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  1. Using Federal grants to build intellectual capital at the State level | Agency for Healthcare Research and Quality

    www.ahrq.gov/policymakers/chipra/demoeval/what-we-learned/finalsummary/finalsummary7.html
    September 01, 2015 - Key Lessons from the National Evaluation of the CHIPRA Quality Demonstration Grant Program Using Federal grants to build intellectual capital at the State level Previous Page Next Page Table of Contents Key Lessons from the National Evaluation of the CHIPRA Quality Demonstration Grant Program Intr…

  2. Patient safety rounds: description of an inexpensive but important strategy to improve the safety culture. | PSNet

    psnet.ahrq.gov/issue/patient-safety-rounds-description-inexpensive-important-strategy-improve-safety-culture
    December 15, 2008 - Commentary Patient safety rounds: description of an inexpensive but important strategy to improve the safety culture. Citation Text: Campbell D, Thompson M. Patient safety rounds: description of an inexpensive but important strategy to improve the safety culture. Am J Med Qual. 2007;22…

  3. The cost of serious fall-related injuries at three midwestern hospitals. | PSNet

    psnet.ahrq.gov/issue/cost-serious-fall-related-injuries-three-midwestern-hospitals
    January 03, 2017 - Study The cost of serious fall-related injuries at three midwestern hospitals. Citation Text: Wong CA, Recktenwald AJ, Jones ML, et al. The cost of serious fall-related injuries at three Midwestern hospitals. Jt Comm J Qual Patient Saf. 2011;37(2):81-87. Copy Citation Format: …

  4. Patient safety during anaesthesia: incorporation of the WHO safe surgery guidelines into clinical practice. | PSNet

    psnet.ahrq.gov/issue/patient-safety-during-anaesthesia-incorporation-who-safe-surgery-guidelines-clinical-practice
    September 20, 2011 - Review Patient safety during anaesthesia: incorporation of the WHO safe surgery guidelines into clinical practice. Citation Text: Schlack WS, Boermeester MA. Patient safety during anaesthesia: incorporation of the WHO safe surgery guidelines into clinical practice. Curr Opin Anaesthesi…

  5. Edgeware: Insights from Complexity Science for Health Care Leaders. Second ed. | PSNet

    psnet.ahrq.gov/issue/edgeware-insights-complexity-science-health-care-leaders
    June 23, 2021 - Book/Report Edgeware: Insights from Complexity Science for Health Care Leaders. Second ed. Citation Text: Edgeware: Insights from Complexity Science for Health Care Leaders. Second ed. Zimmerman B, Lindberg C, Plsek P. Irving, TX: VHA Incorporated; 2008. ISBN: 9780966782806 Copy Citati…

  6. Avoiding medical emergencies. | PSNet

    psnet.ahrq.gov/issue/avoiding-medical-emergencies
    April 07, 2021 - Commentary Avoiding medical emergencies. Citation Text: Omar Y. Avoiding medical emergencies. Br Dent J. 2013;214(5):255-9. doi:10.1038/sj.bdj.2013.217. Copy Citation Format: DOI Google Scholar PubMed BibTeX EndNote X3 XML EndNote 7 XML Endnote tagged PubMedId RIS …

  7. Exhibit 5.4. Chronology of Quality Improvement (QI) and Lean at Heights Hospital | Agency for Healthcare Research and Quality

    www.ahrq.gov/practiceimprovement/systemdesign/leancasestudies/lean-exhibit5-4.html
    November 01, 2014 - Improving Care Delivery Through Lean: Implementation Case Studies Exhibit 5.4. Chronology of Quality Improvement (QI) and Lean at Heights Hospital Previous Page Next Page Table of Contents Improving Care Delivery Through Lean: Implementation Case Studies Introduction to the Case Studies Case 1. …

  8. Clinical decision support and malpractice risk. | PSNet

    psnet.ahrq.gov/issue/clinical-decision-support-and-malpractice-risk
    September 24, 2017 - Commentary Clinical decision support and malpractice risk. Citation Text: Greenberg MD, Ridgely MS. Clinical Decision Support and Malpractice Risk. JAMA. 2011;306(1). doi:10.1001/jama.2011.929. Copy Citation Format: DOI Google Scholar BibTeX EndNote X3 XML EndNote 7 XML E…

  9. Alcohol based surgical prep solution and the risk of fire in the operating room: a case report. | PSNet

    psnet.ahrq.gov/issue/alcohol-based-surgical-prep-solution-and-risk-fire-operating-room-case-report
    February 02, 2022 - Commentary Alcohol based surgical prep solution and the risk of fire in the operating room: a case report. Citation Text: Batra S, Gupta R. Alcohol based surgical prep solution and the risk of fire in the operating room: a case report. Patient Saf Surg. 2008;2(1):10. doi:10.1186/1754-9…

  10. Rapid response systems: should we still question their implementation? | PSNet

    psnet.ahrq.gov/issue/rapid-response-systems-should-we-still-question-their-implementation
    January 06, 2017 - Commentary Rapid response systems: should we still question their implementation? Citation Text: Winters BD, Pronovost P. Rapid response systems: should we still question their implementation? J Hosp Med. 2013;8(5):278-81. doi:10.1002/jhm.2050. Copy Citation Format: DOI G…

