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psnet.ahrq.gov/issue/cutting-out-human-error
February 25, 2009 - Alliance for Patient Safety Safe Surgery Checklist as one tool to improve the reliability of surgical care … Patients' and doctors' views and experiences of the patient safety trajectory of breast cancer care … stepped interventional programme to minimise central venous catheter-blood stream infections in intensive care … 30, 2009
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Operating Room
Health Care … Providers
Health Care Executives and Administrators
Surgery
Surgical Complications
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psnet.ahrq.gov/issue/patient-safety-tool-kit
February 14, 2024 - January 29, 2019
Exploring Patient Engagement in Reducing Health-Care-Related Safety … March 17, 2021
Support strategies for health care professionals who are second victims … March 18, 2020
Implementation of hand hygiene in health-care facilities: results from … January 27, 2016
Utilizing pharmacy students in transitions-of-care services. … June 12, 2007
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Hospitals
Health Care
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psnet.ahrq.gov/node/845353/psn-pdf
March 01, 2023 - Inadequate Outpatient Mental Health Triage and Care of a
Patient at the Chico Community-Based Outpatient … https://psnet.ahrq.gov/issue/inadequate-outpatient-mental-health-triage-and-care-patient-chico-community … -
based-outpatient
Gaps in care for psychologically vulnerable patients can result in harm to family … organizational failures in responding to staff and clinical leaders’ concerns regarding
access, triage, and care … Recommendations for improvement include
same-day access to appropriate specialty care, medication management
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psnet.ahrq.gov/issue/how-surgeons-disclose-medical-errors-patients-study-using-standardized-patients
July 10, 2008 - , 2024
Perspective
Patient Safety in Office-Based Care … January 1, 2009
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Health Care … Providers
Health Care Executives and Administrators
Surgery
Patient Disclosure
Provider-Patient
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psnet.ahrq.gov/issue/surgical-safety-checklist-reduce-morbidity-and-mortality-global-population
February 09, 2011 - 26, 2008
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Operating Room
Health Care … Providers
Health Care Executives and Administrators
Surgery
Surgical Complications
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psnet.ahrq.gov/issue/addressing-health-worker-burnout
May 25, 2022 - Health care staff and clinician wellbeing is known to affect safety and quality. … February 1, 2023
Comprehensive Healthcare Inspection Summary Report: Evaluation of Care … July 26, 2023
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Related Resources
Roadmap to Health Care … March 1, 2023
Comprehensive Healthcare Inspection Summary Report: Evaluation of Care … June 8, 2022
Caring for Those Who Care: Guide for the Development and Implementation
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psnet.ahrq.gov/issue/improved-diagnostic-accuracy-through-probability-based-diagnosis
October 05, 2022 - May 1, 2017
How PSOs Help Health Care Organizations Improve Patient Safety Culture. … October 19, 2022
Eliminating explicit and implicit biases in health care: evidence and … January 19, 2022
Developing critical thinking skills for delivering optimal care … September 30, 2020
Misdiagnosis, mistreatment, and harm - when medical care ignores social
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psnet.ahrq.gov/issue/exploring-situational-awareness-diagnostic-errors-primary-care
September 20, 2011 - Study
Exploring situational awareness in diagnostic errors in primary care. … Exploring situational awareness in diagnostic errors in primary care. … Exploring situational awareness in diagnostic errors in primary care. … September 20, 2011
Types and origins of diagnostic errors in primary care settings. … September 14, 2011
Electronic health record use and the quality of ambulatory care in
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psnet.ahrq.gov/issue/identifying-discrepancies-electronic-medical-records-through-pharmacist-medication
August 03, 2022 - This study found that pharmacist-led medication reconciliation in primary care settings identified … January 25, 2016
Weekly variation in health-care quality by day and time of admission … : a nationwide, registry-based, prospective cohort study of acute stroke care. … through coordination of care. … Providers
Family Medicine
Primary Care
General Internal Medicine
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psnet.ahrq.gov/issue/community-living-centers-va-needs-strengthen-its-approach-addressing-resident-complaints
October 12, 2022 - Patient complaints have the potential to be used for care improvement as they surface problems in health … to Augment Patient Care. … December 6, 2017
DOD and VA Health Care: Medication Needs During Transitions May Not … February 1, 2023
Comprehensive Healthcare Inspection Summary Report: Evaluation of Care … 2015
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See More About The Topic
General Public
Long-Term Care
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psnet.ahrq.gov/issue/when-no-news-bad-news-improving-diagnostic-testing-communication-through-patient-engagement
August 20, 2018 - Unintended consequences of patient online access to health records: a qualitative study in UK primary care … July 6, 2011
Trends in primary care clinician perceptions of a new electronic health … February 18, 2011
The management of test results in primary care: does an electronic … , 2009
WebM&M Cases
Recurrent Hypoglycemia: A Care … See More About The Topic
Ambulatory Clinic or Office
Information Professionals
Primary Care
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psnet.ahrq.gov/issue/miscoding-misclassification-and-misdiagnosis-diabetes-primary-care
September 23, 2020 - Study
Miscoding, misclassification and misdiagnosis of diabetes in primary care. … Miscoding, misclassification and misdiagnosis of diabetes in primary care. … This audit of electronic primary care registries in the United Kingdom found a significant incidence … Miscoding, misclassification and misdiagnosis of diabetes in primary care. … in an inner-city primary care clinic.
