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psnet.ahrq.gov/issue/striving-zero-error-patient-surgical-journey-through-adoption-aviation-style-challenge-and
July 10, 2017 - Study
Striving for a zero-error patient surgical journey through adoption of aviation-style challenge and response flow checklists: a quality improvement project.
Citation Text:
Low DK, Reed MA, Geiduschek JM, et al. Striving for a zero-error patient surgical journey through adoption …
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www.ahrq.gov/news/newsroom/case-studies/201516.html
June 01, 2015 - San Diego Universities Collaborate Using TeamSTEPPS® to Boost Professional Education
Search All Impact Case Studies
June 2015
About 900 students at two San Diego universities have been instructed in the team-based methods of TeamSTEPPS® , AHRQ's evidence-based patient safety training program for health car…
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psnet.ahrq.gov/issue/improving-medication-management-patients-effect-pharmacist-post-admission-ward-rounds
February 02, 2011 - Study
Improving medication management for patients: the effect of a pharmacist on post-admission ward rounds.
Citation Text:
Fertleman M, Barnett N, Patel T. Improving medication management for patients: the effect of a pharmacist on post-admission ward rounds. Qual Saf Health Care. 20…
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psnet.ahrq.gov/issue/effect-clinical-pharmacists-care-emergency-department-systematic-review
January 16, 2008 - Review
Classic
Effect of clinical pharmacists on care in the emergency department: a systematic review.
Citation Text:
Cohen V, Jellinek SP, Hatch A, et al. Effect of clinical pharmacists on care in the emergency department: a systematic review. Am J Health Sy…
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psnet.ahrq.gov/issue/determination-health-care-teamwork-training-competencies-delphi-study
May 15, 2024 - Study
Determination of health-care teamwork training competencies: a Delphi study.
Citation Text:
Clay-Williams R, Braithwaite J. Determination of health-care teamwork training competencies: a Delphi study. Int J Qual Health Care. 2009;21(6):433-40. doi:10.1093/intqhc/mzp042.
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psnet.ahrq.gov/issue/significant-and-sustained-reduction-chemotherapy-errors-through-improvement-science
October 19, 2022 - Study
Significant and sustained reduction in chemotherapy errors through improvement science.
Citation Text:
Weiss BD, Scott M, Demmel K, et al. Significant and sustained reduction in chemotherapy errors through improvement science. J Oncol Pract. 2017;13(4):e329-e336. doi:10.1200/JOP.20…
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psnet.ahrq.gov/issue/risk-management-extreme-honesty-may-be-best-policy
January 04, 2017 - Study
Classic
Risk management: extreme honesty may be the best policy.
Citation Text:
Kraman SS, Hamm G. Risk management: extreme honesty may be the best policy. Ann Intern Med. 1999;131(12):963-967.
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psnet.ahrq.gov/issue/hospital-image-repair-strategies-organizational-apology-and-medical-errors-analysis-coxhealth
July 17, 2024 - Commentary
Hospital image repair strategies, organizational apology, and medical errors: an analysis of the CoxHealth brain over-radiation case.
Citation Text:
Carmack HJ. Hospital Image Repair Strategies, Organizational Apology, and Medical Errors: An Analysis of the CoxHealth Brain Ove…
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psnet.ahrq.gov/issue/safety-inpatient-care-surgical-settings-cohort-study
May 15, 2024 - Study
Safety of inpatient care in surgical settings: cohort study.
Citation Text:
Duclos A, Frits ML, Iannaccone C, et al. Safety of inpatient care in surgical settings: cohort study. BMJ. 2024;387:e080480. doi:10.1136/bmj-2024-080480.
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psnet.ahrq.gov/issue/what-safety-leadership-systematic-review-definitions
October 26, 2022 - Review
What is safety leadership? A systematic review of definitions.
Citation Text:
Adra I, Giga S, Hardy C, et al. What is safety leadership? A systematic review of definitions. J Safety Res. 2024;90:181-191. doi:10.1016/j.jsr.2024.04.001.
