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psnet.ahrq.gov/issue/impact-attending-physician-workload-patient-care-survey-hospitalists
November 26, 2014 - Study
Impact of attending physician workload on patient care: a survey of hospitalists.
Citation Text:
Michtalik HJ, Yeh H-C, Pronovost P, et al. Impact of attending physician workload on patient care: a survey of hospitalists. JAMA Intern Med. 2013;173(5):375-7. doi:10.1001/jamainternme…
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www.ahrq.gov/research/publications/search.html?page=17
October 01, 2011 - Search Publications
The Agency for Healthcare Research and Quality (AHRQ)'s publications offer practical information to help a variety of health care organizations, providers, and others make care safer in all health care settings. 171 - 180 of 191 Publications displayed
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psnet.ahrq.gov/issue/should-operations-be-regionalized-empirical-relation-between-surgical-volume-and-mortality
August 04, 2021 - Study
Classic
Should operations be regionalized? The empirical relation between surgical volume and mortality.
Citation Text:
Luft HS, Bunker JP, Enthoven AC. Should operations be regionalized? The empirical relation between surgical volume and mortality. N En…
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psnet.ahrq.gov/issue/hybrid-methodology-modeling-risk-adverse-events-complex-health-care-settings
November 11, 2015 - Study
A hybrid methodology for modeling risk of adverse events in complex health-care settings.
Citation Text:
Kazemi R, Mosleh A, Dierks M. A Hybrid Methodology for Modeling Risk of Adverse Events in Complex Health-Care Settings. Risk Anal. 2017;37(3):421-440. doi:10.1111/risa.12702.
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psnet.ahrq.gov/issue/sbar-improves-nurse-physician-communication-and-reduces-unexpected-death-pre-and-post
November 21, 2018 - Study
SBAR improves nurse–physician communication and reduces unexpected death: a pre and post intervention study.
Citation Text:
De Meester K, Verspuy M, Monsieurs KG, et al. SBAR improves nurse-physician communication and reduces unexpected death: a pre and post intervention study. Re…
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psnet.ahrq.gov/issue/healthy-life-years-lost-and-excess-bed-days-due-6-patient-safety-incidents-empirical-evidence
May 18, 2022 - Study
Healthy life-years lost and excess bed-days due to 6 patient safety incidents: empirical evidence from English hospitals.
Citation Text:
Hauck KD, Wang S, Vincent CA, et al. Healthy Life-Years Lost and Excess Bed-Days Due to 6 Patient Safety Incidents: Empirical Evidence From Engli…
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psnet.ahrq.gov/issue/resident-duty-hour-restrictions-and-neurosurgical-training-review-literature
September 23, 2020 - Review
On resident duty hour restrictions and neurosurgical training: review of the literature.
Citation Text:
Bina RW, Lemole M, Dumont TM. On resident duty hour restrictions and neurosurgical training: review of the literature. J Neurosurg. 2016;124(3):842-8. doi:10.3171/2015.3.JNS1427…
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www.ahrq.gov/news/newsroom/case-studies/cquips0802.html
October 01, 2014 - AHRQ Research Helps Pharmacists in Mentoring Program to Reduce Drug Errors in Emergency Departments
Search All Impact Case Studies
June 2008
AHRQ-sponsored research on how clinical pharmacy services can reduce medication-related errors in hospital emergency departments has been put to use in hospitals in a …
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psnet.ahrq.gov/issue/nature-response-airway-management-incident-reports-high-income-countries-scoping-review
December 15, 2014 - Review
The nature of the response to airway management incident reports in high income countries: a scoping review.
Citation Text:
Endlich Y, Davies EL, Kelly J. The nature of the response to airway management incident reports in high income countries: a scoping review. Anaesth Intensive…
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psnet.ahrq.gov/issue/improving-nursing-home-safety-through-adoption-practical-resilient-health-care-approach
August 26, 2020 - Commentary
Improving nursing home safety through adoption of a practical resilient health care approach.
Citation Text:
Hartmann CW, Clark V, Nash P, et al. Improving nursing home safety through adoption of a practical resilient health care approach. J Am Med Dir Assoc. 2024;25(9):105014…
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psnet.ahrq.gov/issue/reducing-high-risk-medication-use-through-pharmacist-led-interventions-outpatient-setting
September 23, 2020 - Study
Reducing high-risk medication use through pharmacist-led interventions in an outpatient setting.
