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psnet.ahrq.gov/node/46196/psn-pdf
October 13, 2018 - Association of a surgical task during training with team
skill acquisition among surgical residents: the missing
piece in multidisciplinary team training.
October 13, 2018
Sparks JL, Crouch DL, Sobba K, et al. Association of a Surgical Task During Training With Team Skill
Acquisition Among Surgical Residents: The …
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psnet.ahrq.gov/node/44709/psn-pdf
November 18, 2016 - Lost information during the handover of critically injured
trauma patients: a mixed-methods study.
November 18, 2016
Zakrison TL, Rosenbloom B, McFarlan A, et al. Lost information during the handover of critically injured
trauma patients: a mixed-methods study. BMJ Qual Saf. 2016;25(12):929-936. doi:10.1136/bmjqs-2…
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psnet.ahrq.gov/node/41866/psn-pdf
November 28, 2012 - "It's like two worlds apart": an analysis of vulnerable
patient handover practices at discharge from hospital.
November 28, 2012
Groene RO, Orrego C, Suñol R, et al. "It's like two worlds apart": an analysis of vulnerable patient handover
practices at discharge from hospital. BMJ Qual Saf. 2012;21 Suppl 1:i67-75. d…
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psnet.ahrq.gov/node/40289/psn-pdf
March 16, 2011 - Unintentional therapeutic errors involving insulin in the
ambulatory setting reported to poison centers.
March 16, 2011
Spiller HA, Borys DJ, Ryan ML, et al. Unintentional therapeutic errors involving insulin in the ambulatory
setting reported to poison centers. Ann Pharmacother. 2011;45(1):17-22. doi:10.1345/aph.1…
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psnet.ahrq.gov/node/44447/psn-pdf
September 02, 2015 - Community-, healthcare-, and hospital-acquired severe
sepsis hospitalizations in the University HealthSystem
Consortium.
September 2, 2015
Page DB, Donnelly JP, Wang HE. Community-, Healthcare-, and Hospital-Acquired Severe Sepsis
Hospitalizations in the University HealthSystem Consortium. Crit Care Med. 2015;43(9…
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psnet.ahrq.gov/node/41175/psn-pdf
December 31, 2014 - Design and implementation of an automated email
notification system for results of tests pending at
discharge.
December 31, 2014
Dalal A, Schnipper JL, Poon EG, et al. Design and implementation of an automated email notification
system for results of tests pending at discharge. J Am Med Inform Assoc. 2012;19(4):52…
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psnet.ahrq.gov/node/39548/psn-pdf
November 02, 2010 - Patient-specific electronic decision support reduces
prescription of excessive doses.
November 2, 2010
Seidling HM, Schmitt SPW, Bruckner T, et al. Patient-specific electronic decision support reduces
prescription of excessive doses. Qual Saf Health Care. 2010;19(5):e15. doi:10.1136/qshc.2009.033175.
https://psnet…
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psnet.ahrq.gov/node/45352/psn-pdf
September 01, 2018 - Predictors of gaps in patient safety and quality in U.S.
hospitals.
September 1, 2018
Unruh L, Hofler R. Predictors of Gaps in Patient Safety and Quality in U.S. Hospitals. Health Serv Res.
2016;51(6):2258-2281. doi:10.1111/1475-6773.12468.
https://psnet.ahrq.gov/issue/predictors-gaps-patient-safety-and-quality-us…
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psnet.ahrq.gov/node/40946/psn-pdf
January 19, 2012 - Effects of a multicentre teamwork and communication
programme on patient outcomes: results from the Triad
for Optimal Patient Safety (TOPS) project.
January 19, 2012
Auerbach AD, Sehgal NL, Blegen MA, et al. Effects of a multicentre teamwork and communication
programme on patient outcomes: results from the Triad f…
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psnet.ahrq.gov/node/45769/psn-pdf
December 21, 2016 - National Scorecard on Rates of Hospital-Acquired
Conditions 2010 to 2015: Interim Data From National
Efforts to Make Health Care Safer.
December 21, 2016
Rockville, MD: Agency for Healthcare Research and Quality; December 2016.
https://psnet.ahrq.gov/issue/national-scorecard-rates-hospital-acquired-conditions-2010…
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psnet.ahrq.gov/node/38710/psn-pdf
September 14, 2009 - Patient readmissions, emergency visits, and adverse
events after software-assisted discharge from hospital:
cluster randomized trial.
