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psnet.ahrq.gov/issue/building-better-delivery-system-new-engineeringhealth-care-partnership
September 12, 2018 - Washington, DC: National Academies Press; 2005.
ISBN-10: 030909643X. … Washington, DC: National Academies Press; 2005.
ISBN-10: 030909643X. … systems approach in health care, the role of engineering tools and information technology, and a strategy … Citation
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Crossing the Global Quality … July 5, 2016
Preventing Medication Errors: Quality Chasm Series.
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psnet.ahrq.gov/node/33663/psn-pdf
September 15, 2008 - , and patient safety initiatives
Alignment of AHS clinical outcomes and quality measures with national … Milestones on Our Patient Safety Journey
Early Engagement and Education
In 1996, AHS began a strategy … Our study on pneumonia patients using
this strategy showed an improvement in patient outcomes, as measured … Alignment with the National Quality Forum's "Safe Practices"
The revised 2006 National Quality Forum … Washington DC: National
Quality Forum; 2007.
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Figure.
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psnet.ahrq.gov/issue/intraoperative-sentinel-events-era-surgical-safety-checklists-results-national-survey
August 04, 2021 - Intraoperative sentinel events in the era of surgical safety checklists: results of a national … Intraoperative sentinel events in the era of surgical safety checklists: results of a national survey … Intraoperative sentinel events in the era of surgical safety checklists: results of a national survey … September 23, 2020
A randomized trial of a multifactorial strategy to prevent serious … View More
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Operating Room
Risk Managers
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psnet.ahrq.gov/issue/moving-beyond-readmission-penalties-creating-ideal-process-improve-transitional-care
June 14, 2017 - This commentary describes a 10-domain framework to ensure high-quality care transitions and reduce … June 14, 2017
Hospital ward adaptation during the COVID-19 pandemic: a national survey … September 23, 2020
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psnet.ahrq.gov/issue/vhas-movement-change-implementing-high-reliability-principles-and-practices
August 21, 2024 - This commentary describes the VHA's implementation strategy and progress since 2019 at the patient, employee … The three pillars of the VHA's HRO strategy are leadership commitment, a culture of safety, and continuous … April 26, 2023
Quality and safety: learning from the past and (re)imagining … October 7, 2020
Safer Together: A National Action Plan to Advance Patient Safety. … Consequences of Safety-II on governmental regulation of healthcare quality.
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psnet.ahrq.gov/issue/national-quality-forum-safe-practice-standard-computerized-physician-order-entry-updating
December 18, 2013 - Review
The National Quality Forum safe practice standard for computerized physician … The National Quality Forum Safe Practice Standard for Computerized Physician Order Entry. … The authors discuss the National Quality Forum (NQF) computerized physician order entry (CPOE) standard … The National Quality Forum Safe Practice Standard for Computerized Physician Order Entry.
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psnet.ahrq.gov/issue/operational-measurement-diagnostic-safety-state-science
February 17, 2021 - Rockville, MD: Agency for Healthcare Research and Quality; April 2020. … Rockville, MD: Agency for Healthcare Research and Quality; April 2020. … The publication recommends a strategy to support health care organizations in identifying and beginning … February 28, 2025
National Healthcare Quality and Disparities Report Chartbook on Patient … March 22, 2024
National Healthcare Quality and Disparities Reports.
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psnet.ahrq.gov/Information/Panel
January 01, 2012 - partners and collaborates with senior leadership and the Board of Directors to develop and execute a strategy … During her tenure at KP, she provided health plan and hospital quality leadership for several national … Influential research products include over 100 evidence-based national quality, prevention, and safety … In this role, she teaches informatics at the master’s and doctoral levels and provides strategy-level … Safety Standing Committee of the National Quality Forum, a consumer representative on the U.S.
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psnet.ahrq.gov/issue/individual-surgeon-mortality-rates-can-outliers-be-detected-national-utility-analysis
October 27, 2021 - A national utility analysis.
