-
www.ahrq.gov/funding/process/study-section/peerrev.html
January 01, 2025 - It reviews applications relating to identifying risks and hazards that lead to medical errors and identifying … The research findings and products encompass providing information on the scope and impact of medical errors … healthcare associated infections; and examining effective ways to make system-level changes to help prevent errors … Dissemination and translation of research findings and methods to reduce medical errors, examining effective … ways to make system-level changes to help prevent errors, and developing, testing and evaluating various
-
www.ahrq.gov/research/findings/final-reports/ptfamilyscan/ptfamilyapc.html
July 01, 2018 - Award
Manitoba Institute for Patient Safety
Massachusetts Coalition for the Prevention of Medical Errors … Council—Calgary, Alberta
Patients are Powerful
Patients.About.Com
Persons United Limiting Sub standards and Errors … Care
Picker Institute
Picker Institute Europe
Planetree
Persons United Limiting Sub standards and Errors … of America
Persons United Limiting Sub standards and Errors of NY
Quality and Safety Education for
-
www.ahrq.gov/sites/default/files/wysiwyg/diagnostic/resources/issue-briefs/dxsafety-terminology.pdf
April 01, 2025 - adverse event16 was introduced and defined as diagnostic errors that cause harm. … Diagnosing diagnosis errors: lessons from
a multi-institutional collaborative project. … Missed opportunities for diagnosis: lessons learned from
diagnostic errors in primary care. … Use of e-triggers to identify diagnostic errors in
the paediatric ED. … Detection and classification of diagnostic discrepancies (errors) in surgical pathology.
-
www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety-2/vol1/Advances-Schade_63.pdf
January 01, 2007 - Smaller numbers focused on infections, devices,
laboratory errors, surgical errors, and falls. … Reducing errors in medicine.
Br Med J 1999; 319: 136-137.
9. … Prescribing
errors in hospital inpatients: Their incidence and
clinical significance. … Medication
errors and adverse drug events in pediatric inpatients. … Factors related to
errors in medication prescribing. JAMA 1997; 277:
312-317.
21.
-
www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol2/Anthony.pdf
January 01, 2005 - both active and latent
errors occurring at the time of hospital discharge. … Taxonomy of errors at time of hospital discharge
Highlighted boxes indicate errors potentially addressable … Medical errors as an epidemic. … A
presentation at the national Summit on medical errors
and patient safety research. … Taxonomy of errors at time of hospital discharge
Figure 3.
-
www.ahrq.gov/sites/default/files/2024-01/moss-berner-report.pdf
January 01, 2024 - of errors at the administration
stage. … Medication Errors Observed in 36 Health Care
Facilities. … Medication errors at the
administration stage in an intensive care unit. … Ethnographic study of incidence and severity of intravenous drug errors. … Medication administration
errors in adult patients in the ICU.
-
www.ahrq.gov/sites/default/files/wysiwyg/professionals/education/curriculum-tools/cusptoolkit/modules/understand/scisafetynotes.docx
June 02, 2025 - Slide 4
SAY:
Errors occur within the health care setting because people are fallible. … Providers, executives, and managers need to understand why errors occur. … Errors occur because medicine is still treated as an art, not a science. … In analyzing how errors occur, frontline providers must recognize the scientific nature of medicine. … Errors also occur because systems frequently do not catch mistakes before they reach the patient.
-
www.ahrq.gov/patient-safety/resources/learning-lab/dream-lab-long-desc.html
August 01, 2025 - The specific aims were to: Identify factors contributing to diagnostic errors and inappropriate clinical … patterns in diagnostic error risk. 1,2 The lab developed a taxonomy for patient-perceived diagnostic errors … Evaluation of a natural language processing approach to identify diagnostic errors and analysis of safety … Evaluation of a natural language processing approach to identify diagnostic errors and analysis of safety
-
www.ahrq.gov/sites/default/files/2024-12/thorpe-rask-report.pdf
January 01, 2024 - technology; and 5) patient safety communication, including informing
patients about harm caused by errors … Key Words: Leadership role in safety, error reporting, medication errors, patient
safety, voluntary … Can a statewide hospital initiative
reduce medication errors? Under Review
I.B. … Doing the right thing: Disclosing medical errors. Momentum 2003; 6(2):22-23.
Banja J. … Medical Errors and Medical Narcissism. Jones and Bartlett Publishers,
Sudbury, MA. 2005.
