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81. Final Progress Report: Improving Patient Safety by Examining Pathology Errors (pdf file)
    www.ahrq.gov/sites/default/files/2025-02/raab-report.pdf
    January 01, 2025 - and diagnostic error. … Error detection measures: Error frequencies, error proportions, and error rates. … Error and error reduction in pathology. Arch Pathol Lab Med 2005;129:1228-1233. … Pathology error taxonomy. … Anatomic pathology error.

82. Final Progress Report: Medication Error Reduction, Technologies and Human Factors (pdf file)
    www.ahrq.gov/sites/default/files/2024-01/carayon-report.pdf
    January 01, 2024 - Final Progress Report: Medication Error Reduction, Technologies and Human Factors Medication Error … To describe a human factors prospective error analysis and to qualitatively evaluate its effectiveness … PSN utilizes the National Coordinating Council for Medication Error Reporting and Prevention taxonomy … Four “drip-drip-gush” instances with NO error messages/alarms resulted. … National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP).

83. The Contribution of Diagnostic Error to Maternal Mortality and Severe Maternal Morbidity | Agency for Healthcare Research and Quality
    www.ahrq.gov/diagnostic-safety/resources/issue-briefs/maternal-mortality-2.html
    September 01, 2021 - Mortality During and Immediately After Childbirth: State of the Science The Contribution of Diagnostic Error … Immediately After Childbirth: State of the Science Introduction The Contribution of Diagnostic Error … adaptation of the multidisciplinary Safer Dx framework for measuring, monitoring, and improving diagnostic error … Measurement and learning from diagnostic error (and circumstances without diagnostic error) must include … Using the Safer Dx Framework 16 as a Model for Improvement of Diagnostic Error and Contributions to

84. Strategies for Improving Clinician Psychological Safety in Reporting and Discussing Diagnostic Error | Agency for Healthcare Research and Quality
    www.ahrq.gov/diagnostic-safety/resources/issue-briefs/dxsafety-psychological-safety.html
    September 01, 2023 - Strategies for Improving Clinician Psychological Safety in Reporting and Discussing Diagnostic Error … Strategies for Improving Clinician Psychological Safety in Reporting and Discussing Diagnostic Error … Strategies for Improving Clinician Psychological Safety in Reporting and Discussing Diagnostic Error.

85. Risk Reduction and Systematic Error Management: Standardization of the Pediatric Chemotherapy Process (pdf file)
    www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety-2/vol2/Advances-David_13.pdf
    March 19, 2008 - Risk Reduction and Systematic Error Management: Standardization of the Pediatric Chemotherapy Process … Risk Reduction and Systematic Error Management: Standardization of the Pediatric Chemotherapy Process … reactive error management. … Reducing prescribing error: Competence, control and culture. … Chemotherapy error reduction: A multidisciplinary approach to create templated order sets.

86. Evidence in Use of Clinical Reasoning Checklists for Diagnostic Error Reduction (pdf file)
    www.ahrq.gov/sites/default/files/wysiwyg/patient-safety/reports/issue-briefs/diagnostic-error-reduction.pdf
    September 04, 2020 - Evidence in Use of Clinical Reasoning Checklists for Diagnostic Error Reduction PATIENT SAFETY e … Evidence on Use of Clinical Reasoning Checklists for Diagnostic Error Reduction. … Successful checklists for preventing other error types list very specific tasks. … Developing checklists to prevent diagnostic error in Emergency Room settings. … Human Error. Cambridge, UK: Cambridge University Press; 1990. AHRQ Pub.

87. Final Progress Report: Minimizing Error, Maximizing Outcome (MEMO): The Physician Worklife Study II (pdf file)
    www.ahrq.gov/sites/default/files/2024-09/linzer-schwartz-report.pdf
    January 01, 2024 - Low information emphasis predicts likelihood of future error. … Stress and Preventable Error measure, or OSPRE). 3. … Organizational climate, stress, and error in primary care: the MEMO Study. … MEMO: Minimizing Error, Maximizing Outcome. … Error in medicine. JAMA, 1994: 272:1851-7.

88. Evidence on Use of Clinical Reasoning Checklists for Diagnostic Error Reduction | Agency for Healthcare Research and Quality
    www.ahrq.gov/diagnostic-safety/resources/issue-briefs/dxchecklists.html
    September 01, 2020 - Evidence on Use of Clinical Reasoning Checklists for Diagnostic Error Reduction Next Page … Table of Contents Evidence on Use of Clinical Reasoning Checklists for Diagnostic Error Reduction … Evidence on Use of Clinical Reasoning Checklists for Diagnostic Error Reduction.

89. A Conceptual Model for Disclosure of Medical Errors (pdf file)
    www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol2/Fein.pdf
    January 01, 2004 - Error factors included level of harm and whether patients and others were aware of the error and the … The level of harm caused by the error and whether patients and others were aware of the error and any … You put yourself in the hands of your professional…” Error factors The outcome of the error—who … Error outcome and patient awareness of the error outweighed any other determinants for disclosure related … to the error itself.

