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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/ambulatory-surgery/sections/implementation/training-tools/communication-material-guide.docx
May 01, 2017 - Overview
Communication and Teamwork Defined
· Slides 4-11
Improving Surgical Team Communication With Briefings*
· Slides 12-17
· Example Briefing* (2 min 14)
Improving Surgical Team Communication With Debriefings*
· Slides 18-25
· Example Debriefing* (1 min 24)
The Surgical Checklist as a Communication and Teamwork …
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psnet.ahrq.gov/issue/faultno-fault-bearing-brunt-medical-mishaps
January 27, 2021 - Commentary
Fault/no fault: bearing the brunt of medical mishaps.
Citation Text:
Silversides A. Fault/no fault: bearing the brunt of medical mishaps. CMAJ. 2008;179(4):309-11. doi:10.1503/cmaj.081020.
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psnet.ahrq.gov/issue/adverse-drug-reactions-and-therapeutic-errors-older-adults-hazard-factor-analysis-poison
September 09, 2013 - Study
Adverse drug reactions and therapeutic errors in older adults: a hazard factor analysis of poison center data.
Citation Text:
Cobaugh DJ, Krenzelok EP. Adverse drug reactions and therapeutic errors in older adults: a hazard factor analysis of poison center data. Am J Health Syst …
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psnet.ahrq.gov/issue/or-and-just-culture
February 01, 2017 - Commentary
The OR and a "just culture."
Citation Text:
Hamlin L. The OR and a "just culture". AORN J. 2009;90(4):495-498. doi:10.1016/j.aorn.2009.09.003.
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psnet.ahrq.gov/issue/observational-study-practice-during-transfer-patients-anaesthetic-room-operating-theatre
September 27, 2016 - Study
An observational study of practice during transfer of patients from anaesthetic room to operating theatre.
Citation Text:
Broom MA, Slater J, Ure DS. An observational study of practice during transfer of patients from anaesthetic room to operating theatre. Anaesthesia. 2006;61(10…
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psnet.ahrq.gov/issue/reducing-incidence-retained-surgical-instrument-fragments
June 01, 2021 - Commentary
Reducing the incidence of retained surgical instrument fragments.
Citation Text:
Reece M, Troeleman ND, McGowan JE, et al. Reducing the incidence of retained surgical instrument fragments. AORN J. 2011;94(3):301-4. doi:10.1016/j.aorn.2011.05.014.
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psnet.ahrq.gov/issue/electronic-medical-record-dermatology
October 19, 2022 - Commentary
The electronic medical record in dermatology.
Citation Text:
Grosshandler JA, Tulbert B, Kaufmann MD, et al. The electronic medical record in dermatology. Arch Dermatol. 2010;146(9):1031-6. doi:10.1001/archdermatol.2010.229.
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psnet.ahrq.gov/issue/functional-health-literacy-and-understanding-medications-discharge
April 24, 2018 - Study
Functional health literacy and understanding of medications at discharge.
Citation Text:
Maniaci MJ, Heckman MG, Dawson NL. Functional health literacy and understanding of medications at discharge. Mayo Clin Proc. 2008;83(5):554-8. doi:10.4065/83.5.554.
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psnet.ahrq.gov/issue/measure-twice-cut-once
June 14, 2023 - Commentary
Measure twice, cut once.
Citation Text:
Atkinson WK. Measure twice, cut once. AORN J. 2013;98(1):77-80. doi:10.1016/j.aorn.2013.05.004.
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psnet.ahrq.gov/issue/practical-application-high-reliability-principles-healthcare-optimize-quality-and-safety
August 14, 2024 - Commentary
Practical application of high-reliability principles in healthcare to optimize quality and safety outcomes.
Citation Text:
Oster CA, Deakins S. Practical Application of High-Reliability Principles in Healthcare to Optimize Quality and Safety Outcomes. J Nurs Admin. 2017;48(1):…
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psnet.ahrq.gov/issue/perspective-beyond-counting-hours-importance-supervision-professionalism-transitions-care-and
September 20, 2011 - Commentary
Perspective: beyond counting hours: the importance of supervision, professionalism, transitions of care, and workload in residency training.
