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  1. Patient Safety and Quality Improvement | Agency for Healthcare Research and Quality

    www.ahrq.gov/patient-safety/index.html
    January 01, 2024 -     Patient Safety Research Summaries As the lead … Primary Care Settings About AHRQ's Quality & Patient Safety Work AHRQ is the lead

  2. Conflict Resolution (ppt file)

    www.ahrq.gov/sites/default/files/wysiwyg/professionals/education/curriculum-tools/cusptoolkit/toolkit/contentcalls/conflict_resolution-slides/Conflict-Resolution-Oct-12-2010-508.ppt
    January 01, 2010 - Inevitable in dynamic environments Can lead to feelings of powerlessness Can cause anyone, especially … physicians as adversaries and creates conflict and divided loyalties in the workplace * Powerlessness can lead … our ability to work effectively, change our opinion of our workplace and in most severe situations lead

  3. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/848314/psn-pdf
    May 03, 2023 - safety issues (e.g., potentially inappropriate prescribing, polypharmacy, adverse drug reactions) that lead … medication-errors-and-adverse-drug-events https://psnet.ahrq.gov/issue/polypharmacy-elderly-when-good-drugs-lead-bad-outcomes-teachable-moment

  4. Exploring challenges in quality and safety work in nursing homes and home care - a case study as basis for theory development. | PSNet

    psnet.ahrq.gov/issue/exploring-challenges-quality-and-safety-work-nursing-homes-and-home-care-case-study-basis
    August 14, 2019 - A part of the SAFE-LEAD program to promote safety culture in Norwegian nursing homes and home … of a leadership intervention to improve quality and safety in nursing homes and home care (the SAFE-LEAD

  5. Leading change: why transformation efforts fail. | PSNet

    psnet.ahrq.gov/issue/leading-change-why-transformation-efforts-fail
    March 03, 2021 - Commentary Classic Leading change: why transformation efforts fail. Citation Text: Leading change: why transformation efforts fail. Kotter JP. Harvard Bus Rev  1995;73(2);59-67. Copy Citation Save Save to your library …

  6. An Incomplete Anesthesia History Leads to Adverse Outcomes | PSNet

    psnet.ahrq.gov/web-mm/incomplete-anesthesia-history-leads-adverse-outcomes
    January 29, 2021 - An Incomplete Anesthesia History Leads to Adverse Outcomes Citation Text: Bohringer C. An Incomplete Anesthesia History Leads to Adverse Outcomes. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2022. Copy Citation Format: …

  7. Investigating the influence of selected leadership styles on patient safety and quality of care: a systematic review and meta-analysis. | PSNet

    psnet.ahrq.gov/issue/investigating-influence-selected-leadership-styles-patient-safety-and-quality-care-systematic
    October 07, 2020 - BMJ Lead. 2024;18(3):208-214. doi:10.1136/leader-2023-000846. … BMJ Lead . 2024; 18 (3) :208-214 . View more articles from the same authors. … BMJ Lead. 2024;18(3):208-214. doi:10.1136/leader-2023-000846.

  8. Incivility in healthcare: the impact of poor communication. | PSNet

    psnet.ahrq.gov/issue/incivility-healthcare-impact-poor-communication
    October 19, 2022 - BMJ Lead. 2024;8(1):83-87. doi:10.1136/leader-2022-000717. … BMJ Lead . 2024; 8 (1) :83-87 . View more articles from the same authors. … BMJ Lead. 2024;8(1):83-87. doi:10.1136/leader-2022-000717.

  9. System planning for modern-day Just Culture to mitigate worker distress and second victim response. | PSNet

    psnet.ahrq.gov/issue/system-planning-modern-day-just-culture-mitigate-worker-distress-and-second-victim-response
    July 19, 2023 - BMJ Lead. 2024;8(2):149-152. doi:10.1136/leader-2023-000811. … BMJ Lead . 2024; 8 (2) :149-152 . View more articles from the same authors. … BMJ Lead. 2024;8(2):149-152. doi:10.1136/leader-2023-000811.

  10. What I wish I’d known: how experienced physician managers diagnose, treat and prevent disruptive behaviour. | PSNet

    psnet.ahrq.gov/issue/what-i-wish-id-known-how-experienced-physician-managers-diagnose-treat-and-prevent-disruptive
    September 23, 2020 - BMJ Lead. 2023;7(2):128-132. doi:10.1136/leader-2022-000615. … BMJ Lead . 2023; 7 (2) :128-132 . View more articles from the same authors. … BMJ Lead. 2023;7(2):128-132. doi:10.1136/leader-2022-000615.

