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psnet.ahrq.gov/issue/consensus-statement-effective-communication-urgent-diagnoses-and-significant-unexpected
November 16, 2022 - Organizational Policy/Guidelines
Consensus statement on effective communication of urgent diagnoses and significant, unexpected diagnoses in surgical pathology and cytopathology from the College of American Pathologists and Association of Directors of Anatomic and Surgical Pathology.
Cit…
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psnet.ahrq.gov/issue/high-profile-investigations-hospital-safety-problems-england-did-not-prompt-patients-switch
July 11, 2012 - Study
High-profile investigations into hospital safety problems in England did not prompt patients to switch providers.
Citation Text:
Laverty AA, Smith PC, Pape UJ, et al. High-profile investigations into hospital safety problems in England did not prompt patients to switch providers.…
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psnet.ahrq.gov/issue/crisis-management-surgical-teams-and-their-leaders-lessons-covid-19-pandemic-structured
February 12, 2020 - Review
Crisis management for surgical teams and their leaders, lessons from the COVID-19 pandemic; a structured approach to developing resilience or natural organisational responses.
Citation Text:
Pring ET, Malietzis G, Kendall SWH, et al. Crisis management for surgical teams and their …
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psnet.ahrq.gov/issue/frequency-failure-inform-patients-clinically-significant-outpatient-test-results
April 24, 2018 - Study
Frequency of failure to inform patients of clinically significant outpatient test results.
Citation Text:
Casalino LP, Dunham D, Chin MH, et al. Frequency of failure to inform patients of clinically significant outpatient test results. Arch Intern Med. 2009;169(12):1123-9. doi:10…
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digital.ahrq.gov/ahrq-funded-projects/health-information-technology-and-mental-health-way-forward
January 01, 2023 - Health Information Technology and Mental Health: The Way Forward
Project Final Report ( PDF , 638.39 KB)
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psnet.ahrq.gov/issue/association-between-transfer-emergency-department-boarders-inpatient-hallways-and-mortality-4
October 28, 2020 - Study
The association between transfer of emergency department boarders to inpatient hallways and mortality: a 4-year experience.
Citation Text:
Viccellio A, Santora C, Singer AJ, et al. The association between transfer of emergency department boarders to inpatient hallways and mortali…
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psnet.ahrq.gov/issue/identification-patient-information-corruption-intensive-care-unit-using-scoring-tool-direct
August 04, 2021 - Study
Identification of patient information corruption in the intensive care unit: using a scoring tool to direct quality improvements in handover.
Citation Text:
Pickering BW, Hurley K, Marsh B. Identification of patient information corruption in the intensive care unit: using a scori…
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digital.ahrq.gov/ahrq-funded-projects/rural-health-information-technology-cooperative-promote-clinical-improvement
January 01, 2023 - A Rural Health Information Technology Cooperative to Promote Clinical Improvement
Project Final Report ( PDF , 203.76 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 …
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psnet.ahrq.gov/issue/impact-automated-notification-follow-actionable-tests-pending-discharge-cluster-randomized
March 04, 2015 - Study
Classic
The impact of automated notification on follow-up of actionable tests pending at discharge: a cluster-randomized controlled trial.
Citation Text:
Dalal A, Schaffer A, Gershanik EF, et al. The Impact of Automated Notification on Follow-up of Actiona…
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psnet.ahrq.gov/issue/adverse-drug-events-hospitalized-patients-excess-length-stay-extra-costs-and-attributable
February 10, 2011 - Study
Classic
Adverse drug events in hospitalized patients: excess length of stay, extra costs, and attributable mortality.
Citation Text:
Classen DC, Pestotnik SL, Evans RS, et al. Adverse drug events in hospitalized patients. Excess length of stay, extra cos…
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psnet.ahrq.gov/issue/impact-drug-error-reduction-software-preventing-harmful-adverse-drug-events-england
November 16, 2022 - Study
The impact of drug error reduction software on preventing harmful adverse drug events in England: a retrospective database study.