September 14, 2009
Graumlich JF, Novotny NL, Nace S, et al. Patient readmissions, emergency visits, and adverse events after
software-assisted discharge from hospital: cluster rando…
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psnet.ahrq.gov/node/40146/psn-pdf
March 02, 2011 - Primary care–relevant interventions to prevent falling in
older adults: a systematic evidence review for the U.S.
Preventive Services Task Force.
March 2, 2011
Michael YL, Whitlock EP, Lin JS, et al. Primary care-relevant interventions to prevent falling in older adults:
a systematic evidence review for the U.S. P…
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www.ahrq.gov/sites/default/files/wysiwyg/sops/events/webinar/2-unc-webcast-ginsberg.pdf
June 02, 2025 - Implementation of an Event Reporting and Learning System Leads to Improvements in Patient Safety Culture at UNC Medical Center-Ginsberg
AHRQ’s Surveys on Patient Safety Culture™
(SOPS™) Program
Caren Ginsberg, PhD
Center for Quality Improvement and Patient Safety, AHRQ
6
AHRQ’s Core Competencies
AHRQ is a rese…
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www.ahrq.gov/sites/default/files/wysiwyg/sops/events/webinar/2-ASC_Webcast_2021-Ginsberg.pdf
January 01, 2021 - How to Use the AHRQ SOPS Ambulatory Surgery Center Survey to Improve Patient Safety -Ginsberg
6
Overview of AHRQ’s Patient Safety Priorities and Programs
Caren Ginsberg, Ph.D.
Center for Quality Improvement and Patient Safety
Agency for Healthcare Research and Quality (AHRQ)
AHRQ’s Core Competencies
AHRQ is a …
-
www.ahrq.gov/sites/default/files/wysiwyg/sops/events/webinar/2-sops101-webcast-2023-ginsberg.pdf
January 01, 2023 - An Overview of the SOPS® Surveys for New Users - Ginsberg
AHRQ’s Surveys on Patient Safety
Culture™ (SOPS®) Program
Caren Ginsberg, Ph.D.
Center for Quality Improvement and Patient Safety, AHRQ
Agency for Healthcare Research and Quality
• AHRQ is:
► A research and science-based agency of the US Department of H…
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www.ahrq.gov/sites/default/files/wysiwyg/sops/events/webinar/sops-101-webcast-ginsberg.pdf
September 01, 2022 - Understanding SOPS® Surveys: A Primer for New Users - Ginsberg
AHRQ’s Surveys on Patient Safety Culture™
(SOPS®) Program
Caren Ginsberg, Ph.D.
Center for Quality Improvement and Patient Safety, AHRQ
Agency for Healthcare Research and Quality
• AHRQ is:
► A research and science-based agency of the US Departme…
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/engagingfamilies/strategy3/Strat3_Tool_2_Nurse_Chklst_508.docx
June 02, 2025 - Strategy 3: Bedside Shift Report (Tool 2)
Strategy 1: Working with Patients & Families as Advisors
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Strategy 3: Nurse Bedside Shift Report (Tool 2)
Bedside Shift Report Checklist
Introduce the nursing staff to the patient and family. Invite the patient and family to take part in th…
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www.ahrq.gov/sites/default/files/wysiwyg/evidencenow/evaluation/capacity-infographic.pdf
April 01, 2018 - AHRQ’s EvidenceNOW Results: Increased Capacity for Quality Improvement in Small Primary Care Practices
AHRQ’s EvidenceNOW Results: Increased Capacity
for Quality Improvement in Small Primary Care Practices
One of the main goals of EvidenceNOW is increasing the capacity of primary care practices to implement evidenc…
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www.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/outcomes/chipra-140-acknowledgments.pdf
June 02, 2025 - HCAHPS Child Acknowledgments
…
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www.uspreventiveservicestaskforce.org/uspstf/methods-and-processes/uspstf-analytic-framework-child-and-adolescent-health-topics
October 01, 2017 - USPSTF Analytic Framework for Child and Adolescent Health Topics
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The USPSTF has developed a new way of approaching the evidence on preventive services for children and adoles…