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psnet.ahrq.gov/node/33620/psn-pdf
September 01, 2005 - In response to “Getting to the Root of the Matter” (June
2005)
September 1, 2005
Grondin L, Saint S, Flanders S, et al. In response to “Getting to the Root of the Matter” (June 2005). PSNet
[internet]. 2005.
https://psnet.ahrq.gov/perspective/response-getting-root-matter-june-2005
In response to "Getting to the R…
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psnet.ahrq.gov/issue/impact-care-quality-commission-provider-performance-room-improvement
November 18, 2015 - Book/Report
Impact of the Care Quality Commission on Provider Performance: Room for Improvement?
Citation Text:
Impact of the Care Quality Commission on Provider Performance: Room for Improvement? Smithson R, Richardson E, Roberts J, et al. The King's Fund, Alliance Manchester Business S…
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psnet.ahrq.gov/issue/standardized-postoperative-handover-process-improves-outcomes-intensive-care-unit-model
June 21, 2015 - Study
Standardized postoperative handover process improves outcomes in the intensive care unit: a model for operational sustainability and improved team performance.
Citation Text:
Bhakta RT, Stockwell DC. Transitions of care in the pediatric cardiac intensive care unit*. Crit Care Med…
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psnet.ahrq.gov/issue/how-safety-compromised-when-hospital-equipment-poor-fit-patients-who-are-obese
October 07, 2020 - Study
How safety is compromised when hospital equipment is a poor fit for patients who are obese.
Citation Text:
Kukielka E. How safety is compromised when hospital equipment is a poor fit for patients who are obese. Patient Saf J. 2020;2(1):48-56. doi:10.33940/data/2020.3.4.
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www.ahrq.gov/teamstepps-program/curriculum/mutual/tools/advocacy.html
June 01, 2023 - Tool: Advocacy and Assertion
Providing mutual support also sometimes requires the use of advocacy and assertion. Advocacy and assertion interventions are invoked when a team member's viewpoint does not coincide with that of a decision maker. In advocating by or for the patient and asserting the need for correct…
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psnet.ahrq.gov/issue/saying-goodbye
September 11, 2019 - Commentary
Saying goodbye.
Citation Text:
DeFilippis EM. Saying Goodbye. JAMA Intern Med. 2017;177(11):1565. doi:10.1001/jamainternmed.2017.4017.
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DOI Google Scholar PubMed BibTeX EndNote X3 XML EndNote 7 XML Endnote tagged PubMedId RIS
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psnet.ahrq.gov/issue/investigating-improvement-five-strategies-ensure-national-patient-safety-investigations
February 28, 2024 - Commentary
Investigating for improvement? Five strategies to ensure national patient safety investigations improve patient safety.
Citation Text:
Macrae C. Investigating for improvement? Five strategies to ensure national patient safety investigations improve patient safety. J R Soc Med.…
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/ambulatory-surgery/sections/sustainability/training-tools/sustainability-tool.docx
May 01, 2017 - AHRQ Safety Program for Ambulatory Surgery
Module 4: Sustainability
Sustainability Tool
Background: This tool can be used to identify sustainability issues in planning and implementing your improvement efforts.
How to use this tool: The Implementation Team leader (or individual designated by the leader) should comple…
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www.ahrq.gov/talkingquality/translate/presentation.html
April 01, 2016 - Why Does the Presentation of Health Care Quality Scores Matter?
Most people have trouble understanding complex information.
Only a small fraction of Americans can easily read complex tables or understand the words typically used in medicine and health. The 2003 National Assessment of Adult Literacy found that…
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psnet.ahrq.gov/issue/rates-new-or-missed-colorectal-cancers-after-colonoscopy-and-their-risk-factors-population
August 28, 2024 - Study
Rates of new or missed colorectal cancers after colonoscopy and their risk factors: a population-based analysis.
