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8681. Choosing a Patient Safety Organization: Tips for Hospitals and Health Care Providers (pdf file)
      pso.ahrq.gov/sites/default/files/Choosing%20a%20PSO.pdf
      August 01, 2012 - Choosing a Patient Safety Organization: Tips for Hospitals and Health Care Providers Background The Patient Safety and Quality Improvement Act of 2005 (Patient Safety Act) authorized the creation of Patient Safety Organizations (PSOs). It encourages clinicians and health care organizations to voluntarily report to…

8682. Measuring What Matters: Catalyzing Conversations on the Quality of Long-Term Care | Agency for Healthcare Research and Quality
      www.ahrq.gov/news/blog/ahrqviews/ltc-quality-measures.html
      December 01, 2022 - AHRQ Views: Blog posts from AHRQ leaders Measuring What Matters: Catalyzing Conversations on the Quality of Long-Term Care DEC 15 2022 By Members of AHRQ’s National Advisory Council: Catherine H. Ivory, Ph.D., R.N.; Komal Bajaj, M.D.; MS-HPEd, Jiajie Zhang, Ph.D.; and Kannan Ramar, …

8683. Federal Interagency Workgroup on Improving Diagnostic Safety and Quality in Health Care November Meeting Summary (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/topics/fed-IWG-dxsafety-Nov19mtg.pdf
      November 15, 2019 - Federal Interagency Workgroup on Improving Diagnostic Safety and Quality in Health Care November Meeting Summary Federal Interagency Workgroup on Improving Diagnostic Safety and Quality in Health Car…

8684. Applying the Lessons of Social Marketing to a Quality Report | Agency for Healthcare Research and Quality
      www.ahrq.gov/talkingquality/distribute/promote/social-marketing.html
      June 01, 2019 - Applying the Lessons of Social Marketing to a Quality Report Social marketing is the application of the principles and techniques of commercial marketing to promote socially desirable goals. It has been applied extensively, and with considerable success, in efforts to encourage/discourage specific health beha…

8685. Current State of Diagnosis Education | Agency for Healthcare Research and Quality
      www.ahrq.gov/diagnostic-safety/resources/issue-briefs/education-dx-outcomes-3.html
      March 01, 2022 - Improving Education—A Key to Better Diagnostic Outcomes Current State of Diagnosis Education Previous Page Next Page Table of Contents Improving Education—A Key to Better Diagnostic Outcomes Introduction Foundations of Diagnosis Education Current State of Diagnosis Education Competencies To …

8686. Disclosure Checklist | Agency for Healthcare Research and Quality
      www.ahrq.gov/patient-safety/settings/hospital/candor/modules/checklist5.html
      August 01, 2022 - Disclosure Checklist AHRQ Communication and Optimal Resolution Toolkit Purpose: To provide guidance to individuals who are conducting initial or followup disclosure conversations, including key disclosure communication skills. Who should use this tool? Disclosure Lead and any staff who will be engaged in …

8687. Mod5-Disclosure-Checklist (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/candor/module5/mod5-disclosure-checklist.pdf
      April 01, 2016 - Purpose: To provide guidance to individuals who are conducting initial or followup disclosure conversations, including key disclosure communication skills. Who should use this tool? Disclosure Lead and any staff who will be engaged in disclosure conversations. How to use this tool: Use Part I of the checklist to pre…

8688. Federal Interagency Workgroup: Improving Diagnostic Safety and Quality in Healthcare (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/topics/diagnostic-safety-workgroup-march-2022-meeting-notes.pdf
      January 01, 2022 - Federal Interagency Workgroup: Improving Diagnostic Safety and Quality in Healthcare Federal Interagency Workgroup: Improving Diagnostic Safety and Quality in Healthcare Workgroup Goal: Established by Senate Report 115-150. The Senate Committee on Appropriations requested “AHRQ to convene a cross agency working …

8689. What Is Patient Safety Culture? | Agency for Healthcare Research and Quality
      www.ahrq.gov/sops/about/patient-safety-culture.html
      June 01, 2024 - What Is Patient Safety Culture? Patient Safety Culture Defined Patient safety culture is the extent to which an organization's culture supports and promotes patient safety. It refers to the values, beliefs, and norms that are shared by healthcare practitioners and other staff throughout the organization that in…

8690. Prologue: The Shift toward Performance and Tools (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety-2/vol3/Advances-Prologue_Keyes_Vol3.pdf
      June 02, 2025 - Prologue: The Shift toward Performance and Tools Prologue The Shift toward Performance and Tools Margaret A. Keyes, M.A. The articles in this volume provide a number of perspectives on performance and tools used to improve the safe delivery of health care. They include a wide variety of approaches that …