90. Appendix A. Database Search Strategy | Agency for Healthcare Research and Quality
    www.ahrq.gov/diagnostic-safety/resources/issue-briefs/dxsafety-test-result-communication-apa.html
    July 01, 2024 - Reactions” or “Incidental Findings” diagnos* adj2 (test* or procedur* or imag* or lab* or delay* or error … procedur* or diagnos* NEAR/2 imag* OR diagnos* NEAR/2 lab* OR diagnos* NEAR/2 delay* OR diagnos* NEAR/2 error … /exp OR ‘incidental findings’ OR (diagnos* NEXT/2 (test* OR procedur* OR imag* OR lab* OR delay* OR error … diagnos* N2 procedur* OR diagnos* N2 imag* OR diagnos* N2 lab* OR diagnos* N2 delay* OR diagnos* N2 error

91. Final Progress Report: Automated Image Analysis for the Prevention of Radiotherapy Delivery Errors (pdf file)
    www.ahrq.gov/sites/default/files/2024-11/lamb-report.pdf
    January 01, 2024 - Most if not all knowledge of error rates in radiotherapy is from error reporting. … Error reporting is known to underestimate error prevalence because not all errors are detected, and barriers … Error bars represent one standard error. … The result of our retrospective error search showed that errors were underreported: the actual error … rate was 66% greater than the reported error rate.

92. Final Progress Report: Reducing Harm to Patients from Diagnostic Errors (pdf file)
    www.ahrq.gov/sites/default/files/2025-03/berner-report.pdf
    January 01, 2025 - Diagnostic Error in Medicine. Adv Health Sci Educ Theory Pract. 2009 Sep;14 Suppl 1. … Diagnostic error in medicine: introduction. … Educational strategies to reduce diagnostic error: can you teach this stuff? … Diagnostic error in medical education: where wrongs can make rights. … Reducing diagnostic error with computer-based clinical decision support.

93. Learning from Errors in Ambulatory Pediatrics (pdf file)
    www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol1/Mohr.pdf
    February 01, 2004 - Error reports were then read to ensure that each report represented a mutually exclusive error. … Reports that included more than one error were divided into separate error reports. … Examples of error reports Medical domain categories Example error report Preventive Medicine “ … Examples of error reports, cont. … Error discovered.

94. Final Report: Using Risk Models To Improve Safety With Dispensing High-Alert Medications in Community Pharmacies (pdf file)
    www.ahrq.gov/sites/default/files/2024-01/cohen-report.pdf
    January 01, 2024 - to detect and correct the error before it reaches patients. … This represents a prescribing error capture rate of 74%. … Medication error reporting systems. In Medication Errors. 2nd ed. … The probability and management of human error. … Technique for human error rate prediction (THERP).

95. Final Progress Report: Medication Error Reduction, Technologies and Human Factors (pdf file)
    www.ahrq.gov/sites/default/files/wysiwyg/research/findings/final-reports/14253-Carayon-draft-1.pdf
    December 01, 2006 - Final Progress Report: Medication Error Reduction, Technologies and Human Factors Medication Error … To describe a human factors prospective error analysis and to qualitatively evaluate its effectiveness … PSN utilizes the National Coordinating Council for Medication Error Reporting and Prevention taxonomy … Four “drip-drip-gush” instances with NO error messages/alarms resulted. … National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP).

96. Preparing for Ambulatory Computerized Prescriber Order Entry by Evaluating Preimplementation Medication Errors (pdf file)
    www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol2/Devine.pdf
    July 01, 2003 - Data elements and error characteristics Error characteristics—type of error Illegible prescription … No error A Circumstances or events that have the capacity to cause error Error, no harm B … , did constitute an error. … If more than one error was found per prescription, each error was evaluated separately. … , thus qualifying to be an error.

97. Relationship Between Patient Harm and Reported Medical Errors in Primary Care: A Report from the ASIPS Collaborative (pdf file)
    www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety-2/vol1/Advances-West_102.pdf
    March 31, 2008 - Error Coding and Classification All error reports were reviewed and then coded by teams of at least … attributes could be assigned to the same error. … Multiple roles could be involved in any single error event. … Attributes of errors related to harm (N = 608) Error type Error attributes [N (%)] Future risk … Medical error taxonomies. A research forum; 2003.

98. Quantitative and Qualitative Analysis of Medication Errors: The New York Experience (pdf file)
    www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol1/Duthie.pdf
    January 01, 2004 - These included where in the process the error occurred, what disciplines were involved, the error distribution … error occurred that resulted in a patient death. … error code. … Unit-dose dispensing of the drug involved in the error will prevent an error with that drug, but not … Human error. Cambridge, UK: Cambridge University Press; 1990. 8.

99. Opportunities and Challenges Ahead | Agency for Healthcare Research and Quality
    www.ahrq.gov/diagnostic-safety/resources/issue-briefs/dxsafety-dx-stewardship8.html
    August 01, 2024 - as a Model To Improve the Quality and Safety of Diagnosis Introduction Background Diagnostic Error … in the Testing Process Diagnostic Stewardship Interventions To Reduce Diagnostic Error Diagnostic … models for populations and settings in which problems with the testing process contribute to diagnostic error … efforts to measure these organization-level outcomes as well as those directly related to diagnostic error

100. Patient Experience as a Source for Understanding the Origins, Impact, and Remediation of Diagnostic Errors | Agency for Healthcare Research and Quality
     www.ahrq.gov/diagnostic-safety/resources/issue-briefs/dxsafety-patients-source-understanding-dx-error-vol1.html
     July 01, 2023 - Hopkins University Christina Yuan Johns Hopkins University Helen Haskell Mothers Against Medical Error