-
psnet.ahrq.gov/node/72785/psn-pdf
July 22, 2024 - Using Innovative Digital Healthcare Solutions to Improve
Quality at the Point of Care (R21/R33 - Clinical Trial
Optional).
July 22, 2024
Rockville, MD: Agency for Healthcare Research and Quality; July 19, 2024. PA-24-266.
https://psnet.ahrq.gov/issue/using-innovative-digital-healthcare-solutions-improve-qual…
-
psnet.ahrq.gov/node/37505/psn-pdf
February 06, 2008 - Washington DC: The Commonweath Fund; January 1, 2008.
-
psnet.ahrq.gov/node/42187/psn-pdf
April 10, 2013 - New York, NY: The Commonwealth Fund; March 22, 2013.
-
psnet.ahrq.gov/node/43429/psn-pdf
October 11, 2016 - CA sitting on millions in hospital fines.
October 11, 2016
Clark C.
https://psnet.ahrq.gov/issue/ca-sitting-millions-hospital-fines
Although California has collected an estimated $15 million in penalties from hospitals for adverse events,
this news piece describes how much of the money has yet to be allocated or s…
-
psnet.ahrq.gov/node/38233/psn-pdf
March 03, 2010 - The Science of Simulation in Healthcare: Defining and
Developing Clinical Expertise.
March 3, 2010
Kaji AH, Cone DC, eds. Acad Emerg Med. 2008;15:971-1222.
https://psnet.ahrq.gov/issue/science-simulation-healthcare-defining-and-developing-clinical-expertise
This special issue highlights an AHRQ-funded sympo…
-
psnet.ahrq.gov/node/39474/psn-pdf
June 27, 2011 - A model for medication safety event detection.
June 27, 2011
Snyder RA, Fields W. A model for medication safety event detection. Int J Qual Health Care.
2010;22(3):179-86. doi:10.1093/intqhc/mzq014.
https://psnet.ahrq.gov/issue/model-medication-safety-event-detection
This AHRQ-funded work describes a model to iden…
-
psnet.ahrq.gov/node/38187/psn-pdf
October 29, 2008 - The importance of simulation: preventing hand-off
mistakes.
October 29, 2008
Clancy CM. The importance of simulation: preventing hand-off mistakes. AORN J. 2008;88(4):625-627.
doi:10.1016/j.aorn.2008.09.007.
https://psnet.ahrq.gov/issue/importance-simulation-preventing-hand-mistakes
This article discusses an AHRQ…
-
psnet.ahrq.gov/node/35539/psn-pdf
March 29, 2010 - Differentiating close calls from errors: a multidisciplinary
perspective.
March 29, 2010
Etchegaray JM; Thomas EJ; Geraci JM; Simmons D; Martin SK.
https://psnet.ahrq.gov/issue/differentiating-close-calls-errors-multidisciplinary-perspective
In this AHRQ-funded study, the investigators determined that health care …
-
psnet.ahrq.gov/node/35616/psn-pdf
June 23, 2010 - Potential medication dosing errors in outpatient
pediatrics.
June 23, 2010
McPhillips HA, Stille CJ, Smith DH, et al. Potential medication dosing errors in outpatient pediatrics. J
Pediatr. 2005;147(6):761-7.
https://psnet.ahrq.gov/issue/potential-medication-dosing-errors-outpatient-pediatrics
The authors of this…
-
psnet.ahrq.gov/node/35389/psn-pdf
June 09, 2011 - Working conditions that support patient safety.
June 9, 2011
Hughes RG, Clancy CM. Working conditions that support patient safety. J Nurs Care Qual. 2005;20(4):289-
292.
https://psnet.ahrq.gov/issue/working-conditions-support-patient-safety
Drawing on insights from AHRQ-funded research, the authors recap how human…
-
psnet.ahrq.gov/node/36030/psn-pdf
June 09, 2011 - Human factors of complex sociotechnical systems.
