-
psnet.ahrq.gov/issue/potentially-avoidable-hospitalizations-among-historically-marginalized-nursing-home-residents
September 09, 2011 - Study
Potentially avoidable hospitalizations among historically marginalized nursing home residents.
Citation Text:
Estrada LV, Barcelona V, Dhingra L, et al. Potentially avoidable hospitalizations among historically marginalized nursing home residents. JAMA Netw Open. 2024;7(5):e249312.…
-
psnet.ahrq.gov/issue/nurses-experiences-drug-administration-errors
October 14, 2020 - Study
Nurses' experiences of drug administration errors.
Citation Text:
Schelbred A-B, Nord R. Nurses' experiences of drug administration errors. J Adv Nurs. 2007;60(3):317-24.
Copy Citation
Format:
Google Scholar PubMed BibTeX EndNote X3 XML EndNote 7 XML Endnote tagged …
-
psnet.ahrq.gov/issue/incidence-and-prevention-iatrogenic-urethral-injuries
August 02, 2015 - Study
Incidence and prevention of iatrogenic urethral injuries.
Citation Text:
Kashefi C, Messer K, Barden R, et al. Incidence and prevention of iatrogenic urethral injuries. J Urol. 2008;179(6):2254-7; discussion 2257-8. doi:10.1016/j.juro.2008.01.108.
Copy Citation
Format:
…
-
psnet.ahrq.gov/issue/time-out-impact-physician-burnout-patient-care-quality-and-safety-perioperative-medicine
November 03, 2021 - Commentary
Time out: the impact of physician burnout on patient care quality and safety in perioperative medicine.
Citation Text:
Shin P, Desai V, Conte AH, et al. Time out: the impact of physician burnout on patient care quality and safety in perioperative medicine. Perm J. 2023;27(2):1…
-
psnet.ahrq.gov/issue/identification-warning-signs-during-selection-surgical-trainees
March 17, 2021 - Study
Identification of warning signs during selection of surgical trainees.
Citation Text:
Hagelsteen K, Johansson B-M, Bergenfelz A, et al. Identification of Warning Signs During Selection of Surgical Trainees. J Surg Educ. 2019;76(3):684-693. doi:10.1016/j.jsurg.2018.12.002.
Copy Ci…
-
psnet.ahrq.gov/issue/identifying-hospital-organizational-strategies-reduce-readmissions
May 25, 2016 - Study
Identifying hospital organizational strategies to reduce readmissions.
Citation Text:
Ahmad FS, Metlay JP, Barg FK, et al. Identifying hospital organizational strategies to reduce readmissions. Am J Med Qual. 2013;28(4):278-85. doi:10.1177/1062860612464999.
Copy Citation
F…
-
psnet.ahrq.gov/issue/when-5-rights-go-wrong-medication-errors-nursing-perspective
June 27, 2018 - Study
When the 5 rights go wrong: medication errors from the nursing perspective.
Citation Text:
Jones JH, Treiber LA. When the 5 rights go wrong: medication errors from the nursing perspective. J Nurs Care Qual. 2010;25(3):240-247. doi:10.1097/NCQ.0b013e3181d5b948.
Copy Citation
…
-
psnet.ahrq.gov/issue/patients-right-safety-improving-quality-care-through-litigation-against-hospitals
February 17, 2011 - Commentary
The patient's right to safety—improving the quality of care through litigation against hospitals.
Citation Text:
Annas GJ. The patient's right to safety--improving the quality of care through litigation against hospitals. N Engl J Med. 2006;354(19):2063-2066.
Copy Citation…
-
psnet.ahrq.gov/issue/effectiveness-graduate-medical-education-program-improving-medical-event-reporting-attitude
August 04, 2021 - Study
Effectiveness of a graduate medical education program for improving medical event reporting attitude and behavior.
Citation Text:
Coyle YM, Mercer SQ, Murphy-Cullen CL, et al. Effectiveness of a graduate medical education program for improving medical event reporting attitude a…
-
www.ahrq.gov/news/newsroom/case-studies/cquips0901.html
October 01, 2014 - New York City Uses AHRQ Patient Safety Culture Survey to Reduce Patient Harm
Search All Impact Case Studies
November 2008
The New York City Health and Hospitals Corporation (HHC) has integrated the use of AHRQ's Hospital Survey on Patient Safety Culture as a core component of its corporate-wide patient sa…
-
psnet.ahrq.gov/issue/simulated-settings-powerful-arenas-learning-patient-safety-practices-and-facilitating
December 07, 2011 - Study
Simulated settings; powerful arenas for learning patient safety practices and facilitating transference to clinical practice. A mixed method study.