8691. High rate of implementation of proposed actions for improvement with the Healthcare Failure Mode Effect Analysis method: evaluation of 117 analyses. | PSNet
      psnet.ahrq.gov/issue/high-rate-implementation-proposed-actions-improvement-healthcare-failure-mode-effect-analysis
      December 09, 2020 - Study High rate of implementation of proposed actions for improvement with the Healthcare Failure Mode Effect Analysis method: evaluation of 117 analyses. Citation Text: Öhrn A, Ericsson C, Andersson C, et al. High Rate of Implementation of Proposed Actions for Improvement With the Healt…

8692. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/33653/psn-pdf
      June 01, 2007 - In response to "Failure to Report" (March 2007) June 1, 2007 Paparella S, Vaida AJ, Spath P. In response to "Failure to Report" (March 2007). PSNet [internet]. 2007. https://psnet.ahrq.gov/perspective/response-failure-report-march-2007 In response to "Failure to Report" (March 2007) Letter To the editors: Dr. Sp…

8693. Patient safety incidents associated with obesity: a review of reports to the National Patient Safety Agency and recommendations for hospital practice. | PSNet
      psnet.ahrq.gov/issue/patient-safety-incidents-associated-obesity-review-reports-national-patient-safety-agency-and
      October 19, 2022 - Study Patient safety incidents associated with obesity: a review of reports to the National Patient Safety Agency and recommendations for hospital practice. Citation Text: Booth CMA, Moore CE, Eddleston J, et al. Patient safety incidents associated with obesity: a review of reports to …

8694. The intended and unintended consequences of communication systems on general internal medicine inpatient care delivery: a prospective observational case study of five teaching hospitals. | PSNet
      psnet.ahrq.gov/issue/intended-and-unintended-consequences-communication-systems-general-internal-medicine
      October 31, 2011 - Study The intended and unintended consequences of communication systems on general internal medicine inpatient care delivery: a prospective observational case study of five teaching hospitals. Citation Text: Wu RC, Lo V, Morra D, et al. The intended and unintended consequences of communi…

8695. Types and effects of feedback for emergency ambulance staff: a systematic mixed studies review and meta-analysis. | PSNet
      psnet.ahrq.gov/issue/types-and-effects-feedback-emergency-ambulance-staff-systematic-mixed-studies-review-and-meta
      April 06, 2022 - Study Types and effects of feedback for emergency ambulance staff: a systematic mixed studies review and meta-analysis. Citation Text: Wilson C, Janes G, Lawton R, et al. Types and effects of feedback for emergency ambulance staff: a systematic mixed studies review and meta-analysis. BMJ…

8696. Medication event huddles: a tool for reducing adverse drug events. | PSNet
      psnet.ahrq.gov/issue/medication-event-huddles-tool-reducing-adverse-drug-events
      December 19, 2014 - Commentary Medication event huddles: a tool for reducing adverse drug events. Citation Text: Morvay S, Lewe D, Stewart B, et al. Medication event huddles: a tool for reducing adverse drug events. Jt Comm J Qual Patient Saf. 2014;40(1):39-45. Copy Citation Format: Google S…

8697. Medical errors during training: how do residents cope?: a descriptive study. | PSNet
      psnet.ahrq.gov/issue/medical-errors-during-training-how-do-residents-cope-descriptive-study
      October 13, 2021 - Study Medical errors during training: how do residents cope?: a descriptive study. Citation Text: Fatima S, Soria S, Esteban- Cruciani N. Medical errors during training: how do residents cope?: a descriptive study. BMC Med Educ. 2021;21(1):408. doi:10.1186/s12909-021-02850-1. Copy Cit…

8698. Identifying risks areas related to medication administrations - text mining analysis using free-text descriptions of incident reports. | PSNet
      psnet.ahrq.gov/issue/identifying-risks-areas-related-medication-administrations-text-mining-analysis-using-free
      December 18, 2019 - Study Identifying risks areas related to medication administrations - text mining analysis using free-text descriptions of incident reports. Citation Text: Härkänen M, Paananen J, Murrells T, et al. Identifying risks areas related to medication administrations - text mining analysis usin…

8699. Infections and interaction rituals in the organisation: clinician accounts of speaking up or remaining silent in the face of threats to patient safety. | PSNet
      psnet.ahrq.gov/issue/infections-and-interaction-rituals-organisation-clinician-accounts-speaking-or-remaining
      November 03, 2015 - Study Infections and interaction rituals in the organisation: clinician accounts of speaking up or remaining silent in the face of threats to patient safety. Citation Text: Szymczak JE. Infections and interaction rituals in the organisation: clinician accounts of speaking up or remaining…

8700. Implementation and adaptation of the Re-Engineered Discharge (RED) in five California hospitals: a qualitative research study. | PSNet
      psnet.ahrq.gov/issue/implementation-and-adaptation-re-engineered-discharge-red-five-california-hospitals
      August 04, 2021 - Study Implementation and adaptation of the Re-Engineered Discharge (RED) in five California hospitals: a qualitative research study. Citation Text: Mitchell SE, Weigel GM, Laurens V, et al. Implementation and adaptation of the Re-Engineered Discharge (RED) in five California hospitals: a…