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psnet.ahrq.gov/issue/incidence-adverse-events-and-negligence-hospitalized-patients-results-harvard-medical
February 18, 2011 - Study
Classic
Incidence of adverse events and negligence in hospitalized patients. Results of the Harvard Medical Practice Study I.
Citation Text:
Brennan TA, Leape LL, Laird NM, et al. Incidence of Adverse Events and Negligence in Hospitalized Patients. N Eng…
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digital.ahrq.gov/sites/default/files/Real%20World%20PC%20CDS_Patient-Centered%20CDS%20for%20Postpartum%20Hypertension%20Monitoring_508_Jan26.pdf
August 20, 2025 - Patient-Centered CDS for Postpartum Hypertension Monitoring
Patient-Centered CDS for Postpartum Hypertension Monitoring
At age 42, Brittany McFarland was excited about her first pregnancy after over a year of trying to conceive. All was going well
with the pregnancy until she developed preeclampsia in her third…
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psnet.ahrq.gov/issue/multidisciplinary-approaches-reducing-error-and-risk-patient-care-setting
January 05, 2017 - Study
Classic
Multidisciplinary approaches to reducing error and risk in a patient care setting.
Citation Text:
Connor M, Ponte PR, Conway JB. Multidisciplinary approaches to reducing error and risk in a patient care setting. Crit Care Nurs Clin North Am. 2002…
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psnet.ahrq.gov/issue/failure-rescue-female-patients-undergoing-high-risk-surgery
October 25, 2017 - Study
Failure to rescue female patients undergoing high-risk surgery.
Citation Text:
Wagner CM, Joynt Maddox KE, Ailawadi G, et al. Failure to rescue female patients undergoing high-risk surgery. JAMA Surg. 2024;160(1):29-36. doi:10.1001/jamasurg.2024.4574.
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psnet.ahrq.gov/issue/how-do-we-know-when-we-have-done-enough-ensuring-sufficient-patient-notification-efforts
August 18, 2021 - Commentary
How do we know when we have done enough? Ensuring sufficient patient notification efforts after a large-scale adverse event.
Citation Text:
Alfandre D, Foglia MB, Holodniy M, et al. How do we know when we have done enough? Ensuring sufficient patient notification efforts after…
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psnet.ahrq.gov/issue/organizational-learning-health-care-leaders-need-design-structures-and-processes-enhance
November 18, 2020 - Commentary
Organizational learning: health care leaders need to design structures and processes that enhance collective learning.
Citation Text:
Bohmer RM, Edmondson AC. Organizational learning in health care. Health Forum J. 2001;44(2):32-35.
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psnet.ahrq.gov/issue/influence-organizational-culture-climate-and-commitment-speaking-about-medical-errors
December 31, 2018 - Study
Emerging Classic
The influence of organizational culture, climate and commitment on speaking up about medical errors.
Citation Text:
Levine KJ, Carmody M, Silk KJ. The influence of organizational culture, climate and commitment on speaking up about medical…
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digital.ahrq.gov/program-overview/research-stories/decision-support-emergency-department-improve-medication-safety
January 01, 2023 - Decision Support in the Emergency Department to Improve Medication Safety for Older Adults
Theme:
Optimizing Care Delivery for Clinicians
Subtheme:
Using Real-Time Digital Healthcare Data to Improve Timely Treatment or Diagnosis
Using the clinical decision support system Enhancing Quality …
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psnet.ahrq.gov/issue/nurses-experiences-organizational-learning
July 21, 2021 - Study
Nurses' experiences of organizational learning.
Citation Text:
Lyman B, Biddulph ME, Hopper VG, et al. Nurses' experiences of organisational learning: a qualitative descriptive study. J Nurs Manag. 2020;28(6):1241-1249. doi:10.1111/jonm.13070.
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DO…
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digital.ahrq.gov/ahrq-funded-projects/building-and-implementing-predictive-decision-support-system-based-proactive
September 29, 2025 - Building and Implementing a Predictive Decision Support System Based on a Proactive Full Capacity Protocol to Mitigate Emergency Department Overcrowding Problems
Project Description
Publications
Using deep learning and predictive analytics, this research has the potential…
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www.uspreventiveservicestaskforce.org/home/getfilebytoken/_CqYnP2r9XUSuDgkPpF9y8
May 01, 2025 - Summary of USPSTF Final Recommendation: Screening for Syphilis Infection During Pregnancy
Clinicians
Summary of USPSTF Final Recommendation
Screening for Syphilis Infection During Pregnancy
May 2025
What does the USPSTF recommend?
