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psnet.ahrq.gov/node/48069/psn-pdf
July 24, 2019 - Patient and visitor aggression in healthcare: a survey
exploring organisational safety culture and team efficacy.
July 24, 2019
Heckemann B, Hahn S, Halfens RJG, et al. Patient and visitor aggression in healthcare: A survey exploring
organisational safety culture and team efficacy. J Nurs Manag. 2019;27(5):1039-104…
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psnet.ahrq.gov/node/42894/psn-pdf
January 29, 2014 - An exploratory study of knowledge brokering in hospital
settings: facilitating knowledge sharing and learning for
patient safety?
January 29, 2014
Waring J, Currie G, Crompton A, et al. An exploratory study of knowledge brokering in hospital settings:
facilitating knowledge sharing and learning for patient safety?…
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psnet.ahrq.gov/node/47057/psn-pdf
July 14, 2018 - A framework for operationalizing risk: a practical
approach to patient safety.
July 14, 2018
Mathews SC, Sutcliffe K, Garrett MR, et al. A framework for operationalizing risk: A practical approach to
patient safety. J Healthc Risk Manag. 2018;38(1):38-46. doi:10.1002/jhrm.21317.
https://psnet.ahrq.gov/issue/frame…
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psnet.ahrq.gov/node/43361/psn-pdf
July 16, 2014 - An Avoidable Death of a Three-year-old Child from
Sepsis.
July 16, 2014
London, UK: Parliamentary and Health Service Ombudsman; June 2014.
https://psnet.ahrq.gov/issue/avoidable-death-three-year-old-child-sepsis
This investigation outlines how inadequate care contributed to the death of a child who developed sepsi…
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psnet.ahrq.gov/node/50710/psn-pdf
December 04, 2019 - Safety in office-based anesthesia: an updated review of
the literature from 2016 to 2019
December 4, 2019
de Lima A, Osman BM, Shapiro FE. Safety in office-based anesthesia. Curr Opin Anaesthesiol.
2019;32(6):749-755. doi:10.1097/aco.0000000000000794.
https://psnet.ahrq.gov/issue/safety-office-based-anesthesia-upd…
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psnet.ahrq.gov/node/45119/psn-pdf
November 18, 2016 - Encouraging employees to speak up to prevent
infections: opportunities to leverage quality improvement
and care management processes.
November 18, 2016
Robbins J, McAlearney AS. Encouraging employees to speak up to prevent infections: Opportunities to
leverage quality improvement and care management processes. Am …
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psnet.ahrq.gov/node/844048/psn-pdf
February 08, 2023 - The incidence of opioid misuse among the surgical
patients with persistent opioid use.
February 8, 2023
Namiranian, MD, PhD K. The incidence of opioid misuse among the surgical patients with persistent opioid
use. J Opioid Manag. 2023;19(1):69-76. doi:10.5055/jom.2023.0760.
https://psnet.ahrq.gov/issue/incidence-o…
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digital.ahrq.gov/ahrq-funded-projects/tulare-district-hospital-rural-health-electronic-medical-record-consortium/final-report
January 01, 2023 - Tulare District Hospital Rural Health EMR Consortium - Final Report
Citation
Davison R. Tulare District Hospital Rural Health EMR Consortium - Final Report. (Prepared by Tulare Local Healthcare District under Grant No. UC1 HS015096). Rockville, MD: Agency for Healthcare Research and Quality, 2009.
…
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digital.ahrq.gov/location/usa-va-arlington
January 01, 2023 - USA, VA, Arlington
Personal Health Information Management and Design of Consumer Health IT
Description
The purpose of this project was to establish a foundation and propose an action agenda for the integration of patients’ personal health information management into the design…
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/education/curriculum-tools/cusptoolkit/toolkit/bckgrndqiteam.doc
June 02, 2025 - Background Quality Improvement Team Information Form
Who should use this tool? Health care providers.
