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psnet.ahrq.gov/innovation/advance-alert-monitor-program-automated-early-warning-system-adults-risk-hospital
October 30, 2024 - care and escalation plan. 7
Context of the Innovation
Failure to identify, communicate, or act on indicators
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psnet.ahrq.gov/web-mm/add-case-and-missing-checklist
September 01, 2012 - Quality indicators for EGD. Gastrointest Endosc. 2015;81:17-30. [go to PubMed] 9.
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psnet.ahrq.gov/node/73985/psn-pdf
October 20, 2021 - The effects of three consecutive 12-hour shifts on
cognition, sleepiness, and domains of nursing
performance in day and night shift nurses: a quasi-
experimental study.
October 20, 2021
James L, Elkins-Brown N, Wilson M, et al. The effects of three consecutive 12-hour shifts on cognition,
sleepiness, and domains …
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psnet.ahrq.gov/node/61065/psn-pdf
October 28, 2020 - Health care-associated infections among critically ill
children in the US, 2013-2018.
October 28, 2020
Hsu HE, Mathew R, Wang R, et al. Health care-associated infections among critically ill children in the US,
2013-2018. JAMA Pediatr. 2020;174(12):1176-1183. doi:10.1001/jamapediatrics.2020.3223.
https://psnet.ahr…
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psnet.ahrq.gov/node/43544/psn-pdf
December 07, 2016 - Development of an electronic pediatric all-cause harm
measurement tool using a modified Delphi method.
December 7, 2016
Stockwell DC, Bisarya H, Classen D, et al. Development of an Electronic Pediatric All-Cause Harm
Measurement Tool Using a Modified Delphi Method. J Patient Saf. 2016;12(4):180-189.
https://psnet.…
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psnet.ahrq.gov/node/40148/psn-pdf
June 20, 2012 - Systematic review: association of shift length, protected
sleep time, and night float with patient care, residents'
health, and education.
June 20, 2012
Reed DA, Fletcher KE, Arora V. Systematic review: association of shift length, protected sleep time, and
night float with patient care, residents' health, and edu…
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psnet.ahrq.gov/node/861772/psn-pdf
January 31, 2024 - Rapid expansion of the Healing Emotional Lives of Peers
program during COVID-19: a second victim peer support
program for healthcare professionals.
January 31, 2024
Rivera-Chiauzzi EY, Huang L, Osborne AK, et al. Rapid expansion of the Healing Emotional Lives of Peers
program during COVID-19: a second victim peer …
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psnet.ahrq.gov/node/37630/psn-pdf
February 15, 2011 - The Accreditation Council for Graduate Medical
Education's limits on residents' work hours and patient
safety.
February 15, 2011
Jagsi R, Weinstein DF, Shapiro J, et al. The Accreditation Council for Graduate Medical Education's limits
on residents' work hours and patient safety. A study of resident experiences an…
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psnet.ahrq.gov/node/44586/psn-pdf
June 21, 2016 - 2013 Annual Hospital-Acquired Condition Rate and
Estimates of Cost Savings and Deaths Averted From 2010
to 2013.
June 21, 2016
Rockville, MD: Agency for Healthcare Research and Quality; October 2015. AHRQ Publication No.16-
0006-EF.
https://psnet.ahrq.gov/issue/2013-annual-hospital-acquired-condition-rate-and-est…
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psnet.ahrq.gov/node/47579/psn-pdf
December 12, 2018 - A prescription for enhancing electronic prescribing
safety.
December 12, 2018
Schiff G, Mirica MM, Dhavle AA, et al. A Prescription For Enhancing Electronic Prescribing Safety. Health
Aff (Millwood). 2018;37(11):1877-1883. doi:10.1377/hlthaff.2018.0725.
https://psnet.ahrq.gov/issue/prescription-enhancing-electroni…
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psnet.ahrq.gov/node/37063/psn-pdf
January 02, 2017 - Housestaff and medical student attitudes toward medical
errors and adverse events.
