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psnet.ahrq.gov/issue/why-do-gdps-fail-recognise-oral-cancer-argument-oral-cancer-checklist
March 13, 2024 - Commentary
Why do GDPs fail to recognise oral cancer? The argument for an oral cancer checklist.
Citation Text:
Dave B. Why do GDPs fail to recognise oral cancer? The argument for an oral cancer checklist. Br Dent J. 2013;214(5):223-5. doi:10.1038/sj.bdj.2013.214.
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psnet.ahrq.gov/issue/surgical-procedure-grid-safety-and-operating-room-communication-multisite-surgery
June 17, 2014 - Commentary
A surgical procedure grid for safety and operating room communication in multisite surgery.
Citation Text:
Insalaco LF, Spiegel JH. A Surgical Procedure Grid for Safety and Operating Room Communication in Multisite Surgery. JAMA Facial Plast Surg. 2018;20(3):185-186. doi:10.10…
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psnet.ahrq.gov/issue/junior-doctors-reflections-patient-safety
July 15, 2015 - Study
Junior doctors' reflections on patient safety.
Citation Text:
Ahmed M, Arora S, Carley S, et al. Junior doctors' reflections on patient safety. Postgrad Med J. 2012;88(1037):125-9. doi:10.1136/postgradmedj-2011-130301.
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psnet.ahrq.gov/issue/multicentre-observational-study-evaluate-new-tool-assess-emergency-physicians-non-technical
December 12, 2012 - Study
A multicentre observational study to evaluate a new tool to assess emergency physicians' non-technical skills.
Citation Text:
Flowerdew L, Gaunt A, Spedding J, et al. A multicentre observational study to evaluate a new tool to assess emergency physicians' non-technical skills. Em…
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psnet.ahrq.gov/issue/model-chemotherapy-education-novice-oncology-nurses-supports-culture-safety
September 24, 2010 - Commentary
A model of chemotherapy education for novice oncology nurses that supports a culture of safety.
Citation Text:
Sheridan-Leos N. A model of chemotherapy education for novice oncology nurses that supports a culture of safety. Clin J Oncol Nurs. 2007;11(4):545-51.
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psnet.ahrq.gov/issue/do-split-side-rails-present-increased-risk-patient-safety
November 02, 2010 - Study
Do split-side rails present an increased risk to patient safety?
Citation Text:
Hignett S, Griffiths P. Do split-side rails present an increased risk to patient safety? Qual Saf Health Care. 2005;14(2):113-6.
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psnet.ahrq.gov/issue/medication-errors-ambulatory-treatment-pediatric-attention-deficit-hyperactivity-disorder
April 08, 2011 - Study
Medication errors in the ambulatory treatment of pediatric attention deficit hyperactivity disorder.
Citation Text:
Bundy DG, Rinke ML, Shore AD, et al. Medication errors in the ambulatory treatment of pediatric attention deficit hyperactivity disorder. Jt Comm J Qual Patient Sa…
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/ambulatory-surgery/sections/sustainability/training-tools/sustainability-tool.docx
May 01, 2017 - AHRQ Safety Program for Ambulatory Surgery
Module 4: Sustainability
Sustainability Tool
Background: This tool can be used to identify sustainability issues in planning and implementing your improvement efforts.
How to use this tool: The Implementation Team leader (or individual designated by the leader) should comple…
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psnet.ahrq.gov/issue/pros-and-cons-electronic-prescribing-children
October 30, 2024 - Commentary
The pros and cons of electronic prescribing for children.
Citation Text:
Caldwell NA, Power B. The pros and cons of electronic prescribing for children. Arch Dis Child. 2011;97(2). doi:10.1136/adc.2010.204446.
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psnet.ahrq.gov/issue/quantifying-and-monitoring-overdiagnosis-cancer-screening-systematic-review-methods
September 15, 2021 - Review
Quantifying and monitoring overdiagnosis in cancer screening: a systematic review of methods.