Citation Text:
Sutherland A, Gerrard WS, Patel A, et al. The impact of drug error reduction software on preventing harmful adverse drug events in Englan…
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psnet.ahrq.gov/issue/changes-cancer-detection-and-false-positive-recall-mammography-using-artificial-intelligence
August 23, 2023 - Study
Classic
Changes in cancer detection and false-positive recall in mammography using artificial intelligence: a retrospective, multireader study.
Citation Text:
Kim H-E, Kim HH, Han B-K, et al. Changes in cancer detection and false-positive recall in mammogr…
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psnet.ahrq.gov/issue/look-alikesound-alike-drugs-literature-review-causes-and-solutions
September 28, 2022 - Review
Look alike/sound alike drugs: a literature review on causes and solutions.
Citation Text:
Ciociano N, Bagnasco L. Look alike/sound alike drugs: a literature review on causes and solutions. Int J Clin Pharm. 2014;36(2):233-242. doi:10.1007/s11096-013-9885-6.
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psnet.ahrq.gov/issue/impact-teamstepps-training-obstetric-team-attitudes-and-outcomes-labor-and-delivery-unit
October 27, 2021 - Study
The impact of TeamSTEPPS training on obstetric team attitudes and outcomes on the labor and delivery unit of a regional perinatal center.
Citation Text:
Kwon CS, Duzyj C. The impact of TeamSTEPPS training on obstetric team attitudes and outcomes on the labor and delivery unit of a …
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psnet.ahrq.gov/issue/second-victim-experiences-health-care-learners-and-influence-training-environment-postevent
January 31, 2024 - Study
Second victim experiences of health care learners and the influence of the training environment on postevent adaptation.
Citation Text:
Huang L, Riggan KA, Torbenson VE, et al. Second victim experiences of health care learners and the influence of the training environment on postev…
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psnet.ahrq.gov/issue/unintentional-therapeutic-errors-involving-insulin-ambulatory-setting-reported-poison-centers
June 06, 2018 - Study
Unintentional therapeutic errors involving insulin in the ambulatory setting reported to poison centers.
Citation Text:
Spiller HA, Borys DJ, Ryan ML, et al. Unintentional therapeutic errors involving insulin in the ambulatory setting reported to poison centers. Ann Pharmacother.…
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digital.ahrq.gov/sites/default/files/docs/resource/James_Veline_IQHIT_Q6_Compliance_and_Adherence_Patient_Handout.pdf
June 16, 2021 - We use medicines to treat illness so that we
can avoid going to the hospital and have a
better life. Medical scientists have shown
that medicines help us deal with illness and
improve our health Yet many people do not
know how important their medicines are This
is true for people taking medicine to keep
their bl…
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psnet.ahrq.gov/issue/incidence-and-characteristics-potential-and-actual-retained-foreign-object-events-surgical
January 02, 2017 - Study
Classic
Incidence and characteristics of potential and actual retained foreign object events in surgical patients.
Citation Text:
Cima RR, Kollengode A, Garnatz J, et al. Incidence and characteristics of potential and actual retained foreign object event…
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psnet.ahrq.gov/issue/challenges-and-potential-solutions-patient-safety-infectious-agent-isolation-environment
October 27, 2021 - Study
Challenges and potential solutions for patient safety in an infectious-agent-isolation environment: a study of 484 COVID-19-related event reports across 94 hospitals
Citation Text:
Taylor M, Reynolds C, Jones RM. Challenges and potential solutions for patient safety in an infectiou…
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psnet.ahrq.gov/issue/urgent-referrals-primary-care-dermatology-lesions-suspicious-skin-cancer-patterns-outcomes
November 02, 2022 - Study
Urgent referrals from primary care to dermatology for lesions suspicious for skin cancer: patterns, outcomes, and need for systems improvement.
Citation Text:
Pagani K, Lukac D, Olbricht SM, et al. Urgent referrals from primary care to dermatology for lesions suspicious for skin ca…