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psnet.ahrq.gov/issue/perceived-disability-based-discrimination-health-care-children-medical-complexity
November 16, 2022 - Study
Perceived disability-based discrimination in health care for children with medical complexity.
Citation Text:
Ames SG, Delaney RK, Houtrow AJ, et al. Perceived disability-based discrimination in health care for children with medical complexity. Pediatrics. 2023;152(1):e2022060975. …
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psnet.ahrq.gov/issue/eliminating-perioperative-adverse-events-ascension-health
November 16, 2022 - Commentary
Eliminating perioperative adverse events at Ascension Health.
Citation Text:
Ewing H, Bruder G, Baroco P, et al. Eliminating perioperative adverse events at Ascension Health. Jt Comm J Qual Patient Saf. 2007;33(5):256-66.
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psnet.ahrq.gov/issue/learning-every-death
June 28, 2011 - Commentary
Learning from every death.
Citation Text:
Huddleston JM, Diedrich DA, Kinsey GC, et al. Learning from every death. J Patient Saf. 2014;10(1):6-12. doi:10.1097/PTS.0000000000000053.
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psnet.ahrq.gov/issue/always-having-say-youre-sorry-ethical-response-making-mistakes-professional-practice
September 09, 2011 - Review
Always having to say you're sorry: an ethical response to making mistakes in professional practice.
Citation Text:
Crigger NJ. Always having to say you're sorry: an ethical response to making mistakes in professional practice. Nurs Ethics. 2004;11(6):568-76.
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psnet.ahrq.gov/issue/fmea-team-performance-health-care-qualitative-analysis-team-member-perceptions
December 31, 2014 - Study
FMEA team performance in health care: a qualitative analysis of team member perceptions.
Citation Text:
Wetterneck TB, Hundt AS, Carayon P. FMEA Team Performance in Health Care. J Patient Saf. 2009;5(2). doi:10.1097/pts.0b013e3181a852be.
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psnet.ahrq.gov/issue/do-safety-checklists-improve-teamwork-and-communication-operating-room-systematic-review
January 19, 2016 - Review
Do safety checklists improve teamwork and communication in the operating room? A systematic review.
Citation Text:
Russ S, Rout S, Sevdalis N, et al. Do safety checklists improve teamwork and communication in the operating room? A systematic review. Ann Surg. 2013;258(6):856-71. …
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psnet.ahrq.gov/issue/what-ethically-informed-approach-managing-patient-safety-risk-during-discharge-planning
November 16, 2022 - Commentary
What is an ethically informed approach to managing patient safety risk during discharge planning?
Citation Text:
West JC. What Is an Ethically Informed Approach to Managing Patient Safety Risk During Discharge Planning? AMA J Ethics. 2020;22(!1):e919-e923. doi:10.1001/amajethi…
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psnet.ahrq.gov/issue/medical-resident-pharmacist-collaboration-improves-rate-medication-reconciliation
September 24, 2010 - Study
A medical resident–pharmacist collaboration improves the rate of medication reconciliation verification at discharge.
Citation Text:
Caroff DA, Bittermann T, Leonard CE, et al. A Medical Resident-Pharmacist Collaboration Improves the Rate of Medication Reconciliation Verification a…
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psnet.ahrq.gov/issue/reduction-warfarin-adverse-events-requiring-patient-hospitalization-after-implementation
October 23, 2024 - Study
Reduction in warfarin adverse events requiring patient hospitalization after implementation of a pharmacist-managed anticoagulation service.
Citation Text:
Locke C, Ravnan SL, Patel R, et al. Reduction in warfarin adverse events requiring patient hospitalization after implementat…
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psnet.ahrq.gov/issue/rapid-response-teams-seen-through-eyes-nurse
June 03, 2010 - Study
Rapid response teams seen through the eyes of the nurse.
Citation Text:
Shapiro SE, Donaldson NE, Scott MB. Rapid response teams seen through the eyes of the nurse. Am J Nurs. 2010;110(6):28-34; quiz 35-36. doi:10.1097/01.NAJ.0000377686.64479.84.
