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psnet.ahrq.gov/issue/sample-sample-carryover-source-analytical-laboratory-error-and-its-relevance-integrated
January 12, 2022 - Study
Sample to sample carryover: a source of analytical laboratory error and its relevance to integrated clinical chemistry/immunoassay systems.
Citation Text:
Armbruster DA, Alexander DB. Sample to sample carryover: a source of analytical laboratory error and its relevance to integra…
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psnet.ahrq.gov/issue/high-reliability-organizations-hros-what-they-know-we-dont-part-ii
June 10, 2018 - Newspaper/Magazine Article
High-reliability organizations (HROs): what they know that we don't (Part II).
Citation Text:
High-reliability organizations (HROs): what they know that we don't (Part II). ISMP Medication Safety Alert! Acute Care Edition. July 28, 2005;10:1-3.
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psnet.ahrq.gov/issue/when-should-leader-apologize-and-when-not
October 07, 2020 - Commentary
When should a leader apologize—and when not?
Citation Text:
Kellerman B. When should a leader apologize and when not? Harv Bus Rev. 2006;84(4):72-81; 148.
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psnet.ahrq.gov/issue/radically-redesigning-patient-safety
November 13, 2024 - Newspaper/Magazine Article
Radically redesigning patient safety.
Citation Text:
Radick LE. Radically Redesigning Patient Safety. Healthcare executive. 2016;31(2):32-4, 36-40, 42.
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psnet.ahrq.gov/issue/implement-strategies-prevent-persistent-medication-errors-and-hazards
March 14, 2023 - Newspaper/Magazine Article
Implement strategies to prevent persistent medication errors and hazards.
Citation Text:
Implement strategies to prevent persistent medication errors and hazards. ISMP Medication Safety Alert! Acute care edition. March 23, 2023;28(6):1-4.
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www.ahrq.gov/news/newsroom/case-studies/201715.html
March 01, 2018 - Southern California Health Center Uses AHRQ Surveys for Patient Feedback and Improvements
Search All Impact Case Studies
March 2018
AltaMed Health Services, a Federally Qualified Community Health Center providing care to 300,000 Southern California residents, uses AHRQ's Consumer Assessment of Healthcare Pr…
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psnet.ahrq.gov/issue/medication-safety-issue-brief-look-alike-sound-alike-drugs
June 17, 2014 - Newspaper/Magazine Article
Medication safety issue brief. Look-alike, sound-alike drugs.
Citation Text:
Association AH, Pharmacists AS of H-S, Networks H & H. Medication safety issue brief, look-alike, sound-alike drugs. Hospitals and Health Networks. October 2005;79(10):57-58.
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psnet.ahrq.gov/issue/covid-19-focused-inspection-initiative-healthcare
April 01, 2024 - Press Release/Announcement
COVID-19 Focused Inspection Initiative in Healthcare.
Citation Text:
COVID-19 Focused Inspection Initiative in Healthcare. Occupational Safety and Health Administration. March 2, 2022.
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psnet.ahrq.gov/issue/ashp-guidelines-safe-use-automated-dispensing-devices
July 05, 2017 - Organizational Policy/Guidelines
ASHP guidelines on the safe use of automated dispensing devices.
Citation Text:
Cello R, Conley M, Cooley TW, et al. ASHP Guidelines on the Safe Use of Automated Dispensing Cabinets. Am J Health Syst Pharm. 2021;79(1):e71-e82. doi:10.1093/ajhp/zxab325. …
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psnet.ahrq.gov/issue/organizational-learning-framework-patient-safety
November 28, 2018 - Commentary
An organizational learning framework for patient safety.
Citation Text:
Edwards MT. An Organizational Learning Framework for Patient Safety. Am J Med Qual. 2016;32(2):148-155. doi:10.1177/1062860616632295.
