-
psnet.ahrq.gov/node/37082/psn-pdf
January 02, 2017 - Improving rapid response systems: progress, issues, and
future directions.
January 2, 2017
Ovretveit J, Suffoletto J-A. Improving rapid response systems: progress, issues, and future directions.
https://psnet.ahrq.gov/issue/improving-rapid-response-systems-progress-issues-and-future-directions
The authors discuss …
-
psnet.ahrq.gov/node/36609/psn-pdf
January 14, 2011 - Anaesthetists' management of oxygen pipeline failure:
room for improvement.
January 14, 2011
Weller JM, Merry AF, Warman GR, et al. Anaesthetists' management of oxygen pipeline failure: room for
improvement. Anaesthesia. 2007;62(2):122-6.
https://psnet.ahrq.gov/issue/anaesthetists-management-oxygen-pipeline-failur…
-
psnet.ahrq.gov/node/40698/psn-pdf
August 17, 2011 - Improving patient safety in the office: The Institute for
Safety in Office-Based Surgery.
August 17, 2011
Urman RD, Shapiro FE. APSF Newsletter. 2011;3-4,9.
https://psnet.ahrq.gov/issue/improving-patient-safety-office-institute-safety-office-based-surgery
This piece discusses an ambulatory surgery safety im…
-
psnet.ahrq.gov/node/35055/psn-pdf
November 04, 2015 - Using pharmacogenetics to improve drug safety and
efficacy.
November 4, 2015
Haga SB, Burke W. Using pharmacogenetics to improve drug safety and efficacy. JAMA.
2004;291(23):2869-71.
https://psnet.ahrq.gov/issue/using-pharmacogenetics-improve-drug-safety-and-efficacy
The authors outline reasons why pharmacogeneti…
-
digital.ahrq.gov/organization/rural-healthcare-quality-network
January 01, 2023 - Rural Healthcare Quality Network
A Rural Health Information Technology Cooperative to Promote Clinical Improvement - 2008
Principal Investigator
Huck, Jacqueline
Project Name
A Rural Health Information Technology Cooperative to Promote Clinical Improvement
…
-
psnet.ahrq.gov/node/35699/psn-pdf
November 18, 2011 - Improving the Reliability of Health Care.
November 18, 2011
Nolan T, Resar R, Haraden C, et al. Boston, MA: Institute for Healthcare Improvement; 2004.
https://psnet.ahrq.gov/issue/improving-reliability-health-care
This report shares a three-step model for applying reliability principles to health care. The element…
-
www.ahrq.gov/sites/default/files/wysiwyg/sops/events/webinar/2-SOPS_101_Webcast_2020-Gray.pdf
January 01, 2020 - Understanding SOPS Surveys: A Primer for New users -Gray
Overview of the SOPS Surveys
6
Laura Gray, MPH
Senior Study Director
User Network for the AHRQ Surveys on Patient Safety Culture (SOPS)
Westat
AHRQ’s SOPS Program
• Initiated and funded by AHRQ since 2001
• Develops survey measures that are validated an…
-
www.ahrq.gov/patient-safety/reports/engage/gaps.html
March 01, 2017 - Guide to Improving Patient Safety in Primary Care Settings by Engaging Patients and Families
Gaps Identified
Previous Page Next Page
Table of Contents
Guide to Improving Patient Safety in Primary Care Settings by Engaging Patients and Families
Executive Summary
Introduction
Limitations of th…
-
www.ahrq.gov/news/blog/ahrqviews/35-year-history.html
May 01, 2024 - AHRQ Views: Blog posts from AHRQ leaders
Continuing a 35-Year History, AHRQ Pursues Vital Pathways to Improve Patient Care
MAY
16
2024
By
Robert Otto
Valdez,
Ph.D., M.H.S.A.