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psnet.ahrq.gov/issue/introduction-computerized-physician-order-entry-and-change-management-tertiary-pediatric
January 22, 2016 - Review
The introduction of computerized physician order entry and change management in a tertiary pediatric hospital.
Citation Text:
Upperman JS, Staley P, Friend K, et al. The introduction of computerized physician order entry and change management in a tertiary pediatric hospital. Pe…
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psnet.ahrq.gov/issue/enhancing-patient-safety-intelligent-intravenous-infusion-devices-experience-specialty
January 07, 2015 - Study
Enhancing patient safety with intelligent intravenous infusion devices: experience in a specialty cardiac hospital.
Citation Text:
Wood JL, Burnette JS. Enhancing patient safety with intelligent intravenous infusion devices: Experience in a specialty cardiac hospital. Heart & Lun…
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psnet.ahrq.gov/issue/implementation-protocol-reduce-occurrence-retained-sponges-after-vaginal-delivery
May 18, 2022 - Commentary
Implementation of a protocol to reduce occurrence of retained sponges after vaginal delivery.
Citation Text:
Lutgendorf MA, Schindler LL, Hill JB, et al. Implementation of a protocol to reduce occurrence of retained sponges after vaginal delivery. Mil Med. 2011;176(6):702-704.…
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psnet.ahrq.gov/issue/pediatric-rapid-response-teams-academic-medical-center
November 21, 2016 - Study
Pediatric rapid response teams in the academic medical center.
Citation Text:
Mistry KP, Turi J, Hueckel RM, et al. Pediatric Rapid Response Teams in the Academic Medical Center. Clin Pediatr Emerg Med. 2006;7(4). doi:10.1016/j.cpem.2006.08.010.
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psnet.ahrq.gov/issue/evaluation-implementation-alert-issued-uk-national-patient-safety-agency-storage-and-handling
September 04, 2013 - Study
Evaluation of the implementation of the alert issued by the UK National Patient Safety Agency on the storage and handling of potassium chloride concentrate solution.
Citation Text:
Lankshear AJ, Sheldon TA, Lowson K, et al. Evaluation of the implementation of the alert issued by th…
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psnet.ahrq.gov/issue/discharge-rounds-80-hour-workweek-importance-trauma-nurse-practitioner
October 19, 2022 - Study
Discharge rounds in the 80-hour workweek: importance of the trauma nurse practitioner.
Citation Text:
Haan JM, Dutton RP, Willis M, et al. Discharge rounds in the 80-hour workweek: importance of the trauma nurse practitioner. J Trauma. 2007;63(2):339-43.
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digital.ahrq.gov/health-it-tools-and-resources/workflow-assessment-health-it-toolkit/research/lesselroth-bj-felder-rs
January 01, 2023 - Lesselroth BJ, Felder RS, Adams SM, et al. "Design and implementation of a medication reconciliation kiosk: the Automated Patient History Intake Device (APHID)."
Reference
Lesselroth BJ, Felder RS, Adams SM, et al. Design and implementation of a medication reconciliation kiosk: the Automated Patient H…
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integrationacademy.ahrq.gov/products/playbooks/moud-playbook/obtain-training-and-support
October 01, 2025 - An official website of the Department of Health & Human Services
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digital.ahrq.gov/location/usa-il-chicago
January 01, 2023 - USA, IL, Chicago
A Machine Learning Health System to Integrate Care for Substance Misuse and HIV Treatment and Prevention Among Hospitalized Patients
Description
This research will develop, train, test, and evaluate a machine learning classifier to identify risk for HIV acquis…
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digital.ahrq.gov/health-care-theme/adverse-events
January 01, 2023 - Adverse Events
Implementation of DDInteract: A Shared Decision Making Tool for Anticoagulant Drug-Drug Interactions
Description
This research will implement, evaluate, and disseminate DDInteract, a shared decision making clinical decision support tool that aims to reduce harm …