-
www.ahrq.gov/hai/tools/mvp/modules/cusp/science-of-safety-fac-guide.html
February 01, 2017 - Slide 5: Errors Happen Because…
Say:
Errors happen because people are fallible. … By accepting that people are not perfect, we are taking the first step toward realizing that medical errors … realize that we can redesign care and delivery processes to improve care and minimize the occurrence of errors … Errors also occur because systems frequently are not designed to catch mistakes before they reach the … 9: The Science of Safety
Say:
Science of Safety training helps providers recognize that most errors
-
www.ahrq.gov/teamstepps-program/resources/additional/check-back-team.html
July 01, 2023 - instructions are described—and heard—correctly is an important safeguard against potential medication errors … part of an evidence-based approach to safer care, can improve communication and reduce the risk of errors
-
www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol1/Rundall.pdf
January 01, 2003 - to reduce errors. … Patient
safety: views of practicing physicians and the public
on medical errors. … Physicians, public not overly concerned
about medical errors. … Physician and public opinions on quality of health care
and the problem of medical errors. … The identification
of medical errors by family physicians during
outpatient visits.
-
www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/perinatal-care/modules/teamwork/understand/understand-facilitator-guide.docx
May 01, 2017 - In 1999, 44,000 to 99,000 people die from medical errors in hospitals each year. … Providers, executives, and managers need to understand why errors occur. … Errors occur because medicine is still treated as an art, not a science. … In analyzing how errors occur, frontline providers must recognize the scientific nature of medicine. … Errors also occur because systems frequently do not catch mistakes before they reach the patient.
-
www.ahrq.gov/funding/process/study-section/peerdesc.html
July 01, 2017 - It reviews applications relating to identifying risks and hazards that lead to medical errors and identifying … The research findings and products encompass providing information on the scope and impact of medical errors … healthcare associated infections; and examining effective ways to make system-level changes to help prevent errors … Dissemination and translation of research findings and methods to reduce medical errors, examining effective … ways to make system-level changes to help prevent errors, and developing, testing and evaluating various
-
www.ahrq.gov/diagnostic-safety/resources/issue-briefs/dxsafety-terminology7.html
April 01, 2025 - The concept of error is particularly problematic for diagnosis as most diagnostic errors are real but … subject to hindsight and outcome bias and is thus not entirely objective. 29 In addition, diagnostic errors … Unlike safety “events,” diagnostic errors tend to become evident over time and across different sites … encountered during medical care. 3 In general, medical adverse events tend to be (but are not always) errors … Diagnostic adverse events commonly include errors of omission (e.g., failure to order or properly interpret
-
www.ahrq.gov/sites/default/files/publications2/files/dx-safety-21-diagnostic-stewardship.pdf
August 01, 2024 - AHRQ Publication No. 24-0010-6-EF.
1
e
Introduction
Diagnostic errors often involve problems in … Preanalytic errors may also result from specimen
mishandling; for instance, contamination of specimens … Diagnostic error in medicine: analysis
of 583 physician-reported errors. … Relating faults in diagnostic
reasoning with diagnostic errors and patient harm. … Challenges and errors in genetic testing: the Fifth Case Series. Cancer J. 2021;27(6):417-422.
-
www.ahrq.gov/hai/cusp/modules/understand/science-safety-notes.html
July 01, 2018 - How Can These Errors Happen?
Slide 6. The Science of Safety
Slide 7. … Return to Contents
Slide 5: How Can These Errors Happen? … Say:
Errors occur within the health care setting because people are fallible. … Providers, executives, and managers need to understand why errors occur. … Errors occur because medicine is still treated as an art, not a science.
-
www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety-2/vol3/Advances-Jack_28.pdf
February 21, 2008 - Medical Errors and Adverse Events at Hospital Discharge
Errors and Adverse Events Are Common on Both … • Filing system errors.
• Errors in dispensing medications. … • Errors in responding to abnormal laboratory test results. … Waiting days or weeks leads to errors.
6. … Medication
errors observed in 36 health care facilities.
-
www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-family-engagement/pfeprimarycare/infographicposter-final508_0.pdf
June 02, 2025 - Annually,
1 in 20 outpatients experiences a diagnostic error
55%
of patients said
diagnostic errors … 9
ED admissions
are related to an
adverse drug event
An estimated
160
million
medication
errors … Reduce errors
and improve visit
efficiency by setting
the visit agenda
together with
Be Prepared
-
www.ahrq.gov/sites/default/files/wysiwyg/data/infographics/patient-safety-issues.pdf
June 02, 2025 - Annually,
1 in 20 outpatients experiences a diagnostic error
55%
of patients said
diagnostic errors … 9
ED admissions
are related to an
adverse drug event
An estimated
160
million
medication
errors … Reduce errors
and improve visit
efficiency by setting
the visit agenda
together with
Be Prepared