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  1. Exhibit 6.8. Kaizen Activities | Agency for Healthcare Research and Quality

    www.ahrq.gov/practiceimprovement/systemdesign/leancasestudies/lean-exhibit6-8.html
    November 01, 2014 - Improving Care Delivery Through Lean: Implementation Case Studies Exhibit 6.8. Kaizen Activities Previous Page Next Page Table of Contents Improving Care Delivery Through Lean: Implementation Case Studies Introduction to the Case Studies Case 1. Lakeview Healthcare Case 2. Central Hospital C…

  2. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/44248/psn-pdf
    May 26, 2016 - Wrong-site surgery, retained surgical items, and surgical fires: a systematic review of surgical never events. May 26, 2016 Hempel S, Maggard-Gibbons M, Nguyen DK, et al. Wrong-Site Surgery, Retained Surgical Items, and Surgical Fires : A Systematic Review of Surgical Never Events. JAMA Surg. 2015;150(8):796-805. …

  3. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/44304/psn-pdf
    September 09, 2015 - Association of the 2011 ACGME resident duty hour reform with postoperative patient outcomes in surgical specialties. September 9, 2015 Rajaram R, Chung JW, Cohen ME, et al. Association of the 2011 ACGME Resident Duty Hour Reform with Postoperative Patient Outcomes in Surgical Specialties. J Am Coll Surg. 2015;221(…

  4. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/45216/psn-pdf
    June 08, 2016 - Ambulatory computerized prescribing and preventable adverse drug events. June 8, 2016 Overhage JM, Gandhi TK, Hope C, et al. Ambulatory Computerized Prescribing and Preventable Adverse Drug Events. J Patient Saf. 2016;12(2):69-74. doi:10.1097/PTS.0000000000000194. https://psnet.ahrq.gov/issue/ambulatory-computeriz…

  5. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/849596/psn-pdf
    May 31, 2023 - Patients admitted on weekends have higher in-hospital mortality than those admitted on weekdays: analysis of national inpatient sample. May 31, 2023 Manadan A, Arora S, Whittier M, et al. Patients admitted on weekends have higher in-hospital mortality than those admitted on weekdays: analysis of national inpatient…

  6. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/37546/psn-pdf
    June 14, 2011 - Effective interventions and implementation strategies to reduce adverse drug events in the Veterans Affairs (VA) system. June 14, 2011 Mills PD, Neily J, Kinney LM, et al. Effective interventions and implementation strategies to reduce adverse drug events in the Veterans Affairs (VA) system. Qual Saf Health Care. …

  7. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/45891/psn-pdf
    October 11, 2017 - Extent of diagnostic agreement among medical referrals. October 11, 2017 Van Such M, Lohr R, Beckman T, et al. Extent of diagnostic agreement among medical referrals. J Eval Clin Pract. 2017;23(4):870-874. doi:10.1111/jep.12747. https://psnet.ahrq.gov/issue/extent-diagnostic-agreement-among-medical-referrals Diagn…

  8. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/848315/psn-pdf
    May 03, 2023 - Nurse staffing and inpatient mortality in the English National Health Service: a retrospective longitudinal study. May 3, 2023 Zaranko B, Sanford NJ, Kelly E, et al. Nurse staffing and inpatient mortality in the English National Health Service: a retrospective longitudinal study. BMJ Qual Saf. 2023;32(5):254-263. …

  9. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/61061/psn-pdf
    October 28, 2020 - Safer prescribing for hospitalized older adults with an electronic health records?based prescribing context. October 28, 2020 Drago K, Sharpe J, De Lima B, et al. Safer prescribing for hospitalized older adults with an electronic health records?based prescribing context. J Am Geriatrics Soc. 2020;68(9):2123-2127. d…

  10. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/35572/psn-pdf
    February 03, 2011 - The long road to patient safety: a status report on patient safety systems. February 3, 2011 Longo DR, Hewett JE, Ge B, et al. The long road to patient safety: a status report on patient safety systems. JAMA. 2005;294(22):2858-65. https://psnet.ahrq.gov/issue/long-road-patient-safety-status-report-patient-safety-s…