Citation Text:
Harrison EM, Drake TM, O'Neill S, et al. … A national utility analysis. BMJ Open. 2016;6(10):e012471. doi:10.1136/bmjopen-2016-012471. … In 2013, the National Health Service began to publish mortality rates for individual surgeons. … September 23, 2015
A randomized trial of a multifactorial strategy to prevent serious … April 22, 2009
Continuous monitoring of adverse events: influence on the quality of care
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psnet.ahrq.gov/issue/crisis-standards-care-ten-years-successes-and-challenges-proceedings-workshop
September 12, 2018 - National Academies of Sciences, Engineering, and Medicine. … Citation
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psnet.ahrq.gov/primer/measurement-patient-safety
September 15, 2024 - Background The 1999 Institute of Medicine (IOM) To Err Is Human report drew national attention to the … The 2015 Free From Harm report by the National Patient Safety Foundation called for the creation of … recommendations included establishing a standardized set of process and outcome measures for use on a national … The CMS National Quality Strategy emphasizes the ongoing transition to digital quality measures (such … The 2020 National Action Plan to Advance Patient Safety recommends the use of comprehensive patient
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psnet.ahrq.gov/issue/impact-hospital-wide-hand-hygiene-initiative-healthcare-associated-infections-results
September 20, 2011 - safety: the Veterans Affairs National Quality Scholars Program. … May 2, 2012
The Veterans Affairs National Quality Scholars Program: a model for interprofessional … education in quality and safety. … Status of the implementation of the World Health Organization multimodal hand hygiene strategy … May 7, 2014
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psnet.ahrq.gov/issue/adverse-events-0
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Quality of Care Concerns and the Facility Response Following a Medical … January 16, 2025
AHRQ National Healthcare Safety Dashboard. … July 19, 2024
Impact of repeated reimbursement penalties on hospital total quality scores … July 1, 2020
AHRQ National Scorecard on Hospital-Acquired Conditions Updated Baseline
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psnet.ahrq.gov/issue/toolkit-disseminate-best-practices-inpatient-medication-reconciliation-multi-center
January 23, 2019 - disseminate best practices in inpatient medication reconciliation: Multi-Center Medication Reconciliation Quality … disseminate best practices in inpatient medication reconciliation: multi-center medication reconciliation quality … reconciliation improvement toolkit, along with results and lessons learned from implementing the strategy … May 8, 2017
Preventability and causes of readmissions in a national cohort of general … Results of a medication reconciliation survey from the 2006 Society of Hospital Medicine national
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psnet.ahrq.gov/issue/association-hospital-participation-surgical-outcomes-monitoring-program-inpatient
August 20, 2018 - American Medical Association , this retrospective study found no association between participation in the National … the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) postoperative … July 1, 2019
A randomized trial of a multifactorial strategy to prevent serious fall … surgical complications and patient safety at the nation's largest military hospital: an analysis of National … Surgical Quality Improvement Program data.
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psnet.ahrq.gov/issue/coding-success-simple-technology-safer-patient-care
July 01, 2020 - Healthcare Quality Directorate, Department of Health. London, UK; Crown Copyright: 2007. … could have on health care in the United Kingdom and provides a plan to support their adoption in the National … Healthcare Quality Directorate, Department of Health. London, UK; Crown Copyright: 2007. … March 16, 2025
The NHS Patient Safety Strategy. … March 1, 2023
National Safety Standards for Invasive Procedures (NatSSIPs2).
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psnet.ahrq.gov/issue/zero-suicide-initiative
July 03, 2013 - Office of the Federal Register, National Archives and Records Administration. Fed Register. … This funding announcement calls for program applications to motivate suicide prevention strategy implementation … Office of the Federal Register, National Archives and Records Administration. Fed Register. … Copy Citation
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psnet.ahrq.gov/issue/association-2011-acgme-resident-duty-hour-reform-postoperative-patient-outcomes-surgical
February 14, 2017 - This pre-post examination of data from the National Surgical Quality Improvement Program found no differences … Although duty hour reform does not appear to be a high-yield strategy for improving surgical outcomes … characteristics, measure reporting, and the Centers for Medicare & Medicaid Services overall hospital quality … March 1, 2017
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psnet.ahrq.gov/issue/two-decades-err-human-progress-still-chasm
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psnet.ahrq.gov/issue/kenneth-w-kizer-md-mph-health-care-quality-evangelist
July 28, 2014 - Kizer, MD, MPH: health care quality evangelist. Interview by Brian Vastag. … Kizer, then of the National Quality Forum , addresses the inception of now well-known quality improvement … Kizer, MD, MPH: health care quality evangelist. Interview by Brian Vastag. … MD
June 1, 2015
Preventing in-facility pressure ulcers as a patient safety strategy … March 20, 2013
Inpatient fall prevention programs as a patient safety strategy: a systematic