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psnet.ahrq.gov/issue/framework-engaging-physicians-quality-and-safety
July 10, 2008 - Study
Classic
A framework for engaging physicians in quality and safety.
Citation Text:
Taitz JM, Lee TH, Sequist TD. A framework for engaging physicians in quality and safety. BMJ Qual Saf. 2012;21(9):722-728. doi:10.1136/bmjqs-2011-000167.
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psnet.ahrq.gov/issue/exploring-relationship-between-hospital-patient-safety-culture-and-performance-measures
August 28, 2024 - Commentary
Exploring the relationship between hospital patient safety culture and performance on measures of hospital-acquired conditions.
Citation Text:
Noghrehchi P, Hefner JL, Stegall H, et al. Exploring the relationship between hospital patient safety culture and performance on measu…
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psnet.ahrq.gov/issue/diagnostic-errors-emergency-department-systematic-review
October 27, 2021 - Book/Report
Diagnostic Errors in the Emergency Department: A Systematic Review.
Citation Text:
Diagnostic Errors in the Emergency Department: A Systematic Review. Newman-Toker DE, Peterson SM, Badihian S, et al. Rockville, MD: Agency for Healthcare Research and Quality; December 2022.&nb…
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effectivehealthcare.ahrq.gov/sites/default/files/pdf/methods-guidance-tests-search_methods.pdf
July 01, 2012 - In the AHRQ report,
Testing for BNP and NT-proBNP in the Diagnosis and Prognosis of Heart Failure,25 … Balion, C., et al., Testing for BNP and NT-
proBNP in the Diagnosis and Prognosis of
Heart Failure.
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hcup-us.ahrq.gov/reports/statbriefs/sb145.pdf
March 01, 2012 - difficile (ICD-9 code 008.45) 37.6 16.5 39.3 15.1
Septicemia (except in labor) 13.7 12.1 13.9 11.8
Congestive … heart failure 4.0 4.9 3.6 5.0
Complication of device, implant or graft 3.4 4.2 3.2 4.2
Pneumonia
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psnet.ahrq.gov/web-mm/impatient-inpatient-dosing
June 24, 2020 - requirements include a body mass index (BMI) less than 20, liver disease (including passive congestion from congestive … heart failure), and being treated with a drug that inhibits warfarin metabolism (eg, metronidazole,
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psnet.ahrq.gov/node/33562/psn-pdf
September 15, 2024 - Rapid Response Systems
September 15, 2024
Rapid Response Systems. PSNet [internet]. 2019.
https://psnet.ahrq.gov/primer/rapid-response-systems
PSNet primers are regularly reviewed and updated by the UC Davis PSNet Editorial Team to ensure that
they reflect current research and practice in the patient safety field.…
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/mvp/modules/technical/painmgmt-slides.pptx
January 01, 2017 - Dre
Diseases
Sepsis, chronic obstructive pulmonary disease, congestive heart failure
Drug Removal
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hcup-us.ahrq.gov/toolssoftware/ccsr/DXCCSR-User-Guide-v2019-1.pdf
September 01, 2019 - Example of One-to-One and One-to-Many CCSR Mappings for Hypertension and
Heart Failure ............. … The
ICD-10-CM diagnosis code I11.9, Hypertensive heart disease without heart failure, maps to a
single … and CIR019 – Heart failure). … Example of One-to-One and One-to-Many CCSR Mappings for Hypertension and Heart
Failure
Abbreviations … failure.
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www.ahrq.gov/sites/default/files/wysiwyg/antibiotic-use/ambulatory-care/cap-guide.docx
September 01, 2022 - To summarize the PSI score, patients younger than 50; without a history of neoplastic disease, congestive … heart failure, cerebrovascular disease, renal disease, or liver disease; at their baseline mental status
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www.uspreventiveservicestaskforce.org/uspstf/document/evidence-summary/aspirin-use-prevent-cardiovascular-disease-colorectal-cancer-preventive-medication-2002
January 15, 2002 - increase the future risk for a more disabling condition, such as recurrent myocardial infarction or congestive … heart failure, and may lead to premature death.
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www.ahrq.gov/sites/default/files/wysiwyg/topics/dx-safety-workgroup-meeting-notes-mar2023.pdf
July 14, 2023 - Federal Interagency Workgroup: Improving Diagnostic Safety and Quality in Healthcare
Federal Interagency Workgroup:
Improving Diagnostic Safety and Quality in Healthcare
March Meeting Summary
Workgroup Goal: Established in response to Senate Report 115-150. The Senate Committee on
Appropriations requested “AHRQ t…
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psnet.ahrq.gov/node/49793/psn-pdf
May 01, 2017 - https://psnet.ahrq.gov/web-mm/hemolysis-holdup
The Case
A 72-year-old man with congestive heart failure
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psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.326_slideshow.ppt
June 01, 2014 - allowed to leave their unit
3
Case: Wandering Off the Floors
A 74-year-old man with a history of congestive … heart failure (CHF) secondary to alcoholic dilated cardiomyopathy was admitted for management of alcohol
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psnet.ahrq.gov/web-mm/lost-transition
November 17, 2010 - SPOTLIGHT CASE
Lost in Transition
Citation Text:
Beach C. Lost in Transition. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2006.
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Format:
Google Scholar BibTeX EndNote X3 XML EndNote 7 XML Endn…
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psnet.ahrq.gov/print/pdf/node/845971
January 01, 2024 - PSNet
Curated Library
AHRQ: Agency for Healthcare Research and Quality
Value and Patient Safety
Curated Library
Foundations
Safety is the preservation of value.
Vandeskog B. J Safety Res. 2024;89:105-115.
Safety is at the heart of safety science, and yet “safety” lacks a consensus definition among safety
resea…
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psnet.ahrq.gov/node/49675/psn-pdf
February 01, 2013 - Delay in Treatment: Failure to Contact Patient Leads to
Significant Complications
February 1, 2013
Shapiro DS. Delay in Treatment: Failure to Contact Patient Leads to Significant Complications. PSNet
[internet]. 2013.
https://psnet.ahrq.gov/web-mm/delay-treatment-failure-contact-patient-leads-significant-complicat…
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hcup-us.ahrq.gov/reports/statbriefs/sb91.pdf
June 01, 2010 - Statistical Brief #91: Diagnostic Groups with Rapidly Increasing Costs, by Payer, 2001-2007
From
HEALTHCARE COST AND
UTILIZATION PROJECT
Agency for Healthcare
Research and Quality
STATISTICAL BRIEF #91
June 2010
Diagnostic Groups with Rapidly
Increasing Costs, by Payer, 2001–
2007
Lauren M…
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psnet.ahrq.gov/primer/retained-surgical-items-causation-and-prevention
January 04, 2024 - Retained Surgical Items: Causation and Prevention
Citation Text:
Gibbs V, Romano P. Retained Surgical Items: Causation and Prevention. PSNet [internet]. Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2025.
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Format:
Google Scholar BibTeX End…
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/perinatal-care/modules/strategies/medication/tool_safe-mgso4.docx
May 30, 2013 - AHRQ Safety Program for Perinatal Care: Safe Medication Administration: Magnesium Sulfate
AHRQ Safety Program for Perinatal Care
Safe Medication Administration
Magnesium Sulfate
Safe Medication Administration—Magnesium Sulfate
Purpose of the tool: This tool describes the key perinatal safety elements with examples for…