January 2, 2017
Vohra PD, Johnson J, Daugherty CK, et al. Housestaff and medical student attitudes toward medical errors
and adverse events. Jt Comm J Qual Patient Saf. 2007;33(8):493-501.
https://psnet.ahrq.gov/issue/housestaff-and…
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psnet.ahrq.gov/node/45667/psn-pdf
November 16, 2016 - Individual surgeon mortality rates: can outliers be
detected? A national utility analysis.
November 16, 2016
Harrison EM, Drake TM, O'Neill S, et al. Individual surgeon mortality rates: can outliers be detected? A
national utility analysis. BMJ Open. 2016;6(10):e012471. doi:10.1136/bmjopen-2016-012471.
https://psn…
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psnet.ahrq.gov/node/44131/psn-pdf
May 13, 2015 - Patient–doctor continuity and diagnosis of cancer:
electronic medical records study in general practice.
May 13, 2015
Ridd MJ, Ferreira DLS, Montgomery AA, et al. Patient-doctor continuity and diagnosis of cancer: electronic
medical records study in general practice. Br J Gen Pract. 2015;65(634):e305-11.
doi:10.33…
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psnet.ahrq.gov/node/865708/psn-pdf
May 01, 2024 - Missed nursing care in surgical care- a hazard to patient
safety: a quantitative study within the inCHARGE
programme.
May 1, 2024
Edfeldt K, Nyholm L, Jangland E, et al. Missed nursing care in surgical care– a hazard to patient safety: a
quantitative study within the inCHARGE programme. BMC Nurs. 2024;23(1):233. d…
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psnet.ahrq.gov/node/860382/psn-pdf
January 10, 2024 - Changes in hospital adverse events and patient outcomes
associated with private equity acquisition.
January 10, 2024
Kannan S, Bruch JD, Song Z. Changes in hospital adverse events and patient outcomes associated with
private equity acquisition. JAMA. 2023;330(24):2365-2375. doi:10.1001/jama.2023.23147.
https://psn…
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psnet.ahrq.gov/node/41924/psn-pdf
April 05, 2013 - Disclosure-and-resolution programs that include
generous compensation offers may prompt a complex
patient response.
April 5, 2013
Murtagh L, Gallagher TH, Andrew P, et al. Disclosure-and-resolution programs that include generous
compensation offers may prompt a complex patient response. Health Aff (Millwood). 2012…
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psnet.ahrq.gov/node/41986/psn-pdf
January 23, 2013 - Slow progress on meeting hospital safety standards:
learning from the Leapfrog Group's efforts.
January 23, 2013
Moran J, Scanlon D. Slow progress on meeting hospital safety standards: learning from the Leapfrog
Group's efforts. Health Aff (Millwood). 2013;32(1):27-35. doi:10.1377/hlthaff.2011.0056.
https://psnet.…
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psnet.ahrq.gov/node/844044/psn-pdf
January 01, 2024 - Effect of contextual factors on the prevalence of
diagnostic errors among patients managed by physicians
of the same specialty: a single-centre retrospective
observational study.
February 8, 2023
Harada Y, Otaka Y, Katsukura S, et al. Effect of contextual factors on the prevalence of diagnostic errors
among patie…
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psnet.ahrq.gov/node/41010/psn-pdf
November 26, 2014 - Preventing hospital-acquired infections: a national survey
of practices reported by U.S. hospitals in 2005 and 2009.
November 26, 2014
Krein SL, Kowalski CP, Hofer TP, et al. Preventing hospital-acquired infections: a national survey of
practices reported by U.S. hospitals in 2005 and 2009. J Gen Intern Med. 2012;2…
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psnet.ahrq.gov/node/43859/psn-pdf
May 28, 2015 - Point prevalence of surgical checklist use in Europe:
relationship with hospital mortality.
May 28, 2015
Jammer I, Ahmad T, Aldecoa C, et al. Point prevalence of surgical checklist use in Europe: relationship
with hospital mortality. Br J Anaesth. 2015;114(5):801-807. doi:10.1093/bja/aeu460.
https://psnet.ahrq.gov…