Citation Text:
Schumacher D, Slovin SR, Riebschleger MP, et al. Perspective. Academic Medicine. 2012;87(7). doi:10.1097/acm.0b013e318257…
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psnet.ahrq.gov/issue/high-fidelity-simulation-research-tool
February 19, 2020 - Review
High fidelity simulation as a research tool.
Citation Text:
Littlewood KE. High fidelity simulation as a research tool. Best Pract Res Clin Anaesthesiol. 2011;25(4):473-87. doi:10.1016/j.bpa.2011.08.001.
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psnet.ahrq.gov/issue/some-cancer-experts-see-overdiagnosis-question-emphasis-early-detection
June 19, 2019 - Newspaper/Magazine Article
Some cancer experts see 'overdiagnosis,' question emphasis on early detection.
Citation Text:
Linos E, Schroeder SA, Chren M-M. Potential Overdiagnosis of Basal Cell Carcinoma in Older Patients With Limited Life Expectancy. JAMA. 2014;312(10). doi:10.1001/jama.…
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psnet.ahrq.gov/issue/impact-nurse-peer-review-culture-safety
November 29, 2023 - Commentary
Impact of nurse peer review on a culture of safety.
Citation Text:
Herrington CR, Hand MW. Impact of Nurse Peer Review on a Culture of Safety. J Nurs Care Qual. 2019;34(2):158-162. doi:10.1097/NCQ.0000000000000361.
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psnet.ahrq.gov/issue/when-things-go-wrong-how-health-care-organizations-deal-major-failures
March 13, 2013 - Commentary
Classic
When things go wrong: how health care organizations deal with major failures.
Citation Text:
Walshe K, Shortell SM. When things go wrong: how health care organizations deal with major failures. Health Aff (Millwood). 2004;23(3):103-11.
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psnet.ahrq.gov/issue/impact-nursing-hospital-patient-mortality-focused-review-and-related-policy-implications
September 21, 2011 - Review
Impact of nursing on hospital patient mortality: a focused review and related policy implications.
Citation Text:
Tourangeau AE, Cranley LA, Jeffs L. Impact of nursing on hospital patient mortality: a focused review and related policy implications. Qual Saf Health Care. 2006;15(…
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psnet.ahrq.gov/issue/different-roles-same-goal-risk-and-quality-management-partnering-patient-safety-ashrm
January 27, 2021 - Book/Report
Different roles, same goal: risk and quality management partnering for patient safety. By the ASHRM Monographs Task Force.
Citation Text:
Bokar V, Perry DG. Different Roles, Same Goal: Risk And Quality Management Partnering For Patient Safety. By The Ashrm Monographs Task Fo…
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psnet.ahrq.gov/issue/reducing-falls-safety-spotter-program
November 16, 2022 - Commentary
Reducing falls with a safety spotter program.
Citation Text:
Primmer P, Borenstein KK, Downing MT, et al. Reducing falls with a safety spotter program. Nursing (Brux). 2015;45(8):16-9. doi:10.1097/01.NURSE.0000469244.89222.27.
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psnet.ahrq.gov/issue/medical-emergency-team-and-rapid-response-system-finding-treating-and-preventing-hypoglycemia
September 23, 2020 - Commentary
The medical emergency team and rapid response system: finding, treating, and preventing hypoglycemia.
Citation Text:
DiNardo M, Noschese M, Korytkowski M, et al. The medical emergency team and rapid response system: finding, treating, and preventing hypoglycemia. Jt Comm J Qua…
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psnet.ahrq.gov/issue/chemotherapy-incident-reporting-and-improvement-system
November 16, 2022 - Study
A chemotherapy incident reporting and improvement system.
Citation Text:
France DJ, Miles P, Cartwright J, et al. A chemotherapy incident reporting and improvement system. Jt Comm J Qual Saf. 2003;29(4):171-80.
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