  11. Rapid response teams: what's the latest? | PSNet

    psnet.ahrq.gov/issue/rapid-response-teams-whats-latest
    December 12, 2012 - Commentary Rapid response teams: what's the latest? Citation Text: Jackson SA. Rapid response teams: What's the latest? Nursing (Brux). 2017;47(12):34-41. doi:10.1097/01.NURSE.0000526885.10306.21. Copy Citation Format: DOI Google Scholar PubMed BibTeX EndNote X3 XML EndNote…

  12. Hypertension Screening for Children Who Are Overweight or Obese: Technical Specifications (pdf file)

    www.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/chronic/chipra-0232-technicalspecs.pdf
    June 02, 2025 - Hypertension Screening for Children Who Are Overweight or Obese: Technical Specifications The percentage of children aged 3 through 17 years with an outpatient care visit and a BMI ≥85th percentile who had a blood pressure percentile documented and classified as normal or abnormal during the measure…

  13. Rethinking peer review: what aviation can teach radiology about performance improvement. | PSNet

    psnet.ahrq.gov/issue/rethinking-peer-review-what-aviation-can-teach-radiology-about-performance-improvement
    July 01, 2017 - Commentary Rethinking peer review: what aviation can teach radiology about performance improvement. Citation Text: Larson DB, Nance JJ. Rethinking peer review: what aviation can teach radiology about performance improvement. Radiology. 2011;259(3):626-32. doi:10.1148/radiol.11102222. …

  14. The spectrum of medical errors: when patients sue. | PSNet

    psnet.ahrq.gov/issue/spectrum-medical-errors-when-patients-sue
    October 28, 2020 - Review The spectrum of medical errors: when patients sue. Citation Text: Grant-Kels J, Kels B. The spectrum of medical errors: when patients sue. Int J Gen Med. 2012. doi:10.2147/ijgm.s24257. Copy Citation Format: DOI Google Scholar BibTeX EndNote X3 XML EndNote 7 XML End…

  15. COVID-19 Focused Inspection Initiative in Healthcare. | PSNet

    psnet.ahrq.gov/issue/covid-19-focused-inspection-initiative-healthcare
    April 01, 2024 - Press Release/Announcement COVID-19 Focused Inspection Initiative in Healthcare. Citation Text: COVID-19 Focused Inspection Initiative in Healthcare. Occupational Safety and Health Administration. March 2, 2022. Copy Citation Save Save to your library …

  16. TeamSTEPPS: assuring optimal teamwork in clinical settings. | PSNet

    psnet.ahrq.gov/issue/teamstepps-assuring-optimal-teamwork-clinical-settings
    January 12, 2011 - Commentary TeamSTEPPS: assuring optimal teamwork in clinical settings. Citation Text: Clancy CM, Tornberg DN. TeamSTEPPS: assuring optimal teamwork in clinical settings. Am J Med Qual. 2007;22(3):214-7. Copy Citation Format: Google Scholar PubMed BibTeX EndNote X3 XML End…

  17. The development of a patient safety program across the continuum of care. | PSNet

    psnet.ahrq.gov/issue/development-patient-safety-program-across-continuum-care
    September 21, 2009 - Commentary The development of a patient safety program across the continuum of care. Citation Text: Wertenberger S, Wilson J. The development of a patient safety program across the continuum of care. Nurs Adm Q. 2005;29(4):303-307. Copy Citation Format: Google Scholar Pub…

  18. Effects of sleep inertia on cognition. | PSNet

    psnet.ahrq.gov/issue/effects-sleep-inertia-cognition
    April 21, 2021 - Study Effects of sleep inertia on cognition. Citation Text: Wertz AT, Ronda JM, Czeisler CA, et al. Effects of sleep inertia on cognition. JAMA. 2006;295(2):163-4. Copy Citation Format: Google Scholar PubMed BibTeX EndNote X3 XML EndNote 7 XML Endnote tagged PubMedId RIS …

  19. Spike in fatal medication errors at the beginning of each month. | PSNet

    psnet.ahrq.gov/issue/spike-fatal-medication-errors-beginning-each-month
    January 26, 2022 - Study Spike in fatal medication errors at the beginning of each month. Citation Text: Phillips DP, Jarvinen JR, Phillips RR. A spike in fatal medication errors at the beginning of each month. Pharmacotherapy. 2005;25(1):1-9. Copy Citation Format: Google Scholar PubMed BibT…

  20. New patient safety organizations lower roadblocks to medical error reporting. | PSNet

    psnet.ahrq.gov/issue/new-patient-safety-organizations-lower-roadblocks-medical-error-reporting
    May 20, 2009 - Commentary New patient safety organizations lower roadblocks to medical error reporting. Citation Text: Clancy CM. New patient safety organizations lower roadblocks to medical error reporting. Am J Med Qual. 2008;23(4):318-21. doi:10.1177/1062860608319673. Copy Citation Format: …
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