silent Treatment: Why Safety Tools and Checklists Aren't Enough to Save Lives. Citation Text: The Silent Treatment: Why Safety Tools and Checklists Aren't Enough to Save Lives. Maxfield D, Grenny J, Lavandero R, et al. Provo, UT: VitalS…
  17. psnet.ahrq.gov/issue/managed-care-penetration-and-other-factors-affecting-computerized-physician-order-entry
    October 06, 2011 - Study Managed care penetration and other factors affecting computerized physician order entry in the ambulatory setting. Citation Text: Menachemi N, Ford E, Chukmaitov A, et al. Managed care penetration and other factors affecting computerized physician order entry in the ambulatory se…
  18. psnet.ahrq.gov/issue/educational-interventions-improve-handover-health-care-systematic-review
    August 04, 2021 - Review Educational interventions to improve handover in health care: a systematic review. Citation Text: Gordon M, Findley R. Educational interventions to improve handover in health care: a systematic review. Med Educ. 2011;45(11):1081-9. doi:10.1111/j.1365-2923.2011.04049.x. Copy Ci…
  19. psnet.ahrq.gov/issue/national-efforts-improve-health-information-system-safety-canada-united-states-america-and
    July 14, 2009 - Review National efforts to improve health information system safety in Canada, the United States of America and England. Citation Text: Kushniruk AW, Bates DW, Bainbridge M, et al. National efforts to improve health information system safety in Canada, the United States of America and …
  20. psnet.ahrq.gov/issue/clinical-decision-support-25-year-retrospective-and-25-year-vision
    May 20, 2019 - Review Clinical decision support: a 25 year retrospective and a 25 year vision. Citation Text: Middleton B, Sittig DF, Wright A. Clinical Decision Support: a 25 Year Retrospective and a 25 Year Vision. Yearb Med Inform. 2016;Suppl 1:S103-16. doi:10.15265/IYS-2016-s034. Copy Citation …