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psnet.ahrq.gov/issue/relationship-adverse-events-and-support-rn-burnout
February 08, 2023 - Study
Relationship of adverse events and support to RN burnout.
Citation Text:
Lewis EJ, Baernholdt MB, Yan G, et al. Relationship of adverse events and support to RN burnout. J Nurs Care Qual. 2015;30(2):144-52. doi:10.1097/NCQ.0000000000000084.
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DOI G…
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psnet.ahrq.gov/issue/measurement-performance-driver-case-national-measurement-system-improve-patient-safety
September 01, 2018 - Review
Measurement as a performance driver: the case for a national measurement system to improve patient safety.
Citation Text:
Krause TR, Bell KJ, Pronovost P, et al. Measurement as a Performance Driver: The Case for a National Measurement System to Improve Patient Safety. J Patient Sa…
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psnet.ahrq.gov/issue/worries-and-concerns-experienced-nurse-specialists-during-inter-hospital-transports
September 19, 2016 - Study
Worries and concerns experienced by nurse specialists during inter-hospital transports of critically ill patients: a critical incident study.
Citation Text:
Gustafsson M, Wennerholm S, Fridlund B. Worries and concerns experienced by nurse specialists during inter-hospital transpo…
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psnet.ahrq.gov/issue/nurses-perceptions-simulation-based-interprofessional-training-program-rapid-response-and
January 04, 2012 - Study
Nurses' perceptions of simulation-based interprofessional training program for rapid response and code blue events.
Citation Text:
Wehbe-Janek H, Lenzmeier CR, Ogden PE, et al. Nurses' perceptions of simulation-based interprofessional training program for rapid response and code …
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psnet.ahrq.gov/issue/defining-attributes-patient-safety-through-concept-analysis
May 08, 2013 - Review
Defining attributes of patient safety through a concept analysis.
Citation Text:
Kim L, Lyder CH, McNeese-Smith D, et al. Defining attributes of patient safety through a concept analysis. J Adv Nurs. 2015;71(11):2490-503. doi:10.1111/jan.12715.
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digital.ahrq.gov/ahrq-funded-projects/access-pediatric-voice-therapy-telehealth-solution
January 01, 2023 - Access to Pediatric Voice Therapy: A Telehealth Solution
Project Final Report ( PDF , 1.16 MB) 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 represent the views of AHRQ…
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psnet.ahrq.gov/issue/multiple-institution-comparison-resident-and-faculty-perceptions-burnout-and-depression
October 19, 2022 - Study
Emerging Classic
Multiple-institution comparison of resident and faculty perceptions of burnout and depression during surgical training.
Citation Text:
Williford ML, Scarlet S, Meyers MO, et al. Multiple-Institution Comparison of Resident and Faculty Perce…
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psnet.ahrq.gov/issue/5-year-analysis-rapid-response-system-activation-hospital-haemodialysis-unit
March 24, 2011 - Study
A 5-year analysis of rapid response system activation at an in-hospital haemodialysis unit.
Citation Text:
Galhotra S, Devita MA, Dew MA, et al. A 5-year analysis of rapid response system activation at an in-hospital haemodialysis unit. Qual Saf Health Care. 2010;19(6):e38. doi:1…
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psnet.ahrq.gov/issue/workarounds-workplace-second-look
December 08, 2021 - Commentary
Workarounds in the workplace: a second look.
Citation Text:
Seaman JB, Erlen JA. Workarounds in the Workplace: A Second Look. Orthop Nurs. 2015;34(4):235-242. doi:10.1097/NOR.0000000000000161.
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psnet.ahrq.gov/issue/unintended-adverse-consequences-clinical-decision-support-system-two-cases
October 23, 2018 - Commentary
Unintended adverse consequences of a clinical decision support system: two cases.
Citation Text:
Stone EG. Unintended adverse consequences of a clinical decision support system: two cases. J Am Med Inform Assoc. 2018;25(5):564-567. doi:10.1093/jamia/ocx096.
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