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psnet.ahrq.gov/issue/diagnostic-error-medicine-analysis-583-physician-reported-errors
June 24, 2009 - Study
Classic
Diagnostic error in medicine: analysis of 583 physician-reported errors.
Citation Text:
Schiff G, Hasan O, Kim S, et al. Diagnostic error in medicine: analysis of 583 physician-reported errors. Arch Intern Med. 2009;169(20):1881-1887. doi:10.1001/a…
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psnet.ahrq.gov/issue/we-want-know-patient-comfort-speaking-about-breakdowns-care-and-patient-experience
May 20, 2020 - Study
Emerging Classic
We want to know: patient comfort speaking up about breakdowns in care and patient experience.
Citation Text:
Fisher K, Smith KM, Gallagher TH, et al. We want to know: patient comfort speaking up about breakdowns in care and patient experie…
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psnet.ahrq.gov/issue/barriers-and-facilitators-adverse-event-reporting-adolescent-patients-and-their-families
February 15, 2023 - Study
Barriers and facilitators of adverse event reporting by adolescent patients and their families.
Citation Text:
Sawhney PN, Davis LS, Daraiseh NM, et al. Barriers and Facilitators of Adverse Event Reporting by Adolescent Patients and Their Families. J Patient Saf. 2020;16(3):232-237…
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psnet.ahrq.gov/issue/changes-default-alarm-settings-and-standard-service-are-insufficient-improve-alarm-fatigue
May 29, 2019 - Study
Changes in default alarm settings and standard in-service are insufficient to improve alarm fatigue in an intensive care unit: a pilot project.
Citation Text:
Sowan AK, Gomez TM, Tarriela AF, et al. Changes in Default Alarm Settings and Standard In-Service are Insufficient to Impro…
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psnet.ahrq.gov/issue/identifying-and-categorising-patient-safety-hazards-cardiovascular-operating-rooms-using
August 25, 2015 - Study
Identifying and categorising patient safety hazards in cardiovascular operating rooms using an interdisciplinary approach: a multisite study.
Citation Text:
Gurses AP, Kim G, Martinez EA, et al. Identifying and categorising patient safety hazards in cardiovascular operating rooms u…
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psnet.ahrq.gov/issue/association-between-leapfrog-safe-practices-score-and-hospital-mortality-major-surgery
September 29, 2017 - Study
Association between Leapfrog safe practices score and hospital mortality in major surgery.
Citation Text:
Qian F, Lustik SJ, Diachun CA, et al. Association between Leapfrog safe practices score and hospital mortality in major surgery. Med Care. 2011;49(12):1082-1088. doi:10.1097/…
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www.ahrq.gov/sites/default/files/wysiwyg/hai/abate/nursing-protocols/standing-order-protocol-mupirocin.docx
March 01, 2022 - Standing Order Protocol: Nasal Mupirocin
Decolonization of
Non-ICU Patients With Devices
Section 9-3 – Standing Order Protocol:
Nasal Mupirocin
The following is a standing order protocol for implementing nasal decolonization in adult non-intensive care unit (ICU) patients who are methicillin-resistant Staphylococcus…
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psnet.ahrq.gov/issue/potential-consequences-patient-complications-surgeon-well-being-systematic-review
May 23, 2018 - Review
Potential consequences of patient complications for surgeon well-being: a systematic review.
Citation Text:
Srinivasa S, Gurney J, Koea J. Potential Consequences of Patient Complications for Surgeon Well-being: A Systematic Review. JAMA Surg. 2019;154(5):451-457. doi:10.1001/jamas…
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psnet.ahrq.gov/issue/two-state-collaborative-study-multifaceted-intervention-decrease-ventilator-associated-events
January 15, 2014 - Study
Two-state collaborative study of a multifaceted intervention to decrease ventilator-associated events.
Citation Text:
Rawat N, Yang T, Ali KJ, et al. Two-State Collaborative Study of a Multifaceted Intervention to Decrease Ventilator-Associated Events. Crit Care Med. 2017;45(7):120…
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psnet.ahrq.gov/issue/learning-patients-experiences-related-diagnostic-errors-essential-progress-patient-safety
May 20, 2020 - Study
Emerging Classic
Learning from patients' experiences related to diagnostic errors is essential for progress in patient safety.