Citation Text:
Deyo JC, Smith BH, Biola H, et al. Reducing high-risk medication use through pharmacist-led interventions in an outpatient setting. J Am Pharm Assoc. 2020. doi:10.1016/j.…
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/qitoolkit/pdi/c2_pdi_prioritizationworksheetexample.pdf
June 02, 2025 - C2 Prioritization Worksheet Example
AHRQ Quality Indicators Toolkit
Prepared by RAND and UHC for AHRQ Tool C.1
Volume of
Cases at
Risk
Cost of Single
Event
Total Cost
Cost To
Implement
Penalties and
Incentives
Proxies for Cost
Strategic
Alignment
External
Mandates
Public
Perception
Executive-
Lev…
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psnet.ahrq.gov/issue/using-situ-simulation-identify-and-resolve-latent-environmental-threats-patient-safety-case
April 17, 2011 - Commentary
Using in situ simulation to identify and resolve latent environmental threats to patient safety: case study involving a labor and delivery ward.
Citation Text:
Hamman WR, Beaudin-Seiler BM, Beaubien JM, et al. Using in situ simulation to identify and resolve latent environme…
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psnet.ahrq.gov/issue/five-topics-health-care-simulation-can-address-improve-patient-safety-results-consensus
June 28, 2023 - Study
Five topics health care simulation can address to improve patient safety: results from a consensus process.
Citation Text:
Sollid SJM, Dieckman P, Aase K, et al. Five Topics Health Care Simulation Can Address to Improve Patient Safety: Results From a Consensus Process. J Patient Sa…
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psnet.ahrq.gov/issue/use-daily-goals-checklist-morning-icu-rounds-mixed-methods-study
November 21, 2021 - Study
Use of a daily goals checklist for morning ICU rounds: a mixed-methods study.
Citation Text:
Centofanti JE, Duan EH, Hoad NC, et al. Use of a daily goals checklist for morning ICU rounds: a mixed-methods study. Crit Care Med. 2014;42(8):1797-803. doi:10.1097/CCM.0000000000000331.
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psnet.ahrq.gov/issue/preventable-anesthesia-related-adverse-events-large-tertiary-care-center-nine-year
November 12, 2014 - Study
Preventable anesthesia-related adverse events at a large tertiary care center: a nine-year retrospective analysis.
Citation Text:
Curatolo CJ, McCormick PJ, Hyman JB, et al. Preventable Anesthesia-Related Adverse Events at a Large Tertiary Care Center: A Nine-Year Retrospective Ana…
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psnet.ahrq.gov/issue/making-move-using-simulation-identify-latent-safety-threats-care-injured-patients-new
December 30, 2014 - Commentary
Making a move: using simulation to identify latent safety threats before the care of injured patients in a new physical space.
Citation Text:
Kotagal M, Falcone RA, Daugherty M, et al. Making a move: Using simulation to identify latent safety threats before the care of injured…
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psnet.ahrq.gov/issue/cognitive-engineering-improve-patient-safety-and-outcomes-cardiothoracic-surgery
January 23, 2017 - Commentary
Cognitive engineering to improve patient safety and outcomes in cardiothoracic surgery
Citation Text:
Zenati MA, Kennedy-Metz L, Dias RD. Cognitive Engineering to Improve Patient Safety and Outcomes in Cardiothoracic Surgery. Semin Thorac Cardiovasc Surg. 2019. doi:10.1053/j.s…
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psnet.ahrq.gov/issue/medication-errors-caregivers-home-neonates-discharged-neonatal-intensive-care-unit
June 07, 2023 - Study
Medication errors by caregivers at home in neonates discharged from the neonatal intensive care unit.
Citation Text:
Solanki R, Mondal N, Mahalakshmy T, et al. Medication errors by caregivers at home in neonates discharged from the neonatal intensive care unit. Arch Dis Child. 2017…
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psnet.ahrq.gov/issue/determinants-patient-oncologist-prognostic-discordance-advanced-cancer
July 13, 2022 - Study
Determinants of patient–oncologist prognostic discordance in advanced cancer.
Citation Text:
Gramling R, Fiscella K, Xing G, et al. Determinants of Patient-Oncologist Prognostic Discordance in Advanced Cancer. JAMA Oncol. 2016;2(11):1421-1426. doi:10.1001/jamaoncol.2016.1861.
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