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  1. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/37259/psn-pdf
    March 23, 2011 - Using a survey of incident reporting and learning practices to improve organisational learning at a cancer care centre. March 23, 2011 Cooke DL, Dunscombe PB, Lee R. Using a survey of incident reporting and learning practices to improve organisational learning at a cancer care centre. Qual Saf Health Care. 2007;16…

  2. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/838196/psn-pdf
    July 01, 2019 - The impact of racism on child and adolescent health. July 1, 2019 Trent M, Dooley DG, Dougé J, et al. The impact of racism on child and adolescent health. Pediatrics. 2019;144(2):e20191765. doi:10.1542/peds.2019-1765. https://psnet.ahrq.gov/issue/impact-racism-child-and-adolescent-health Children and adolescents a…

  3. Action Planning for the SOPS™ Surveys Infographic (pdf file)

    www.ahrq.gov/sites/default/files/wysiwyg/sops/events/webinar/action-planning-webcast-graphic.pdf
    February 01, 2019 - Action Planning for the SOPS™ Surveys Infographic Action Planning for the SOPSTM  Surveys January 2019 Webcast Highlights AHRQ's Surveys on Patient Safety CultureTM(SOPS TM) Action Planning Tool guides survey users seeking to improve patient safety culture through the action planning process. The Action Plann…

  4. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/74848/psn-pdf
    February 16, 2022 - Patients for Patient Safety US. February 16, 2022 404.510.8787; info@pfps.us https://psnet.ahrq.gov/issue/patients-patient-safety-us Patient safety improvement has made progress but more can be done. This organization supports community efforts in the United States to engage policymakers in work toward aligning ef…

  5. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/61054/psn-pdf
    October 21, 2020 - The optimal use of telehealth to deliver safe patient care. October 21, 2020 Quick Safety. October 6, 2020;55:1-4. https://psnet.ahrq.gov/issue/optimal-use-telehealth-deliver-safe-patient-care Telehealth benefits, barriers, and challenges have become more apparent due to its increased use due to COVID-19 phys…

  6. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/44082/psn-pdf
    April 22, 2015 - Impact of including readmissions for qualifying events in the Patient Safety Indicators. April 22, 2015 Davies SM, Saynina O, Baker LC, et al. Impact of including readmissions for qualifying events in the patient safety indicators. Am J Med Qual. 2015;30(2):114-8. doi:10.1177/1062860613518341. https://psnet.ahrq.g…

  7. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/42670/psn-pdf
    January 09, 2014 - Meta-analysis of surgical safety checklist effects on teamwork, communication, morbidity, mortality, and safety. January 9, 2014 Lyons VE, Popejoy LL. Meta-analysis of surgical safety checklist effects on teamwork, communication, morbidity, mortality, and safety. West J Nurs Res. 2014;36(2):245-61. doi:10.1177/019…

  8. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/46614/psn-pdf
    November 29, 2017 - Interventions to improve hand hygiene compliance in the ICU: a systematic review. November 29, 2017 Lydon S, Power M, McSharry J, et al. Interventions to Improve Hand Hygiene Compliance in the ICU. Crit Care Med. 2017;45(11). doi:10.1097/ccm.0000000000002691. https://psnet.ahrq.gov/issue/interventions-improve-hand…

  9. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/39263/psn-pdf
    February 03, 2010 - Is there a benefit to multidisciplinary rounds in an open trauma intensive care unit regarding ventilator-associated pneumonia? February 3, 2010 Johnson V, Mangram A, Mitchell C, et al. Is there a benefit to multidisciplinary rounds in an open trauma intensive care unit regarding ventilator-associated pneumonia? A…

  10. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/73894/psn-pdf
    February 22, 2022 - Achieving Excellence in Cancer Diagnosis: Proceedings of a Workshop—in Brief. February 22, 2022 National Academies of Sciences, Engineering, and Medicine. Washington, DC: The National Academies Press; 2022.  https://psnet.ahrq.gov/issue/achieving-excellence-cancer-diagnosis Diagnostic errors remain an o…