Please indicate people designated as Quality Improvement Team Members. Your team may not have people who serve in all of these roles.
These individuals from are members of the Qual…
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digital.ahrq.gov/location/usa-mt-billings
January 01, 2023 - USA, MT, Billings
Evaluation of Effectiveness of a Health Information Technology-Based Care Transition Information Transfer System
Description
This project developed, implemented, and evaluated a care transition information transfer system to improve provider-to-provider commu…
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www.ahrq.gov/patient-safety/settings/labor-delivery/perinatal-care/modules/teamwork/team-info-form.html
July 01, 2023 - Background Quality Improvement Team Information Form
AHRQ Safety Program for Perinatal Care
Who should use this tool? Health care teams
Please indicate staff members designated as Labor and Delivery Quality Improvement Team members. Your team might not have people who serve in all of these rol…
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psnet.ahrq.gov/node/47168/psn-pdf
April 27, 2019 - Balancing patient-centered and safe pain care for
nonsurgical inpatients: clinical and managerial
perspectives.
April 27, 2019
Mazurenko O, Andraka-Christou BT, Bair MJ, et al. Balancing Patient-Centered and Safe Pain Care for
Nonsurgical Inpatients: Clinical and Managerial Perspectives. Jt Comm J Qual Patient Saf…
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psnet.ahrq.gov/node/861770/psn-pdf
January 31, 2024 - Understanding liability risk from using health care
artificial intelligence tools.
January 31, 2024
Mello MM, Guha N. Understanding liability risk from using health care artificial intelligence tools. N Engl J
Med. 2024;390(3):271-278. doi:10.1056/nejmhle2308901.
https://psnet.ahrq.gov/issue/understanding-liabilit…
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effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/pdf/epc-child-adolesc-mental-health-grand-rounds.pptx
May 22, 2025 - Such literature has been synthesized and can aid in managing youth suicide.13, 20
74
Future Research
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digital.ahrq.gov/sites/default/files/docs/page/09-0071-EF_1.pdf
June 01, 2009 - Most respondents reported that managing current
coverage—renewing the policy annually—is not an administrative … Q9: How significant do you find the administrative burden of managing liability for the RHIO?
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www.ahrq.gov/sites/default/files/wysiwyg/antibiotic-use/long-term-care/one-pager-respiratory-infections.pdf
June 01, 2021 - Respiratory Virus Infections
Diagnosis
• Most respiratory tract infections are caused by viruses, not bacteria, and do not require antibiotic therapy.1-3
• Common infectious syndromes caused by respiratory viruses include:
− Common cold3
− Uncomplicated sinus infections with symptoms present for <2 weeks4-5 …
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www.ahrq.gov/patient-safety/settings/hospital/candor/modules/facguide3.html
August 01, 2022 - Gap Analysis Facilitator's Guide
AHRQ Communication and Optimal Resolution Toolkit
Purpose: To evaluate the extent to which current processes align with the Communication and Optimal Resolution (CANDOR) process and includes:
Identifying the existing process.
Identifying the existing outcome(s).
Ide…
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/quality-resources/tools/chtoolbx/choosing/choosing.doc
June 02, 2025 - Choosing Quality Measures
Choosing Quality Measures
Contents
Some Planning Suggestions
· Think Long Term
· Consider All Available Measurement Tools
· Think Fewer Measures
· Develop a Plan
Factors to Consider
· Making Comparisons
· Databases and Benchmarks
· Trends Over Time
· Service Delivery Systems
· Unit of Ana…
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digital.ahrq.gov/ahrq-funded-projects/enabling-electronic-prescribing-and-enhanced-management-controlled-medication/annual-summary/2010
January 01, 2010 - Enabling Electronic Prescribing and Enhanced Management of Controlled Medications - 2010
Project Name
Enabling Electronic Prescribing and Enhanced Management of Controlled Medications
Principal Investigator
Carrow, Grant
Organization
Massachusetts Department of Public Health …