Citation Text:
Bressler B, Paszat LF, Chen Z, et al. Rates of new or missed colorectal cancers after colonoscopy and their risk factors: a population-based analysis. G…
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psnet.ahrq.gov/issue/information-behavior-context-improving-patient-safety
March 24, 2019 - Commentary
Information behavior in the context of improving patient safety.
Citation Text:
MacIntosh-Murray A, Choo CW. Information behavior in the context of improving patient safety. Journal of the American Society for Information Science and Technology. 2005;56(12). doi:10.1002/asi.…
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psnet.ahrq.gov/issue/beyond-medication-reconciliation-correct-medication-list
February 15, 2017 - Commentary
Beyond medication reconciliation: the correct medication list.
Citation Text:
Rose AJ, Fischer SH, Paasche-Orlow MK. Beyond Medication Reconciliation: The Correct Medication List. JAMA. 2017;317(20):2057-2058. doi:10.1001/jama.2017.4628.
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psnet.ahrq.gov/issue/incorporating-indications-medication-ordering-time-enter-age-reason
June 05, 2018 - Commentary
Incorporating indications into medication ordering—time to enter the age of reason.
Citation Text:
Schiff G, Seoane-Vazquez E, Wright A. Incorporating Indications into Medication Ordering--Time to Enter the Age of Reason. N Engl J Med. 2016;375(4):306-9. doi:10.1056/NEJMp16039…
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psnet.ahrq.gov/issue/health-information-exchange-and-patient-safety
February 03, 2011 - Review
Health information exchange and patient safety.
Citation Text:
Kaelber DC, Bates DW. Health information exchange and patient safety. J Biomed Inform. 2007;40(6 Suppl):S40-5.
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psnet.ahrq.gov/issue/automated-operating-room-team-approach-patient-safety-and-communication
November 16, 2022 - Study
The automated operating room: a team approach to patient safety and communication.
Citation Text:
Nissan J, Campos V, Delgado H, et al. The automated operating room: a team approach to patient safety and communication. JAMA Surg. 2014;149(11):1209-10. doi:10.1001/jamasurg.2014.1825…
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psnet.ahrq.gov/issue/current-and-ideal-state-anatomic-pathology-patient-safety
February 15, 2010 - Commentary
The current and ideal state of anatomic pathology patient safety.
Citation Text:
Raab SS. The current and ideal state of anatomic pathology patient safety. MLO Med Lab Obs. 2014;46(6):8-10.
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www.ahrq.gov/news/newsroom/case-studies/201511.html
May 01, 2015 - St. Joseph’s Hospital Improves Patient Safety Using AHRQ Tools
Search All Impact Case Studies
May 2015
St. Joseph's Hospital, a 72-bed facility in Breese, Illinois, has improved care and increased satisfaction among patients by using three evidence-based resources from AHRQ:
The Hospital Consumer Asses…
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psnet.ahrq.gov/issue/building-culture-safety-through-team-training-and-engagement
September 23, 2017 - Study
Building a culture of safety through team training and engagement.
Citation Text:
Thomas L, Galla C. Building a culture of safety through team training and engagement. BMJ Qual Saf. 2013;22(5):425-34. doi:10.1136/bmjqs-2012-001011.
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/surgery/tools/applying-cusp/perioperative_asst.docx
December 01, 2017 - Tool: Perioperative Staff Safety Assessment
AHRQ Safety Program for Surgery
Perioperative Staff Safety Assessment
Introduction
Problem Statement
One of the strongest determinants of safety culture is whether local and hospital leadership respond to staff patient safety concerns. Frontline providers understand patie…
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www.ahrq.gov/research/findings/final-reports/advisorycouncil/adcouncilapb.html
April 01, 2018 - Guide for Developing a Community-Based Patient Safety Advisory Council
Appendix B. Council Information Sheet and Application
A sample of the member information sheet and application for patients or caregivers for the Aurora Health Care Patient Safety Partnership Council follows. With minor edits, the informat…