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psnet.ahrq.gov/issue/developing-systematic-approach-safer-medication-use-during-pregnancy-summary-centers-disease
February 17, 2011 - Commentary
Developing a systematic approach to safer medication use during pregnancy: summary of a Centers for Disease Control and Prevention–convened meeting.
Citation Text:
Broussard CS, Frey MT, Hernandez-Diaz S, et al. Developing a systematic approach to safer medication use during p…
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psnet.ahrq.gov/issue/effect-patient-safety-strategies-incidence-adverse-events
March 09, 2022 - Study
Effect of patient safety strategies on the incidence of adverse events.
Citation Text:
Sierra AF, del Aguila del MR, Espigares JLN, et al. Effect of patient safety strategies on the incidence of adverse events. J Eval Clin Pract. 2014;20(2):184-90. doi:10.1111/jep.12105.
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psnet.ahrq.gov/issue/natural-lifespan-safety-policy-violations-and-system-migration-anaesthesia
June 22, 2009 - Study
The natural lifespan of a safety policy: violations and system migration in anaesthesia.
Citation Text:
Maurice G de S, Auroy Y, Vincent CA, et al. The natural lifespan of a safety policy: violations and system migration in anaesthesia. Qual Saf Health Care. 2010;19(4):327-31. doi:…
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psnet.ahrq.gov/issue/adverse-event-reporting-tool-standardize-reporting-and-tracking-adverse-events-during
April 20, 2016 - Commentary
Adverse event reporting tool to standardize the reporting and tracking of adverse events during procedural sedation: a consensus document from the World SIVA International Sedation Task Force.
Citation Text:
Mason KP, Mason KP, Green SM, et al. Adverse event reporting tool t…
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www.ahrq.gov/hai/cusp/toolkit/culture-checkup.html
December 01, 2012 - Culture Check-Up Tool
CUSP Toolkit
Health care provider roles
Problem statement: Improving safety culture in a patient care area takes time.
What is culture? Attitudes reflect the norms, values, and beliefs in the unit and, in turn, create the culture. No matter what instrument you use to assess patient…
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/education/curriculum-tools/cusptoolkit/toolkit/Culture-Check-UpTool.docx
June 02, 2025 - Culture Check-Up Tool
Problem statement: Improving safety culture in a patient care area takes time.
What is culture? Attitudes reflect the norms, values, and beliefs in the unit and, in turn, create the culture. No matter what instrument you use to assess patient safety culture, your results provide a snapshot of th…
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www.ahrq.gov/news/newsroom/case-studies/cquips0901.html
October 01, 2014 - New York City Uses AHRQ Patient Safety Culture Survey to Reduce Patient Harm
Search All Impact Case Studies
November 2008
The New York City Health and Hospitals Corporation (HHC) has integrated the use of AHRQ's Hospital Survey on Patient Safety Culture as a core component of its corporate-wide patient sa…
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psnet.ahrq.gov/issue/potentially-inappropriate-prescribing-elderly-patients-2-outpatient-settings
November 18, 2009 - Study
Potentially inappropriate prescribing for elderly patients in 2 outpatient settings.
Citation Text:
Maio V, Hartmann CW, Poston S, et al. Potentially inappropriate prescribing for elderly patients in 2 outpatient settings. Am J Med Qual. 2006;21(3):162-8.
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www.ahrq.gov/news/newsroom/case-studies/ktcquips92.html
October 01, 2014 - Maryland Hospitals Revise Medication Reconciliation Process With AHRQ Toolkit
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April 2012
After participating in AHRQ-sponsored learning sessions and provider support calls, Delmarva Foundation for Medical Care, the Maryland Quality Improvement Organization (QIO), worked with h…
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/ambulatory-surgery/sections/implementation/training-tools/pfengagement-material-guide.docx
May 01, 2017 - Overview
Defining Patient and Family Engagement and its Benefits
· Slides 4-7
Patient and Family Expectations in the ASC
· Slides 8-10
Barriers, Facilitators, and Motivators
· Slides 11-18
General Communication Methods for Engaging Patients and Family Members
· Slides 19-21
Opportunities for Patient and Family Engageme…
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psnet.ahrq.gov/issue/who-makes-prescribing-decisions-hospital-inpatients-observational-study
January 30, 2013 - Study
Who makes prescribing decisions in hospital inpatients? An observational study.
