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psnet.ahrq.gov/node/47884/psn-pdf
May 22, 2019 - Implementation and evaluation of a laboratory safety
process improvement toolkit.
May 22, 2019
Kwan BM, Fernald D, Ferrarone P, et al. Implementation and Evaluation of a Laboratory Safety Process
Improvement Toolkit. J Am Board Fam Med. 2019;32(2):136-145. doi:10.3122/jabfm.2019.02.180109.
https://psnet.ahrq.gov/i…
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psnet.ahrq.gov/node/36060/psn-pdf
September 28, 2010 - Medical emergency teams: a strategy for improving
patient care and nursing work environments.
September 28, 2010
Galhotra S, Scholle CC, Dew MA, et al. Medical emergency teams: a strategy for improving patient care
and nursing work environments. J Adv Nurs. 2006;55(2):180-7.
https://psnet.ahrq.gov/issue/medical-em…
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psnet.ahrq.gov/node/35039/psn-pdf
February 24, 2019 - Managing unnecessary variability in patient demand to
reduce nursing stress and improve patient safety.
February 24, 2019
Litvak E, Buerhaus P, Davidoff F, et al. Managing unnecessary variability in patient demand to reduce
nursing stress and improve patient safety. Jt Comm J Qual Patient Saf. 2005;31(6):330-8.
ht…
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psnet.ahrq.gov/node/36495/psn-pdf
May 11, 2014 - Improving safety throughout the medication use process
in a neonatal intensive care unit.
May 11, 2014
Asdigha MN. Improving Safety Throughout the Medication Use Process in a Neonatal Intensive Care Unit.
Hosp Pharm. 2010;41(11):1067-1075. doi:10.1310/hpj4111-1067.
https://psnet.ahrq.gov/issue/improving-safety-thr…
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psnet.ahrq.gov/node/39439/psn-pdf
May 10, 2010 - Improving insulin distribution and administration safety
using Lean Six Sigma methodologies.
May 10, 2010
Yamamoto J, Abraham D, Malatestinic B. Improving Insulin Distribution and Administration Safety Using
Lean Six Sigma Methodologies. Hosp Pharm. 2010;45(3). doi:10.1310/hpj4503-212.
https://psnet.ahrq.gov/issue…
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psnet.ahrq.gov/node/43984/psn-pdf
November 16, 2015 - Improving resident handoffs for children transitioning
from the intensive care unit.
November 16, 2015
Warrick D, Gonzalez-del-Rey J, Hall D, et al. Improving resident handoffs for children transitioning from the
intensive care unit. Hosp Pediatr. 2015;5(3):127-33. doi:10.1542/hpeds.2014-0067.
https://psnet.ahrq.g…
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psnet.ahrq.gov/node/42057/psn-pdf
February 20, 2013 - Improving patient safety in the operating theatre and
perioperative care: obstacles, interventions, and priorities
for accelerating progress.
February 20, 2013
Sevdalis N, Hull L, Birnbach DJ. Improving patient safety in the operating theatre and perioperative care:
obstacles, interventions, and priorities for acc…
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psnet.ahrq.gov/node/41140/psn-pdf
February 15, 2012 - Is the maturity of hospitals' quality improvement systems
associated with measures of quality and patient safety?
February 15, 2012
Groene O, Mora N, Thompson A, et al. Is the maturity of hospitals' quality improvement systems associated
with measures of quality and patient safety? BMC Health Serv Res. 2011;11:344.…
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psnet.ahrq.gov/node/41629/psn-pdf
January 03, 2017 - Improving team performance during the preprocedure
time-out in pediatric interventional radiology.
January 3, 2017
Gottumukkala R, Street M, Fitzpatrick M, et al. Improving team performance during the preprocedure time-
out in pediatric interventional radiology. Jt Comm J Qual Patient Saf. 2012;38(9):387-94.
https…
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www.ahrq.gov/sites/default/files/wysiwyg/sops/events/webinar/sops101-2-brady-2018.pdf
January 01, 2018 - Understanding SOPS Surveys: A Primer for New Users - Brady
6
Overview of AHRQ’s Patient Safety
Priorities and Programs
Jeff Brady, MD, MPH
Director, Center for Quality Improvement and Patient Safety,
Agency for Healthcare Research and Quality (AHRQ)
Rear Admiral, Assistant Surgeon General, U.S. Public Health Ser…
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psnet.ahrq.gov/node/35407/psn-pdf
September 11, 2009 - Liability reform should make patients safer: "Avoidable
classes of events" are a key improvement.