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psnet.ahrq.gov/issue/inpatient-quality-indicators
December 22, 2014 - December 22, 2014
Preventable Hospitalizations: A Window Into Primary and Preventive Care … August 12, 2016
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See More About The Topic
Hospitals
Health Care
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psnet.ahrq.gov/issue/incidence-adverse-events-indian-health-service-hospitals
May 20, 2020 - Challenges beset safe care delivery for indigenous peoples. … May 20, 2020
Adverse Events in Long-Term-Care Hospitals: National Incidence Among Medicare … January 9, 2019
Adverse Events in Hospitals: Care Study of Incidence Among Medicare Beneficiaries … November 8, 2023
Comprehensive Healthcare Inspection Summary Report: Evaluation of Care
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psnet.ahrq.gov/issue/physician-intent-pharmacy-label-prevalence-and-description-discrepancies-cross-sectional
July 22, 2020 - This study analyzed the frequency of unintended discrepancies in e-prescriptions from three primary care … November 3, 2015
Effect of different interventions to help primary care clinicians avoid … , 2014
Information technology interventions to improve medication safety in primary care … E-prescribing: a focused review and new approach to addressing safety in pharmacies and primary care … Perceptions of standards-based electronic prescribing systems as implemented in outpatient primary care
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psnet.ahrq.gov/node/33633/psn-pdf
May 01, 2006 - Use sample medications with care, if at all. … delivery
of quality care … Qual Saf Health Care. 2002;11:233-238. [go to PubMed]
4. Elder NC, Dovey SM. … National Ambulatory Medical Care Survey: 2002 Summary. … Patient Safety: Achieving a New Standard for
Care.
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psnet.ahrq.gov/issue/adverse-events-toolkit-medical-record-review-methodology
July 19, 2023 - Medical record review is a primary tactic to identify health care actions that contribute to patient … August 1, 2012
Adverse Events in Long-Term-Care Hospitals: National Incidence Among Medicare … October 16, 2012
Adverse Events in Hospitals: Care Study of Incidence Among Medicare … September 7, 2016
Final Report of the Commission on Care. … Nursing Homes: Despite Increased Oversight, Challenges Remain in Ensuring High-Quality Care
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psnet.ahrq.gov/issue/analysis-electronic-health-record-related-patient-safety-concerns
January 21, 2019 - A typology of electronic health record workarounds in small-to-medium size primary care … ) use: linking individual physicians' perceptions of uncertainty and EHR use patterns in ambulatory care … 18, 2013
Electronic health record-based surveillance of diagnostic errors in primary care
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psnet.ahrq.gov/web-mm/case-patient-flow-management
February 23, 2019 - Consider a typical primary care physician (PCP) or specialist office. … and consequently diminished quality of care and safety. … In: From Front Office to Front Line: Essential Issues for Health Care Leaders. … Cost and quality under managed care: irreconcilable differences? Am J Manag Care. 2000;3:305-312. … Patient flow variability and unplanned readmissions to an intensive care unit.
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psnet.ahrq.gov/issue/managing-teamwork-face-pandemic-evidence-based-tips
February 12, 2020 - This article summarizes evidence-based recommendations for team-based patient care during the COVID-19 … November 18, 2020
Systems thinking for managing COVID-19 in health care systems: seven … September 23, 2020
Attending to the emotional well-being of the health care workforce … July 22, 2020
Promoting psychosocial well-being of health care staff during crisis. … Providers
Health Care Executives and Administrators
Nurse Managers
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