Citation Text:
Ross S, Hamilton L, Ryan C, et al. Who makes prescribing decisions in hospital inpatients? An observational study. Postgrad Med J. 2012;88(1043):507-10. doi:10.1136/postgradmedj-2011-13…
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psnet.ahrq.gov/issue/interventions-improve-hand-hygiene-compliance-patient-care
September 09, 2020 - Review
Interventions to improve hand hygiene compliance in patient care.
Citation Text:
Gould DJ, Moralejo D, Drey N, et al. Interventions to improve hand hygiene compliance in patient care. Cochrane Database Syst Rev. 2017;9(9):CD005186. doi:10.1002/14651858.cd005186.pub4.
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psnet.ahrq.gov/issue/hidden-curriculum-and-residents-attitudes-about-medical-error-disclosure-comparison-surgical
September 30, 2020 - Study
The "hidden curriculum" and residents' attitudes about medical error disclosure: comparison of surgical and nonsurgical residents.
Citation Text:
Martinez W, Lehmann LS. The "hidden curriculum" and residents' attitudes about medical error disclosure: comparison of surgical and no…
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psnet.ahrq.gov/issue/minimizing-bias-when-using-artificial-intelligence-critical-care-medicine
September 23, 2020 - Review
Minimizing bias when using artificial intelligence in critical care medicine.
Citation Text:
Ranard BL, Park S, Jia Y, et al. Minimizing bias when using artificial intelligence in critical care medicine. J Crit Care. 2024;82:154796. doi:10.1016/j.jcrc.2024.154796.
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psnet.ahrq.gov/issue/speaking-patient-safety-hospital-based-health-care-professionals-literature-review
October 31, 2011 - Review
Speaking up for patient safety by hospital-based health care professionals: a literature review.
Citation Text:
Okuyama A, Wagner C, Bijnen B. Speaking up for patient safety by hospital-based health care professionals: a literature review. BMC Health Serv Res. 2014;14:61. doi:10.…
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psnet.ahrq.gov/issue/impact-age-anaesthesiologists-competence-narrative-review
December 15, 2014 - Review
Impact of age on anaesthesiologists' competence: a narrative review.
Citation Text:
Giacalone M, Zaouter C, Mion S, et al. Impact of age on anaesthesiologists' competence: A narrative review. Eur J Anaesthesiol. 2016;33(11):787-793.
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psnet.ahrq.gov/issue/equipped-overcoming-barriers-change-improve-quality-care-theories-change
May 23, 2018 - Commentary
Equipped: overcoming barriers to change to improve quality of care (theories of change).
Citation Text:
Lachman P, Runnacles J, Dudley J, et al. Equipped: overcoming barriers to change to improve quality of care (theories of change). Arch Dis Child Educ Pract Ed. 2015;100(1):1…
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psnet.ahrq.gov/issue/medication-orders-are-written-clearly-and-transcribed-accurately-implementing-medication
May 27, 2011 - Commentary
Medication orders are written clearly and transcribed accurately – implementing Medication Management Standard 3.20 and National Patient Safety Goal 2b.
Citation Text:
Laselle TJ, May SK. Medication Orders are Written Clearly and Transcribed Accurately – Implementing Medicatio…
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psnet.ahrq.gov/issue/courage-speak-out-study-describing-nurses-attitudes-report-unsafe-practices-patient-care
April 24, 2018 - Study
The courage to speak out: a study describing nurses' attitudes to report unsafe practices in patient care.
Citation Text:
Cole DA, Bersick E, Skarbek A, et al. The courage to speak out: A study describing nurses' attitudes to report unsafe practices in patient care. J Nurs Manag. 2…
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psnet.ahrq.gov/issue/understanding-psychological-safety-health-care-and-education-organizations-comparative
July 30, 2014 - Commentary
Understanding psychological safety in health care and education organizations: a comparative perspective.
Citation Text:
Edmondson AC, Higgins M, Singer SJ, et al. Understanding Psychological Safety in Health Care and Education Organizations: A Comparative Perspective. Res Hum…