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digital.ahrq.gov/program-overview/research-stories/telehealth-transition-and-improving-health-systems
January 01, 2023 - The Telehealth Transition and Improving Health Systems
Theme:
Supporting Health Systems in Advancing Care Delivery
Subtheme:
Leveraging Telehealth to Improve Health Systems
Evaluation of the rapid transition to telehealth due to the COVID-19 pandemic will inform patient care post-COVID-19 …
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psnet.ahrq.gov/issue/john-m-eisenberg-patient-safety-awards-system-innovation-concord-hospital
October 19, 2022 - Commentary
John M. Eisenberg Patient Safety Awards. System innovation: Concord Hospital.
Citation Text:
Uhlig PN, Brown J, Nason AK, et al. John M. Eisenberg Patient Safety Awards. System innovation: Concord Hospital. Jt Comm J Qual Improv. 2002;28(12):666-672.
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digital.ahrq.gov/national-webinars
July 17, 2025 - National Webinars
The AHRQ Digital Healthcare Research (DHR) Program sponsors national webinars showcasing the latest scientific advancements and key conversations with experts around impactful research in the evolving digital healthcare ecosystem. Access the latest on-demand webinars and up…
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psnet.ahrq.gov/issue/im-er-doctor-heres-what-i-found-when-i-asked-chatgpt-diagnose-my-patients
November 06, 2012 - Newspaper/Magazine Article
I’m an ER doctor: here’s what I found when I asked ChatGPT to diagnose my patients.
Citation Text:
I’m an ER doctor: here’s what I found when I asked ChatGPT to diagnose my patients. Tamayo-Sarver J. Fast Company. March 13, 2023.
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psnet.ahrq.gov/issue/effects-work-shift-or-shift-length-radiation-safety-perception
August 23, 2023 - Study
Effects of work shift or shift length on radiation safety perception.
Citation Text:
Effects of work shift or shift length on radiation safety perception. Moore QT, Bruno MA. Radiol Technol. 2023;94(6):409-418.
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psnet.ahrq.gov/issue/patient-experience-patient-safety-and-provider-well-being-associations-and-paths-quality
January 10, 2024 - Meeting/Conference Proceedings
Patient Experience, Patient Safety, and Provider Well-Being: Associations and Paths for Quality Improvement.
Citation Text:
Patient Experience, Patient Safety, and Provider Well-Being: Associations and Paths for Quality Improvement. Rockville, MD: Agency fo…
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psnet.ahrq.gov/issue/simple-strategies-avoid-medication-errors
April 22, 2017 - Commentary
Simple strategies to avoid medication errors.
Citation Text:
Jenkins RH, Vaida AJ. Simple strategies to avoid medication errors. Fam Pract Manag. 2007;14(2):41-47.
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psnet.ahrq.gov/issue/blind-obedience-and-unnecessary-workup-hypoglycemia-teachable-moment
March 14, 2022 - Commentary
Blind obedience and an unnecessary workup for hypoglycemia: a teachable moment.
Citation Text:
Wang EY, Patrick L, Connor DM. Blind Obedience and an Unnecessary Workup for Hypoglycemia: A Teachable Moment. JAMA Intern Med. 2018;178(2):279-280. doi:10.1001/jamainternmed.2017.71…
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digital.ahrq.gov/medical-condition/osteoporosis
January 01, 2023 - Osteoporosis
Identification of Patients with Low Life Expectancy - Final Report
Citation
Turchin A. Identification of Patients with Low Life Expectancy - Final Report. (Prepared by Cincinnati Children's Hospital Medical Center under Grant No. R21 HS024977). Rockville, MD: Agen…
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www.ahrq.gov/hai/cusp/toolkit/observing-rounds.html
December 01, 2012 - Observing Patient Care Rounds
CUSP Toolkit
Communication among disciplines can be improved if viewed through the eyes of an objective observer.
Problem statement: Interdisciplinary rounds are in the best interest of patients. Poor communication among staff is a root cause of many patient adverse and sentin…