Citation Text:
Carter JL, Coletti RJ, Harris RP. Quantifying and monitoring overdiagnosis in cancer screening: a systematic review of methods. BMJ. 2015;350:g7773. doi:10.1136/bmj.g7773. …
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psnet.ahrq.gov/issue/challenger-launch-decision-risky-technology-culture-and-deviance-nasa
November 18, 2015 - Book/Report
Classic
The Challenger Launch Decision: Risky Technology, Culture, and Deviance at NASA.
Citation Text:
The Challenger Launch Decision: Risky Technology, Culture, and Deviance at NASA. Vaughan D. Chicago, IL: University of Chicago Press; 1996. ISBN…
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psnet.ahrq.gov/issue/applying-lean-sigma-solutions-mistake-proof-chemotherapy-preparation-process
September 02, 2015 - Commentary
Applying Lean Sigma solutions to mistake-proof the chemotherapy preparation process.
Citation Text:
Aboumatar HJ, Winner L, Davis RO, et al. Applying Lean Sigma solutions to mistake-proof the chemotherapy preparation process. Jt Comm J Qual Patient Saf. 2010;36(2):79-86.
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digital.ahrq.gov/2020-year-review/research-summary/creating-health-information-exchange-application-provide-fast-access-patient-data-emergency
January 01, 2020 - Creating a Health Information Exchange Application to Provide Fast Access to Patient Data in Emergency Department Settings
Integrating health information exchange (HIE) data directly into electronic health records has the potential to improve delivery of care and patient outcomes, as well as increase clinician sati…
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psnet.ahrq.gov/issue/nil-os-orders-imaging-teachable-moment
November 13, 2024 - Commentary
Nil per os orders for imaging: a teachable moment.
Citation Text:
Wickerham AL, Schultz EJ, Lewine EB. Nil per Os Orders for Imaging: A Teachable Moment. JAMA Intern Med. 2017;177(11):1670-1671. doi:10.1001/jamainternmed.2017.3943.
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psnet.ahrq.gov/issue/assessing-evidence-base-context-sensitive-effectiveness-and-safety-patient-safety-practices
December 24, 2008 - Press Release/Announcement
Assessing the Evidence Base for Context-Sensitive Effectiveness and Safety of Patient Safety Practices: Developing Criteria.
Citation Text:
Assessing the Evidence Base for Context-Sensitive Effectiveness and Safety of Patient Safety Practices: Developing Crit…
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psnet.ahrq.gov/issue/error-medicine
November 02, 2014 - Commentary
Classic
Error in medicine.
Citation Text:
Leape L. Error in medicine. JAMA. 1994;272(23):1851-1857.
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psnet.ahrq.gov/issue/surgical-data-recording-technology-solution-address-medical-errors
June 22, 2022 - Commentary
Surgical data recording technology: a solution to address medical errors?
Citation Text:
Shah NA, Jue J, Mackey T. Surgical Data Recording Technology. Ann Surg. 2020;271(3):431-433. doi:10.1097/sla.0000000000003510.
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psnet.ahrq.gov/issue/patient-safety-consumers-perspective
January 12, 2022 - Study
Patient safety: a consumer's perspective.
Citation Text:
Hovey RB, Dvorak ML, Burton T, et al. Patient safety: a consumer's perspective. Qual Health Res. 2011;21(5):662-72. doi:10.1177/1049732311399779.
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psnet.ahrq.gov/issue/assessing-and-improving-safety-climate-large-cohort-intensive-care-units
September 20, 2011 - Study
Assessing and improving safety climate in a large cohort of intensive care units.
Citation Text:
Sexton B, Berenholtz SM, Goeschel CA, et al. Assessing and improving safety climate in a large cohort of intensive care units. Crit Care Med. 2011;39(5):934-9. doi:10.1097/CCM.0b013e3…
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www.ahrq.gov/news/newsroom/case-studies/201526.html
January 01, 2018 - Iowa’s Waverly Health Center Uses AHRQ Tools to Improve Patient Safety
Search All Impact Case Studies
September 2015
Waverly Health Center, a critical access hospital in Waverly, Iowa, has used three AHRQ resources to improve communication, teamwork, and leadership engagement as part of ongoing efforts to i…