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psnet.ahrq.gov/issue/mobile-situ-obstetric-emergency-simulation-and-teamwork-training-improve-maternal-fetal
July 09, 2008 - Study
Mobile in situ obstetric emergency simulation and teamwork training to improve maternal–fetal safety in hospitals.
Citation Text:
Guise J-M, Lowe NK, Deering S, et al. Mobile in situ obstetric emergency simulation and teamwork training to improve maternal-fetal safety in hospitals.…
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psnet.ahrq.gov/issue/impact-critical-event-checklists-medical-management-and-teamwork-during-simulated-crises
November 04, 2009 - Study
The impact of critical event checklists on medical management and teamwork during simulated crises in a surgical daycare facility.
Citation Text:
Everett TC, Morgan PJ, Brydges R, et al. The impact of critical event checklists on medical management and teamwork during simulated cri…
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psnet.ahrq.gov/issue/electronic-health-record-modernization-caused-pharmacy-related-patient-safety-issues
January 31, 2024 - Book/Report
Electronic Health Record Modernization Caused Pharmacy-Related Patient Safety Issues Nationally and at the VA Central Ohio Healthcare System in Columbus.
Citation Text:
Electronic Health Record Modernization Caused Pharmacy-Related Patient Safety Issues Nationally and at the …
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www.ahrq.gov/patient-safety/settings/hospital/match/intro.html
July 01, 2022 - Medications at Transitions and Clinical Handoffs (MATCH) Toolkit for Medication Reconciliation
Introduction
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Table of Contents
Medications at Transitions and Clinical Handoffs (MATCH) Toolkit for Medication Reconciliation
Introduction
Chapter 1. Building the Project Founda…
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psnet.ahrq.gov/issue/association-measured-quality-and-future-financial-performance-among-hospitals-performing
May 04, 2022 - Study
Association of measured quality and future financial performance among hospitals performing cardiac surgery.
Citation Text:
Enumah SJ, Sundt TM, Chang DC. Association of measured quality and future financial performance among hospitals performing cardiac surgery. J Healthc Manag. 2…
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psnet.ahrq.gov/issue/enculturation-unsafe-attitudes-and-behaviors-student-perceptions-safety-culture
October 31, 2012 - Study
Enculturation of unsafe attitudes and behaviors: student perceptions of safety culture.
Citation Text:
Bowman C, Neeman N, Sehgal NL. Enculturation of unsafe attitudes and behaviors: student perceptions of safety culture. Acad Med. 2013;88(6):802-10. doi:10.1097/ACM.0b013e31828fd4f…
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psnet.ahrq.gov/issue/structure-and-outcomes-interdisciplinary-rounds-hospitalized-medicine-patients-systematic
January 23, 2017 - Review
Structure and outcomes of interdisciplinary rounds in hospitalized medicine patients: a systematic review and suggested taxonomy.
Citation Text:
Bhamidipati S, Elliott DJ, Justice EM, et al. Structure and outcomes of interdisciplinary rounds in hospitalized medicine patients: A sy…
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www.ahrq.gov/news/newsroom/case-studies/cquips0703.html
October 01, 2014 - Military Hospitals Employ AHRQ Hospital Survey on Patient Safety Culture
Search All Impact Case Studies
May 2007
The Department of Defense Patient Safety Program chose AHRQ's Hospital Survey on Patient Safety Culture as an anonymous, Web-based initiative to assess staff attitudes and beliefs about patient…
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www.ahrq.gov/news/newsroom/case-studies/201419.html
November 01, 2014 - Peterson Regional Medical Center Uses AHRQ's CUSP and Hospital Survey to Advance Patient Safety
Search All Impact Case Studies
November 2014
Peterson Regional Medical Center, a 125-bed rural hospital in Kerrville, TX, is using AHRQ's Comprehensive Unit-based Safety Program (CUSP) to eliminate central-line…
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psnet.ahrq.gov/issue/impact-medication-reconciliation-improving-transitions-care
June 19, 2019 - Review
Emerging Classic
Impact of medication reconciliation for improving transitions of care.