A
Grade
For pregnant women:
Provi…
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psnet.ahrq.gov/issue/using-lean-improve-medication-administration-safety-search-perfect-dose
September 16, 2015 - Study
Using Lean to improve medication administration safety: in search of the "perfect dose."
Citation Text:
Ching JM, Long C, Williams BL, et al. Using lean to improve medication administration safety: in search of the "perfect dose". Jt Comm J Qual Patient Saf. 2013;39(5):195-204.
C…
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psnet.ahrq.gov/issue/infusional-chemotherapy-and-medication-errors-tertiary-care-pediatric-cancer-unit-resource
October 29, 2012 - Study
Infusional chemotherapy and medication errors in a tertiary care pediatric cancer unit in a resource-limited setting.
Citation Text:
Dhamija M, Kapoor G, Juneja A. Infusional chemotherapy and medication errors in a tertiary care pediatric cancer unit in a resource-limited setting. …
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psnet.ahrq.gov/issue/future-artificial-intelligence-applications-cancer-care-global-cross-sectional-survey
April 27, 2022 - Study
Future of artificial intelligence applications in cancer care: a global cross-sectional survey of researchers.
Citation Text:
Cabral BP, Braga LAM, Syed-Abdul S, et al. Future of artificial intelligence applications in cancer care: a global cross-sectional survey of researchers. Cu…
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psnet.ahrq.gov/issue/preventable-adverse-drug-events-hospitalized-patients-comparative-study-intensive-care-and
March 31, 2021 - Study
Classic
Preventable adverse drug events in hospitalized patients: a comparative study of intensive care and general care units.
Citation Text:
Cullen DJ, Sweitzer BJ, Bates DW, et al. Preventable adverse drug events in hospitalized patients. Crit Care Me…
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psnet.ahrq.gov/issue/long-term-care-nurses-experiences-patient-safety-incident-management-qualitative-study
March 24, 2021 - Study
Long-term care nurses' experiences with patient safety incident management: a qualitative study.
Citation Text:
Serre N, Espin S, Indar A, et al. Long-term care nurses' experiences with patient safety incident management: a qualitative study. J Nurs Care Qual. 2022;37(2):188-194. d…
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psnet.ahrq.gov/issue/quest-eliminate-intrathecal-vincristine-errors-40-year-journey
September 15, 2010 - Commentary
The quest to eliminate intrathecal vincristine errors: a 40-year journey.
Citation Text:
Noble DJ, Donaldson LJ. The quest to eliminate intrathecal vincristine errors: a 40-year journey. Qual Saf Health Care. 2010;19(4):323-326. doi:10.1136/qshc.2008.030874.
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psnet.ahrq.gov/issue/design-and-implementation-application-and-associated-services-support-interdisciplinary
February 15, 2011 - Study
Design and implementation of an application and associated services to support interdisciplinary medication reconciliation efforts at an integrated healthcare delivery network.
Citation Text:
Poon EG, Blumenfeld B, Hamann C, et al. Design and Implementation of an Application and …
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digital.ahrq.gov/health-it-tools-and-resources/workflow-assessment-health-it-toolkit/research/ornstein-s-et-al-1995
January 01, 1995 - Ornstein S et al. 1995 "Implementation and evaluation of a computer-based preventive services system."
Reference
Ornstein S, Garr D, Jenkins R, et al. Implementation and evaluation of a computer-based preventive services system. Fam Med 1995;27(4):260.
Abstract
"BACKGROUND AND OBJECTIVES: Insu…
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psnet.ahrq.gov/issue/community-acquired-and-hospital-acquired-medication-harm-among-older-inpatients-and-impact
August 28, 2024 - Study
Community-acquired and hospital-acquired medication harm among older inpatients and impact of a state-wide medication management intervention.
Citation Text:
Pellegrin K, Lozano A, Miyamura J, et al. Community-acquired and hospital-acquired medication harm among older inpatients an…