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psnet.ahrq.gov/perspective/beyond-hospital-new-frontier-patient-safety
August 01, 2014 - Safety in the Outpatient Setting
While much of our progress will come from adapting the things we have learned … RW : Are there any other differences that make it hazardous to extrapolate things we've learned from … being partly we've never had the organizational model, partly finances, partly because physicians never learned … Perspective
African Partnerships for Patient Safety: Lessons Learned
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psnet.ahrq.gov/perspective/diagnostic-errors-new-chapter-patient-safety-science-policy-and-practice
January 01, 2016 - MG : We didn't know either, but after a few calls to the Institute of Medicine we learned. … What I've learned is that IOM reports tend to stay at a very high level, and it's up to the stakeholders … Perspective
Assessing the Safety of Electronic Health Records: What Have We Learned … August 7, 2024
The safety journal: lessons learned with an error reporting tool to stimulate
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www.ahrq.gov/takeheart/training/expanding-cardiac-rehab-capacity/index.html
April 01, 2023 - Implementing Hybrid CR To Expand Access and Capacity
This focus area will provide important context for assessing the appropriateness of implementing a hybrid cardiac rehabilitation (CR) program at your hospital and for understanding what is involved in doing so.
Hybrid CR consists of a combination of o…
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www.ahrq.gov/nursing-home/tg/learning-modules/covid-id-prevention.html
December 01, 2022 - Pagkilala at Pag-iwas sa COVID-19
Nakatuon ang seryeng ito ng tatlong module sa pag-aaral sa pagtukoy sa mga senyales at sintomas ng COVID-19, pag-alam kung kailan at paano mag-uulat ng mga senyales at sintomas ng COVID-19, at pag-alala sa pagpapanatili ng mga proseso ng pag-iwas sa impeksyon.
Module 1: Pagki…
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/quality-resources/tools/cauti-ltc/modules/implementation/long-term-modules/module2/defects.docx
March 01, 2017 - AHRQ Safety Program for Long-Term Care: HAIs/CAUTI
Long-Term Care Safety Modules
Learn From Defects
Purpose: To identify the types of systems that contributed to the defect (an event or situation that you do not want to happen again) and to plan the followup steps needed to improve safety
Who should use this too…
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www.ahrq.gov/priority-populations/observances/index.html
May 01, 2022 - Health Observances
AHRQ recognizes various health observances each year to honor the Nation’s rich diversity and highlight Agency efforts to address disparities in health and healthcare faced by underserved individuals and communities. As part of these observances, AHRQ identifies specific programs, research ac…
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www.ahrq.gov/hai/tools/mrsa-prevention/surgery/translating-research-into-practice.html
September 01, 2025 - MRSA Prevention Toolkit: Targeting SSI
Translating Research Into Practice
Previous Page Next Page
Table of Contents
MRSA Prevention Toolkit: Targeting SSI
The Four Key Strategies of MRSA Prevention: Targeting SSI
MRSA and SSI Prevention Phases
Importance of MRSA and SSI Prevention
MRSA Surve…
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digital.ahrq.gov/principal-investigator/zhu-xi
January 01, 2024 - Zhu, Xi
Patient care in complex Sociotechnological ecosystems and learning health systems.
Citation
Tu SP, Garcia B, Zhu X, Sewell D, Mishra V, Matin K, Dow A. Patient care in complex Sociotechnological ecosystems and learning health systems. Learn Health Syst. 2024 May 23;8(S…
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digital.ahrq.gov/principal-investigator/pratap-jayant
January 01, 2023 - Pratap, Jayant
Mining patient-specific and contextual data with machine learning technologies to predict cancellation of children's surgery.
Citation
Liu L, Ni Y, Zhang N, Nick Pratap J. Mining patient-specific and contextual data with machine learning technologies to predict …
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psnet.ahrq.gov/node/46391/psn-pdf
February 08, 2018 - Nature of blame in patient safety incident reports: mixed
methods analysis of a national database.