Not long ago, Health and Human Services (HHS) Deputy Secretary Andrea Palm visited AHRQ to update …
-
digital.ahrq.gov/ahrq-funded-projects/improving-influenza-vaccine-uptake-acute-care-settings
July 31, 2023 - Improving Influenza Vaccine Uptake in Acute Care Settings
Project Final Report ( PDF , 1.59 MB) Disclaimer
Disclaimer
The findings and conclusions in this document are those of the author(s), who are responsible for its content, and do not necessarily represent the views of AHRQ.…
-
digital.ahrq.gov/ahrq-funded-projects/medication-safety-primary-care-practice-translating-research-practice
January 01, 2023 - Medication Safety in Primary Care Practice - Translating Research into Practice
Project Final Report ( PDF , 142.6 KB) Disclaimer
Disclaimer
The findings and conclusions in this document are those of the author(s), who are responsible for its content, and do not necessarily rep…
-
digital.ahrq.gov/ahrq-funded-projects/improving-pediatric-safety-and-quality-healthcare-information-technology
January 01, 2023 - Improving Pediatric Safety and Quality with Healthcare Information Technology
Project Final Report ( PDF , 92.7 KB) Disclaimer
Disclaimer
The findings and conclusions in this document are those of the author(s), who are responsible for its content, and do not necessarily repres…
-
psnet.ahrq.gov/sites/default/files/2022-10/spotlight_case_missed_pneumothorax_10.09.2022_-_final.pdf
January 01, 2022 - Spotlight
Spotlight
False Assumptions Result in a Missed
Pneumothorax after Bronchoscopy with
Transbronchial Biopsy
Source and Credits
• This presentation is based on the September 2022 AHRQ WebM&M
Spotlight Case
o See the full article at https://psnet.ahrq.gov/webmm
o CME credit is available
o Commentary by:…
-
www.ahrq.gov/hai/tools/ambulatory-surgery/sections/implementation/implementation-guide/app-k-debrief-fac-notes.html
May 01, 2017 - Debrief Example Audio Transcript/Facilitator Notes - Implementation Guide
Slide 1: Debrief Example
Hello everyone, I'm Jeff Durney. I'm one of the quality improvement advisers in the AHRQ Safety Program for Ambulatory Surgery, and for the next few minutes I'll be talking to you about how to turn the work yo…
-
www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/quality-resources/tools/cauti-ltc/modules/implementation/long-term-modules/overview.docx
March 01, 2017 - AHRQ Safety Program for Long-Term Care: HAIs/CAUTI
Long-Term Care Safety Toolkit Modules
Overview of the Long-Term Care Safety Toolkit Modules and Nursing Home Survey on Patient Safety Culture
The Long-Term Care (LTC) Safety Toolkit is designed to support learning and implementation efforts to improve safety cult…
-
www.ahrq.gov/sites/default/files/wysiwyg/pqmp/toolkits/asthma-ed-kdd.pdf
March 10, 2021 - PQMP Asthma ED Visit Quality Metric Key Driver Diagram
PQMP Asthma ED Visit Quality Metric Key Driver Diagram
Authors: Keith Robinson, MD, FAAP; Christine Pellegrino, MS; Judy Shaw, EdD, MPH, RN, FAAP Updated 3/10/2021
SMART Aim:
Key Drivers Secondary Drivers Examples of Interventions
Reduce the # of ED
visits/…
-
www.ahrq.gov/policymakers/chipra/pubs/background-2012/backgrndtab1.html
December 01, 2012 - Recommendations to Improve Children's Health Care Quality Measures
Background Report on the 2012 Process
This background report describes the process used to identify, evaluate, and select children's health care quality measures to be recommended for addition to the initial core set of 24 measures released by…
-
www.ahrq.gov/diagnostic-safety/resources/issue-briefs/leadership-4.html
June 01, 2021 - Leadership To Improve Diagnosis: A Call to Action
What Can Leaders Achieve by Prioritizing Diagnostic Safety?
Previous Page Next Page
Table of Contents
Leadership To Improve Diagnosis: A Call to Action
Diagnostic Safety as a Challenge for Healthcare Leadership
Why Are Leaders Essential to Diagno…
-
www.ahrq.gov/news/newsroom/case-studies/ktcquips52.html
October 01, 2014 - Nebraska Critical Access Hospitals Improve Safety With AHRQ TeamSTEPPS®
Search All Impact Case Studies
December 2010
The University of Nebraska Medical Center (UNMC) customized the coaching strategies used in the Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS®) curriculum fo…
-
www.ahrq.gov/sites/default/files/wysiwyg/professionals/education/curriculum-tools/cusptoolkit/toolkit/obsrounds.doc
June 02, 2025 - Observing Patient Care Rounds
Problem statement: Interdisciplinary rounds are in the best interest of patients. Poor communication among staff is a root cause of many patient adverse and sentinel events. Communication among disciplines can be improved if viewed through the eyes of an objective observer.
What are obser…