  11. Follow-up Visits for Children Who Are Obese or Overweight with a Weight-Related Comorbidity: Tables 1-3 (pdf file)

    www.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/chronic/chipra-0242-tables1-3.pdf
    June 02, 2025 - Follow-up Visits for Children Who Are Obese or Overweight with a Weight-Related Comorbidity: Tables 1-3 Table 1. Documentation of Weight Addressed Table 2: ICD-9 Codes for Weight-Related Comorbidities Description Code Diabetes 250.xx Hyperlipidemia 272.0, 272.1, 272.2, 272.3, 272.4 Hypertension 401 …

  12. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/60635/psn-pdf
    January 01, 2021 - Systemic defenses to prevent intravenous medication errors in hospitals: a systematic review. July 1, 2020 Kuitunen SK, Niittynen I, Airaksinen M, et al. Systemic Defenses to Prevent Intravenous Medication Errors in Hospitals. J Patient Saf. 2021;17(8):e1669-e1680. doi:10.1097/pts.0000000000000688. https://psnet.a…

  13. Exhibit 1.8. Kaizen Activities | Agency for Healthcare Research and Quality

    www.ahrq.gov/practiceimprovement/systemdesign/leancasestudies/lean-exhibit1-8.html
    November 01, 2014 - Improving Care Delivery Through Lean: Implementation Case Studies Exhibit 1.8. Kaizen Activities Previous Page Next Page Table of Contents Improving Care Delivery Through Lean: Implementation Case Studies Introduction to the Case Studies Case 1. Lakeview Healthcare Case 2. Central Hospital C…

  14. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/855097/psn-pdf
    November 08, 2023 - Use of the Second Victim Experience and Support Tool (SVEST) to assess the impact of a departmental peer support program on anesthesia professionals' second victim experiences (SVEs) and perceptions of support two years after implementation. November 8, 2023 Pelikan M, Finney RE, Jacob A. AANA J. 2023;91(5):…

  15. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/45829/psn-pdf
    June 27, 2018 - Learning from errors: analysis of medication order voiding in CPOE systems. June 27, 2018 Kannampallil TG, Abraham J, Solotskaya A, et al. Learning from errors: analysis of medication order voiding in CPOE systems. J Am Med Inform Assoc. 2017;24(4):762-768. doi:10.1093/jamia/ocw187. https://psnet.ahrq.gov/issue/le…

  16. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/48173/psn-pdf
    August 28, 2019 - Does learning from mistakes have to be painful? Analysis of 5 years' experience from the Leeds radiology educational cases meetings identifies common repetitive reporting errors and suggests acknowledging and celebrating excellence (ACE) as a more positive way of teaching the same lessons. August 28, 2019 Koo A,…

  17. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/840170/psn-pdf
    November 16, 2022 - Predicting dispensing errors in community pharmacies: an application of the Systematic Human Error Reduction and Prediction Approach (SHERPA). November 16, 2022 Ashour A, Phipps DL, Ashcroft DM. PLoS ONE. 2022;17(1):e0261672. https://psnet.ahrq.gov/innovation/predicting-dispensing-errors-community-pharmacies-…

  18. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/34892/psn-pdf
    February 03, 2011 - Effects of computerized clinical decision support systems on practitioner performance and patient outcomes: a systematic review. February 3, 2011 Garg AX, Adhikari NKJ, McDonald H, et al. Effects of Computerized Clinical Decision Support Systems on Practitioner Performance and Patient Outcomes. JAMA. 2005;293(10):…

  19. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/37478/psn-pdf
    February 22, 2011 - Programmable infusion pumps in ICUs: an analysis of corresponding adverse drug events. February 22, 2011 Nuckols TK, Bower AG, Paddock SM, et al. Programmable infusion pumps in ICUs: an analysis of corresponding adverse drug events. J Gen Intern Med. 2008;23 Suppl 1:41-5. doi:10.1007/s11606-007- 0414-y. https://p…

  20. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/43474/psn-pdf
    August 28, 2017 - Racial and ethnic disparities in patient safety. August 28, 2017 Okoroh JS, Uribe EF, Weingart SN. Racial and Ethnic Disparities in Patient Safety. J Patient Saf. 2017;13(3):153-161. doi:10.1097/PTS.0000000000000133. https://psnet.ahrq.gov/issue/racial-and-ethnic-disparities-patient-safety Prior studies have raise…
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