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psnet.ahrq.gov/node/47928/psn-pdf
January 01, 2021 - Perceptions of pediatric hospital safety culture in the
United States: an analysis of the 2016 Hospital Survey on
Patient Safety Culture.
April 24, 2019
Gampetro PJ, Segvich JP, Jordan N, et al. Perceptions of Pediatric Hospital Safety Culture in the United
States: An Analysis of the 2016 Hospital Survey on Patien…
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psnet.ahrq.gov/web-mm/fluidity-diagnostic-wet-reads
April 24, 2018 - He was advised to establish care with a primary care physician (PCP). … systems issues as a major contributor to diagnostic errors, radiology departments should take steps to establish
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psnet.ahrq.gov/node/45220/psn-pdf
June 08, 2016 - Medical Office Survey on Patient Safety Culture: 2016
User Comparative Database Report.
June 8, 2016
Famolaro T, Yount ND, Hare R, Thornton S, Sorra J. Rockville, MD: Agency for Healthcare Research and
Quality; May 2016. AHRQ Publication No. 16-0028-EF.
https://psnet.ahrq.gov/issue/medical-office-survey-patient-sa…
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psnet.ahrq.gov/node/44180/psn-pdf
June 21, 2015 - "Never events" and the quest to reduce preventable harm.
June 21, 2015
Austin M, Pronovost P. "Never events" and the quest to reduce preventable harm. Jt Comm J Qual Patient
Saf. 2015;41(6):279-288.
https://psnet.ahrq.gov/issue/never-events-and-quest-reduce-preventable-harm
The introduction of the term never event…
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psnet.ahrq.gov/issue/oregon-patient-safety-commission
June 22, 2007 - Legislation/Regulation
Oregon Patient Safety Commission.
Citation Text:
Oregon Patient Safety Commission. Oregon State Legislature. HB 2349 (2003).
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psnet.ahrq.gov/node/60547/psn-pdf
May 28, 2020 - The Role of the FDA in Ensuring Device Safety
May 28, 2020
Fitall E, Hall KK, Gale B. The Role of the FDA in Ensuring Device Safety . PSNet [internet]. 2020.
https://psnet.ahrq.gov/perspective/role-fda-ensuring-device-safety
Introduction
The Food and Drug Administration (FDA) plays a critical role in ensuring the …
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psnet.ahrq.gov/node/40095/psn-pdf
December 22, 2010 - Assessing and improving safety culture throughout an
academic medical centre: a prospective cohort study.
December 22, 2010
Paine LA, Rosenstein BJ, Sexton B, et al. Assessing and improving safety culture throughout an academic
medical centre: a prospective cohort study. Qual Saf Health Care. 2010;19(6):547-54.
do…
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psnet.ahrq.gov/node/40203/psn-pdf
February 09, 2011 - Changes in safety attitude and relationship to decreased
postoperative morbidity and mortality following
implementation of a checklist-based surgical safety
intervention.
February 9, 2011
Haynes AB, Weiser TG, Berry WR, et al. Changes in safety attitude and relationship to decreased
postoperative morbidity and mo…
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psnet.ahrq.gov/node/33769/psn-pdf
June 01, 2014 - This meeting also saw the
pledge by The Joint Commission to establish its sentinel events database and … by the American Medical
Association (AMA) to establish the National Patient Safety Foundation (NPSF
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psnet.ahrq.gov/perspective/conversation-jeffrey-shuren-md-jd
May 28, 2020 - clinical studies after a product is out in the marketplace, led us to develop a strategy in 2012 to establish
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psnet.ahrq.gov/perspective/role-fda-ensuring-device-safety
May 28, 2020 - clinical studies after a product is out in the marketplace, led us to develop a strategy in 2012 to establish
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psnet.ahrq.gov/issue/creating-culture-caregiver-support
May 18, 2022 - Newspaper/Magazine Article
Creating a culture of caregiver support.
Citation Text:
Gold KJ, Andrew LB, Goldman EB, et al. “I would never want to have a mental health diagnosis on my record”: A survey of female physicians on mental health diagnosis, treatment, and reporting. General Hospi…
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psnet.ahrq.gov/innovation/remote-response-team-and-customized-alert-settings-help-improve-management-sepsis
February 26, 2025 - Establish the CAT and train them in the pathophysiology of sepsis, evidence-based practices for treatment
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psnet.ahrq.gov/issue/peer-support-clinicians-programmatic-approach
July 25, 2018 - Commentary
Peer support for clinicians: a programmatic approach.
Citation Text:
Shapiro J, Galowitz P. Peer Support for Clinicians: A Programmatic Approach. Acad Med. 2016;91(9):1200-4. doi:10.1097/ACM.0000000000001297.
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DOI Google Scholar PubMed BibTeX…
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psnet.ahrq.gov/curated-library/implementation-patient-safety-projects
July 21, 2025 - This study reports on an AHRQ-funded effort to establish communication-and-resolution protocols for general … This study reports on an AHRQ-funded effort to establish communication-and-resolution protocols for general
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psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.335_slideshow.ppt
December 01, 2014 - PowerPoint Presentation
Spotlight
A Stroke of Error
This presentation is based on the December 2014
AHRQ WebM&M Spotlight Case
See the full article at http://webmm.ahrq.gov
CME credit is available
Commentary by: Kevin M. Barrett, MD, MSc, Consultant, Associate Professor of Neurology, Director, Neurohospitalist F…
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psnet.ahrq.gov/issue/implementing-medication-reconciliation-outpatient-pediatrics
September 23, 2020 - Study
Implementing medication reconciliation in outpatient pediatrics.
Citation Text:
Rappaport DI, Collins B, Koster A, et al. Implementing medication reconciliation in outpatient pediatrics. Pediatrics. 2011;128(6):e1600-7. doi:10.1542/peds.2011-0993.
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…
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psnet.ahrq.gov/node/867676/psn-pdf
February 26, 2025 - Responding to Patient Safety Events
February 26, 2025
Shaikh U. Responding to Patient Safety Events. PSNet [internet]. 2025.
https://psnet.ahrq.gov/primer/responding-patient-safety-events
Background
Patient safety events that occur in health care facilities require prompt action to ensure that further harm is
mit…
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psnet.ahrq.gov/issue/role-leaders-health-care-organizations-patient-safety
September 27, 2010 - Commentary
The role for leaders of health care organizations in patient safety.
Citation Text:
Clarke JR, Lerner JC, Marella WM. The role for leaders of health care organizations in patient safety. Am J Med Qual. 2007;22(5):311-8.
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psnet.ahrq.gov/node/47675/psn-pdf
November 28, 2023 - SOPS Surveys.
November 28, 2023
Agency for Healthcare Research and Quality.
https://psnet.ahrq.gov/issue/sops-surveys
Surveys are established mechanisms for organizational assessment of safety culture. This collection of
webinars provides an overview of the AHRQ Surveys on Patient Safety Culture™ (SOPS®) and a ran…