Citation Text:
Reime MH, Johnsgaard T, Kvam FI, et al. Simulated settings; powerful arenas for learning patient safety practices and f…
-
psnet.ahrq.gov/issue/new-world-patient-safety-23rd-annual-samuel-jason-mixter-lecture
November 02, 2014 - Commentary
New world of patient safety. 23rd Annual Samuel Jason Mixter Lecture.
Citation Text:
Leape L. New world of patient safety: 23rd Annual Samuel Jason Mixter lecture. Arch Surg. 2009;144(5):394-8. doi:10.1001/archsurg.2009.78.
Copy Citation
Format:
DOI Google Schola…
-
psnet.ahrq.gov/issue/hospira-carpuject-pre-filled-cartridges-drug-alert-products-may-contain-more-intended-fill
August 05, 2020 - Press Release/Announcement
Hospira Carpuject pre-filled cartridges—drug alert: products may contain more than the intended fill volume.
Citation Text:
Hospira Carpuject pre-filled cartridges—drug alert: products may contain more than the intended fill volume. MedWatch Safety Alert. S…
-
psnet.ahrq.gov/issue/reasons-persistence-adverse-events-era-safer-surgery-qualitative-approach
October 29, 2014 - Study
Reasons for the persistence of adverse events in the era of safer surgery―a qualitative approach.
Citation Text:
Kaderli R, Seelandt JC, Umer M, et al. Reasons for the persistence of adverse events in the era of safer surgery--a qualitative approach. Swiss Med Wkly. 2013;143:w13…
-
psnet.ahrq.gov/issue/patients-experiences-dental-diagnostic-failures-qualitative-study-using-social-media
September 06, 2017 - Study
Patients' experiences of dental diagnostic failures: a qualitative study using social media.
Citation Text:
Obadan-Udoh E, Howard R, Valmadrid LC, et al. Patients' experiences of dental diagnostic failures: a qualitative study using social media. J Patient Saf. 2024;20(3):177-185. …
-
psnet.ahrq.gov/issue/tolerance-uncertainty-and-fears-making-mistakes-among-fifth-year-medical-students
December 09, 2020 - Study
Tolerance of uncertainty and fears of making mistakes among fifth-year medical students.
Citation Text:
Nevalainen M, Kuikka L, Sjoberg L, et al. Tolerance of uncertainty and fears of making mistakes among fifth-year medical students. Fam Med. 2012;44(4):240-6.
Copy Citation
…
-
effectivehealthcare.ahrq.gov/sites/default/files/pdf/fibromyalgia_research-protocol.pdf
April 03, 2014 - Typical treatments may be less effective31 or not feasible in this
group of individuals and treatments … • Women and men
• Individuals with coexisting mental health conditions
• Individuals with high fibromyalgia … )
• Individuals with longer duration of fibromyalgia symptoms
Question 2:
What are the harms of … • Women and men
• Individuals with coexisting mental health conditions
• Individuals with high fibromyalgia … )
• Individuals with longer duration of fibromyalgia symptoms
The subgroups in key questions
-
digital.ahrq.gov/2018-year-review/research-summary/improves-care-patients
January 01, 2018 - Since usability is key to ensuring that health technology meets the needs of the individuals who use … s research concluded that patient-facing technology must be redesigned or enhanced to better allow individuals … with disabilities to fully engage with technology and demonstrated the importance of partnering with individuals
-
effectivehealthcare.ahrq.gov/sites/default/files/related_files/disparities-quality-improvement_executive.pdf
August 01, 2012 - Inclusion and exclusion criteria
Category Criteria
Population Individuals receiving health care in … A minimum sample size of 50 individuals per study and intervention group or subgroup. … • The intervention was more effective in White and Black individuals
relative to those of other or … speaking English as their primary language and
individuals speaking a language other than English. … with limited health literacy (55.7 percent vs. 30 percent) but
not among individuals with adequate
-
psnet.ahrq.gov/issue/health-it-hazard-manager
August 01, 2012 - October 6, 2016
Findings and Lessons From the Improving Management of Individuals With … August 13, 2014
Findings and Lessons From the Improving Management of Individuals With