Citation Text:
Giardina TD, Haskell H, Menon S, et al. Learning From Patients' Experiences Related To Diagnostic Errors Is Essent…
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digital.ahrq.gov/program-overview/research-stories/integrating-patient-voice-patient-reported-health-outcomes
January 01, 2023 - Integrating the Patient Voice in Patient-Reported Health Outcomes
Theme:
Optimizing Care Delivery for Clinicians
Subtheme:
Using Patient-Reported Outcomes to Improve Care Delivery
Changing the focus of patient-reported outcomes to be centered on a patient’s individual goals and preferences…
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psnet.ahrq.gov/issue/parent-reported-errors-and-adverse-events-hospitalized-children
June 29, 2009 - Study
Classic
Parent-reported errors and adverse events in hospitalized children.
Citation Text:
Khan A, Furtak SL, Melvin P, et al. Parent-reported errors and adverse events in hospitalized children. JAMA Pediatr. 2016;170(4):e154608. doi:10.1001/jamapediatrics…
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psnet.ahrq.gov/issue/reengineered-hospital-discharge-program-decrease-rehospitalization-randomized-trial
August 04, 2021 - Study
A reengineered hospital discharge program to decrease rehospitalization: a randomized trial.
Citation Text:
Jack BW, Chetty VK, Anthony D, et al. A reengineered hospital discharge program to decrease rehospitalization: a randomized trial. Ann Intern Med. 2009;150(3):178-87.
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psnet.ahrq.gov/issue/evaluating-shared-decision-making-lung-cancer-screening
May 25, 2016 - Study
Evaluating shared decision making for lung cancer screening.
Citation Text:
Brenner AT, Malo TL, Margolis M, et al. Evaluating Shared Decision Making for Lung Cancer Screening. JAMA Intern Med. 2018;178(10):1311-1316. doi:10.1001/jamainternmed.2018.3054.
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psnet.ahrq.gov/issue/surveys-patient-safety-culture-sops-hospital-survey-20-user-database-report
December 18, 2024 - Book/Report
Surveys on Patient Safety Culture (SOPS) Hospital Survey 2.0: User Database Report.
Citation Text:
Tyler ER, Yalden O, Fan L, et al. Surveys On Patient Safety Culture (Sops) Hospital Survey 2.0: User Database Report. Rockville, MD: Agency for Healthcare Research and Quality; …
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psnet.ahrq.gov/issue/power-and-conflict-effect-superiors-interpersonal-behaviour-trainees-ability-challenge
December 13, 2017 - Study
Power and conflict: the effect of a superior's interpersonal behaviour on trainees' ability to challenge authority during a simulated airway emergency.
Citation Text:
Friedman Z, Hayter MA, Everett TC, et al. Power and conflict: the effect of a superior's interpersonal behaviour on…
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psnet.ahrq.gov/issue/exploring-mediating-effects-between-nursing-leadership-and-patient-safety-person-centred
October 08, 2016 - Study
Exploring mediating effects between nursing leadership and patient safety from a person-centred perspective: a literature review.
Citation Text:
Wang M, Dewing J. Exploring mediating effects between nursing leadership and patient safety from a person‐centred perspective: a literatu…
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psnet.ahrq.gov/issue/effect-patient-and-family-centered-i-pass-adverse-event-rates-hospitalized-children-complex
November 16, 2022 - Study
Effect of Patient and Family Centered I-PASS on adverse event rates in hospitalized children with complex chronic conditions.
Citation Text:
Kuzma N, Khan A, Rickey L, et al. Effect of Patient and Family Centered I‐PASS on adverse event rates in hospitalized children with complex c…
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psnet.ahrq.gov/innovation/improving-formal-incivility-reporting-ambulatory-oncology-implementing-civic-duty
March 14, 2022 - EMERGING INNOVATIONS
Improving formal incivility reporting in ambulatory oncology: implementing the CIVIC Duty program.
Citation Text:
Gordon JN. Improving formal incivility reporting in ambulatory oncology: implementing the CIVIC Duty program. Clin J Oncol Nurs. 2023;27(6):602-606. doi:10.1188/23…
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psnet.ahrq.gov/web-mm/nurse-staffing-ratios-crucible-money-policy-research-and-patient-care
June 01, 2003 - Developing these hospital staffing plans requires a complex dance involving nurse leaders, staff nurses … Accordingly, nurse leaders and their designees must develop strategies to deal with these absences to … It is the responsibility of the board of trustees and senior leaders to empower the Chief Nurse to design … Nurse unit leaders must anticipate changing staffing needs and assess at least 4-8 hours prior to the … As budgets tighten, it is vital that nurse leaders maintain RN ratios when census is high and decrease