June 9, 2011
Carayon P. Human factors of complex sociotechnical systems. Appl Ergon. 2006;37(4):525-35.
https://psnet.ahrq.gov/issue/human-factors-complex-sociotechnical-systems
In this AHRQ–funded study, the author discusses how working across boundaries (organizati…
-
psnet.ahrq.gov/node/37474/psn-pdf
March 30, 2016 - Implementing a Program of Patient Safety in Small Rural
Hospitals.
March 30, 2016
Rockville, MD: Agency for Healthcare Research and Quality; October 2004.
https://psnet.ahrq.gov/issue/implementing-program-patient-safety-small-rural-hospitals
This AHRQ-funded Partnerships in Implementing Patient Safety (PIPS) proje…
-
psnet.ahrq.gov/node/35688/psn-pdf
June 28, 2010 - A practical tool to learn from defects in patient care.
June 28, 2010
Pronovost P, Holzmueller CG, Martinez EA, et al. A practical tool to learn from defects in patient care. Jt
Comm J Qual Patient Saf. 2006;32(2):102-108.
https://psnet.ahrq.gov/issue/practical-tool-learn-defects-patient-care
The authors describe …
-
psnet.ahrq.gov/node/36193/psn-pdf
September 30, 2010 - The Ethics of Using QI Methods to Improve Health Care
Quality and Safety.
September 30, 2010
Baily MA, Bottrell M, Lynn J, Jennings J. Hastings Center Report; 2006(July-August): S2-S40.
https://psnet.ahrq.gov/issue/ethics-using-qi-methods-improve-health-care-quality-and-safety
The participants in this AHRQ–funded …
-
psnet.ahrq.gov/node/34919/psn-pdf
February 25, 2009 - Changes in prognosis after the first postoperative
complication.
February 25, 2009
Silber JH, Rosenbaum PR, Trudeau ME, et al. Changes in prognosis after the first postoperative
complication. Med Care. 2005;43(2):122-31.
https://psnet.ahrq.gov/issue/changes-prognosis-after-first-postoperative-complication
The aut…
-
psnet.ahrq.gov/node/36482/psn-pdf
February 17, 2011 - Dangerous deception--hiding the evidence of adverse
drug events.
February 17, 2011
Avorn J. Dangerous deception--hiding the evidence of adverse drug effects. N Engl J Med.
2006;355(21):2169-71.
https://psnet.ahrq.gov/issue/dangerous-deception-hiding-evidence-adverse-drug-events
This commentary discusses the recen…
-
psnet.ahrq.gov/node/40937/psn-pdf
November 16, 2011 - AHRQ Projects to Prevent Healthcare-Associated
Infections, Fiscal Year 2011.
November 16, 2011
Rockville, MD: Agency for Healthcare Research and Quality; October 2011. AHRQ Publication No. 09-
P013-4-E.
https://psnet.ahrq.gov/issue/ahrq-projects-prevent-healthcare-associated-infections-fiscal-year-2011
This annou…
-
psnet.ahrq.gov/node/42079/psn-pdf
August 15, 2018 - Ambulatory Safety and Quality Program: Health IT
Portfolio.
August 15, 2018
Rockville,MD: Agency for Healthcare Research and Quality; July 2010. AHRQ Pub. No. 10-P004.
https://psnet.ahrq.gov/issue/ambulatory-safety-and-quality-program-health-it-portfolio-2007-2013
This publication summarizes a funding initiative t…
-
psnet.ahrq.gov/node/867188/psn-pdf
November 20, 2024 - Ensuring safe practice by late career physicians:
institutional policies and implementation experiences.
November 20, 2024
White AA, Gallagher TH, Osinska PH, et al. Ensuring safe practice by late career physicians: institutional
policies and implementation experiences. Ann Intern Med. 2024;177(12):1702-1710. doi:1…
-
psnet.ahrq.gov/node/859355/psn-pdf
December 20, 2023 - Systems-Based Approaches to Improve Patient Safety by
Improving Healthcare Worker Safety and Well-Being (R01
Clinical Trial Optional).
December 20, 2023
PA-24-093. Rockville, MD: Agency for Healthcare Research and Quality. December 5, 2023.
https://psnet.ahrq.gov/issue/systems-based-approaches-improve-patient-safe…