February 8, 2018
Cooper J, Edwards A, Williams H, et al. Nature of Blame in Patient Safety Incident Reports: Mixed Methods
Analysis of a National Database. Ann Fam Med. 2017;15(5):455-461. doi:10.1370/afm.2123.
https…
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psnet.ahrq.gov/node/866170/psn-pdf
June 19, 2024 - The World Federation of Chiropractic Global Patient
Safety Task Force: a call to action.
June 19, 2024
Coleman BC, Rubinstein SM, Salsbury SA, et al. The World Federation of Chiropractic Global Patient
Safety Task Force: a call to action. Chiropr Man Therap. 2024;32(1):15. doi:10.1186/s12998-024-00536-1.
https://p…
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psnet.ahrq.gov/node/838629/psn-pdf
October 19, 2022 - Assessing the dangers of a hospital stay for patients with
developmental disability In England, 2017–19.
October 19, 2022
Friebel R, Maynou L. Assessing the dangers of a hospital stay for patients with developmental disability In
England, 2017–19. Health Aff (Millwood). 2022;41(10):1486-1495. doi:10.1377/hlthaff.20…
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www.ahrq.gov/sites/default/files/wysiwyg/hai/tools/mrsa/099-cusp-guide-why-choose-cusp-approach.docx
October 01, 2024 - improve the work settings of other similar areas in the facility facing similar issues when the lessons learned
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www.ahrq.gov/diagnostic-safety/ideas-project/engage-patients-toolkit.html
July 01, 2025 - Toolkit for Engaging Patients To Improve Diagnostic Safety – Enrollment Closed
As part of the Implementing Diagnostic Excellence Across Systems (IDEAS) project, RAND recruited healthcare sites that have clinicians who can commit to using a diagnostic safety tool to improve patient engagement. The Toolkit for En…
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www.ahrq.gov/evidencenow/tools/keydrivers/create-care-teams.html
November 01, 2018 - Key Driver 4: Create and Support High Functioning Care Teams to Deliver High-Quality Evidence-Based Care
Print this page to PDF
Given the demands of primary care practice, no clinician can single-handedly incorporate new evidence into all aspects of practice. Care teams blend a complementary set of skills and…
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www.ahrq.gov/news/newsroom/case-studies/ktcquips85.html
October 01, 2014 - Six New Jersey Hospitals Reduce Adverse Events With AHRQ Medication Reconciliation Toolkit
Search All Impact Case Studies
November 2011
Between January and September 2010, AHRQ partnered with seven Quality Improvement Organizations (QIOs) to deliver a series of onsite learning sessions and provider support …
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digital.ahrq.gov/ahrq-funded-projects/ml-rover-machine-learning-reduce-laboratory-test-overutilization
January 01, 2025 - ML-ROVER: Machine Learning to Reduce Laboratory Test Overutilization
Project Description
Publications
Implementing a validated machine learning based clinical decision support tool to reduce laboratory testing overutilization in pediatric intensive care unit patients will…
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www.ahrq.gov/patient-safety/settings/labor-delivery/perinatal-care/modules/teamwork/learn-about-cusp-fac-guide.html
July 01, 2023 - Learn About the Comprehensive Unit-based Safety Program for Perinatal Safety: Facilitator Guide
AHRQ Safety Program for Perinatal Care
Slide 1: Learn About the Comprehensive Unit-based Safety Program for Perinatal Safety
Say:
This module introduces the comprehensive unit-based safety program, also calle…
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www.ahrq.gov/talkingquality/resources/writing/tip7.html
November 01, 2019 - Tip 7. Test a Health Care Quality Report With Your Audience
Members of your intended audience are the ones who will decide whether your report card is worth reading, and whether they can understand and use it. This means that feedback from readers is the “gold standard” of how well your report card is working…
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patientsafetyculture/hospital/hospwebinar/just-culture-webcast-2-presentation.pdf
May 01, 2007 - Just Culture Webcast Presentation
University of North Carolina Health System
13
Celeste Mayer, PhD
University of North Carolina Health Care
System, Chapel Hill, NC
UNC Medical Center
• Public Academic Medical Center
• Memorial, Children’s, Neurosciences, Women’s and
Cancer Hospital
• ~850 beds
• Chapel Hill, N…