  11. Diagnostic discrepancies in the emergency department: a retrospective study. | PSNet

    psnet.ahrq.gov/issue/diagnostic-discrepancies-emergency-department-retrospective-study
    October 04, 2023 - in the emergency department (ED) is estimated to affect over 7 million patients each year and can lead … 2020 WebM&M Cases Missing ECG and Missed Diagnosis Lead

  12. The compliance with a patient safety bundle for management of placenta accreta spectrum. | PSNet

    psnet.ahrq.gov/issue/compliance-patient-safety-bundle-management-placenta-accreta-spectrum
    October 19, 2022 - in this study, but the intervention did improve adherence to the patient safety bundle, which could lead … November 9, 2016 Quality improvement initiatives lead to reduction in nulliparous term

  13. 036-Sources-Pathways-Mrsa-One-Pager (doc file)

    www.ahrq.gov/sites/default/files/wysiwyg/hai/tools/mrsa/036-sources-pathways-mrsa-one-pager.docx
    October 01, 2024 - Four Main Sources and Pathways of MRSA Transmission and Infection A person’s own MRSA colonization can lead … Environmental reservoirs of MRSA can lead to colonization or infection.10 · High-touch surfaces (HTS … between patients or from the environment to patient(s).9,11-14 · Improving hand hygiene practices can lead

  14. Surgical Safety Team Roles and Responsibilities Tool | Agency for Healthcare Research and Quality

    www.ahrq.gov/hai/tools/surgery/tools/applying-cusp/surgical-roles.html
    December 01, 2017 - Implement Teamwork Tools Who will lead the implementation of briefings, debriefings, and other teamwork … Implementation of Practice Changes Who will lead efforts to align practice with evidence-based guidelines

  15. Module 2: Urinary Catheter Maintenance Facilitator Notes | Agency for Healthcare Research and Quality

    www.ahrq.gov/hai/cauti-tools/facil-guide/preventing-cauti-icu-setting-module2-speaker-notes.html
    February 01, 2023 - and think about this question for a few minutes: What did you notice in the case scenario that could lead … Slide 4 Say: You should have identified three issues that can lead to the development of a CAUTI … Not attaching the catheter to the leg can lead to urethral irritation.

  16. Registration errors among patients receiving blood transfusions: a national analysis from 2008 to 2017. | PSNet

    psnet.ahrq.gov/issue/registration-errors-among-patients-receiving-blood-transfusions-national-analysis-2008-2017
    March 18, 2020 - that registration errors most commonly occur in outpatient areas and emergency departments and can lead … January 12, 2022 Does increased schedule flexibility lead to change?

  17. OY2 Innovation Center Operational Framework (pdf file)

    digital.ahrq.gov/sites/default/files/OY2%20Innovation%20Center%20Operational%20Framework_508.pdf
    November 01, 2024 - Leadership Principal Investigator Prashila Dullabh from NORC at the University of Chicago (NORC) will lead … She will work in partnership with Core 1 Lead Dean Sittig (University of Texas Health) and Core 2 Lead … President, Health Informatics Research, Elimu Informatics Marc Overhage, MD, PhD, Chief Health Informatics Lead … ■ The lead author is generally the individual responsible for writing the first draft of the manuscript … ■ The CDSiC PI or Stakeholder Center lead will serve as the corresponding author.

  18. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/837299/psn-pdf
    June 01, 2022 - new-index-obstetrics-safety-and-quality-care-integrating-cesarean-delivery- rates-maternal-and Cesarean delivery can lead … /psnet.ahrq.gov/primer/maternal-safety https://psnet.ahrq.gov/issue/quality-improvement-initiatives-lead-reduction-nulliparous-term-singleton-vertex-cesarean

  19. AHRQ Safety Program for MRSA Prevention

    www.ahrq.gov/sites/default/files/wysiwyg/hai/tools/mrsa/034-importance-mrsa-prevention-slides.pptx
    October 01, 2024 - Antibiotic pressure can: Lead to selective advantage for resistance of S. aureus. … of MRSA Prevention Pathways of MRSA Transmission and Infection A person’s own MRSA colonization can lead … Environmental reservoirs of MRSA can lead to colonization or infection. … patient(s).10-14 Hands of healthcare workers can transfer organisms to and from patients or surfaces and lead … Contaminated environmental and high-touch surfaces can lead to MRSA infection.

  20. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/60825/psn-pdf
    August 19, 2020 - Results suggest that, for many cancer patients, treatment delays of 2-6 months will lead to a substantial … Results also indicate that even small delays (e.g., 2 months) can lead to substantial survival decrements
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