September 11, 2009
Bovbjerg RR, Tancredi LR. Liability reform should make patients safer: "avoidable classes of events" are a
key improvement. J Law Med Ethics. 2005;33(3):478-500.
https://psnet.ahrq.gov/issue/liabili…
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psnet.ahrq.gov/node/60195/psn-pdf
April 01, 2020 - What every health lawyer should know about the Patient
Safety and Quality Improvement Act of 2005.
April 1, 2020
Hanzal M. What every health lawyer should know about the Patient Safety and Quality Improvement Act of
2005. J Health Life Sci Law. 2020;13(2):71-88.
https://psnet.ahrq.gov/issue/what-every-health-lawye…
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psnet.ahrq.gov/node/38270/psn-pdf
December 01, 2010 - Improving America's Hospitals: The Joint Commission's
Report on Quality and Safety 2008.
December 1, 2010
Oakbrook Terrace, IL: The Joint Commission; November 2008.
https://psnet.ahrq.gov/issue/improving-americas-hospitals-joint-commissions-report-quality-and-safety-2008
The quality of care delivered at US hospita…
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psnet.ahrq.gov/node/45023/psn-pdf
April 17, 2018 - Lean Hospitals: Improving Quality, Patient Safety, and
Employee Engagement, Third Edition.
April 17, 2018
Graban M. Boca Raton, FL: Productivity Press; 2016. ISBN: 9781498743259.
https://psnet.ahrq.gov/issue/lean-hospitals-improving-quality-patient-safety-and-employee-engagement-
third-edition
Lean methodology fo…
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digital.ahrq.gov/principal-investigator/williams-andrew
January 01, 2023 - Williams, Andrew
Factors affecting medication adherence trajectories for patients with heart failure.
Citation
Juarez DT, Williams AE, Chen C, et al. Factors affecting medication adherence trajectories for patients with heart failure. Am J Manag Care 2015 Mar 1;21(3):e197-205.…
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psnet.ahrq.gov/node/41556/psn-pdf
January 03, 2017 - Patient safety reporting systems: sustained quality
improvement using a multidisciplinary team and "Good
Catch" awards.
January 3, 2017
Herzer KR, Mirrer M, Xie Y, et al. Patient Safety Reporting Systems: Sustained Quality Improvement Using
a Multidisciplinary Team and “Good Catch” Awards. Jt Comm J Qual Patient S…
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psnet.ahrq.gov/node/45631/psn-pdf
July 02, 2017 - Implementation science: a neglected opportunity to
accelerate improvements in the safety and quality of
surgical care.
July 2, 2017
Hull L, Athanasiou T, Russ S. Implementation Science: A Neglected Opportunity to Accelerate
Improvements in the Safety and Quality of Surgical Care. Ann Surg. 2017;265(6):1104-1112.
…
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psnet.ahrq.gov/node/46303/psn-pdf
November 21, 2017 - How do hospital boards govern for quality improvement?
A mixed methods study of 15 organisations in England.
November 21, 2017
Jones L, Pomeroy L, Robert G, et al. How do hospital boards govern for quality improvement? A mixed
methods study of 15 organisations in England. BMJ Qual Saf. 2017;26(12):978-986. doi:10.1…
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psnet.ahrq.gov/node/50883/psn-pdf
February 12, 2020 - Time series evaluation of improvement interventions to
reduce alarm notifications in a paediatric hospital.
February 12, 2020
Pater CM, Sosa TK, Boyer J, et al. Time series evaluation of improvement interventions to reduce alarm
notifications in a paediatric hospital. BMJ Qual Saf. 2020;29(9):717-726. doi:10.1136/b…
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psnet.ahrq.gov/node/73346/psn-pdf
June 02, 2021 - Human factors and ergonomics to improve performance
in intensive care units during the COVID-19 pandemic.
June 2, 2021
Della Torre V, E. Nacul F, Rosseel P, et al. Human factors and ergonomics to improve performance in
intensive care units during the COVID-19 pandemic. Anaesthesiol Intensive Ther. 2021;53(3):265-27…