  11. Section 6, Tables 5 and 6 (pdf file)

    www.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/chronic/chipra-216-section-6-tables-5-6.pdf
    June 02, 2025 - Section 6, Tables 5 and 6 Table 5: Agreement and Kappa Statistics for Sickle Cell Disease for Inter‐Rater Reliability at Three Sites Site Measure Numerator/ Eligibility Criteria Number of Records Reviewed N Agreed (%) Kappa Statistic Hospital #1 Antibiotic Treatment 0 ‐ ‐ Hospital #1 Fever Criterion 3 100% 1.…

  12. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/60263/psn-pdf
    April 22, 2020 - Rationing protective gear means checking on coronavirus patients less often. This can be deadly. April 22, 2020 Kaplan J, Presser L, Miller M. ProPublica. April 10, 2020. https://psnet.ahrq.gov/issue/rationing-protective-gear-means-checking-coronavirus-patients-less-often-can- be-deadly Increased complexity and p…

  13. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/45454/psn-pdf
    September 04, 2016 - Headline-grabbing study brings attention back to medical errors. September 4, 2016 Abbasi J. Headline-Grabbing Study Brings Attention Back to Medical Errors. JAMA. 2016;316(7):698-700. doi:10.1001/jama.2016.8073. https://psnet.ahrq.gov/issue/headline-grabbing-study-brings-attention-back-medical-errors The presenc…

  14. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/838182/psn-pdf
    September 28, 2022 - Leadership behaviors, attitudes and characteristics to support a culture of safety. September 28, 2022 Montminy SL. Leadership behaviors, attitudes and characteristics to support a culture of safety. J Healthc Risk Manag. 2022;42(2):31-38. doi:10.1002/jhrm.21521. https://psnet.ahrq.gov/issue/leadership-behaviors-a…

  15. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/41388/psn-pdf
    May 30, 2012 - Observational teamwork assessment for surgery: feasibility of clinical and nonclinical assessor calibration with short-term training. May 30, 2012 Russ S, Hull L, Rout S, et al. Observational teamwork assessment for surgery: feasibility of clinical and nonclinical assessor calibration with short-term training. Ann…

  16. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/44848/psn-pdf
    April 22, 2016 - Ambulatory medication reconciliation: using a collaborative approach to process improvement at an academic medical center. April 22, 2016 Keogh C, Kachalia A, Fiumara K, et al. Ambulatory Medication Reconciliation: Using a Collaborative Approach to Process Improvement at an Academic Medical Center. Jt Comm J Qual …

  17. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/42747/psn-pdf
    November 20, 2013 - Drug related problems and pharmacist interventions in a geriatric unit employing electronic prescribing. November 20, 2013 Raimbault-Chupin M, Spiesser-Robelet L, Guir V, et al. Drug related problems and pharmacist interventions in a geriatric unit employing electronic prescribing. Int J Clin Pharm. 2013;35(5):847-…

  18. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/37056/psn-pdf
    February 24, 2011 - Use of multidisciplinary rounds to simultaneously improve quality outcomes, enhance resident education, and shorten length of stay. February 24, 2011 O'Mahony S, Mazur E, Charney P, et al. Use of multidisciplinary rounds to simultaneously improve quality outcomes, enhance resident education, and shorten length of …

  19. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/44714/psn-pdf
    November 25, 2015 - Continuous Improvement of Patient Safety: The Case for Change in the NHS. November 25, 2015 Illingworth J. London, UK: The Health Foundation; 2015. ISBN: 9781906461706. https://psnet.ahrq.gov/issue/continuous-improvement-patient-safety-case-change-nhs The Francis inquiry uncovered problems in the National Health S…

  20. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/60801/psn-pdf
    August 12, 2020 - Targeting zero harm: a stretch goal that risks breaking the spring. August 12, 2020 Meddings J, Saint S, Lilford RJ, et al. Targeting zero harm: a stretch goal that risks breaking the spring. NEJM Catal Innov Care Deliv. 2020;1(4). doi:10.1056/cat.20.0354. https://psnet.ahrq.gov/issue/targeting-zero-harm-stretch-g…
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