Citation Text:
Redmond P, Grimes TC, McDonnell R, et al. Impact of medication reconciliation for improving transitions of care. Cochrane Database Syst Rev. 2018;8(8):C…
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psnet.ahrq.gov/issue/prevalence-and-predictors-delayed-clinical-diagnosis-type-2-diabetes-longitudinal-cohort
August 04, 2021 - Study
Prevalence and predictors of delayed clinical diagnosis of Type 2 diabetes: a longitudinal cohort study.
Citation Text:
Gopalan A, Mishra P, Alexeeff SE, et al. Prevalence and predictors of delayed clinical diagnosis of Type 2 diabetes: a longitudinal cohort study. Diabet Med. 2018…
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psnet.ahrq.gov/issue/urgent-need-improve-health-care-quality-institute-medicine-national-roundtable-health-care
May 27, 2015 - Commentary
Classic
The urgent need to improve health care quality. Institute of Medicine National Roundtable on Health Care Quality.
Citation Text:
Chassin MR, Galvin RW. The urgent need to improve health care quality. Institute of Medicine National Roundtable o…
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psnet.ahrq.gov/issue/factors-influencing-incident-reporting-surgical-care
March 03, 2011 - Study
Factors influencing incident reporting in surgical care.
Citation Text:
Kreckler S, Catchpole K, McCulloch P, et al. Factors influencing incident reporting in surgical care. Qual Saf Health Care. 2009;18(2):116-20. doi:10.1136/qshc.2008.026534.
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www.ahrq.gov/sites/default/files/wysiwyg/cahps/news-and-events/events/webinars/cahps-creative-strategies-lee.pdf
June 02, 2025 - Creative Strategies to Improve Patient Care Experience - Part 4 Lee
What Is A Creative Idea?
Creative idea: An idea that is novel and useful
Creative
Improvement
Ideas
Process
Improvement
Promoting efficiency
by tweaking existing
routines
Patient Engagement
Enhancing patient
partnership by
knowing…
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psnet.ahrq.gov/issue/5th-national-audit-project-nap5-accidental-awareness-during-general-anaesthesia-patient
October 01, 2014 - Study
The 5th National Audit Project (NAP5) on accidental awareness during general anaesthesia: patient experiences, human factors, sedation, consent and medicolegal issues.
Citation Text:
Cook TM, Andrade J, Bogod DG, et al. The 5th National Audit Project (NAP5) on accidental awareness …
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psnet.ahrq.gov/issue/randomized-trial-improve-prescribing-safety-ambulatory-elderly-patients
March 10, 2011 - Study
Randomized trial to improve prescribing safety in ambulatory elderly patients.
Citation Text:
Raebel MA, Charles J, Dugan J, et al. Randomized trial to improve prescribing safety in ambulatory elderly patients. J Am Geriatr Soc. 2007;55(7):977-85.
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psnet.ahrq.gov/issue/racial-disparities-maternal-mortality-and-impact-structural-racism-and-implicit-racial-bias
July 13, 2009 - Review
The racial disparities in maternal mortality and impact of structural racism and implicit racial bias on pregnant Black women: a review of the literature.
Citation Text:
Montalmant KE, Ettinger AK. The racial disparities in maternal mortality and impact of structural racism and im…
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psnet.ahrq.gov/issue/implementation-medication-reconciliation-outpatient-cancer-care
December 20, 2023 - Study
Implementation of medication reconciliation in outpatient cancer care.
Citation Text:
Powis M, Dara C, Macedo A, et al. Implementation of medication reconciliation in outpatient cancer care. BMJ Open Quality. 2023;12(2):e002211. doi:10.1136/bmjoq-2022-002211.
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psnet.ahrq.gov/issue/talking-patients-about-other-clinicians-errors
October 27, 2021 - Study
Classic
Talking with patients about other clinicians' errors.
Citation Text:
Gallagher TH, Mello MM, Levinson W, et al. Talking with patients about other clinicians' errors. N Engl J Med. 2013;369(18):1752-7. doi:10.1056/NEJMsb1303119.
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digital.ahrq.gov/2018-year-review/research-dissemination/conference-proceedings/ahrq-funded-research-2018-amia-annual-symposium
January 01, 2018 - AHRQ-Funded Research at the 2018 AMIA Annual Symposium
Investigator Name
AHRQ Research Profile
AMIA Title
Type
Abraham, Joanna
An Etiology for Medication Ordering Errors in Computerized Provider Order Entry Systems
Clinician Perspectives on Duplicate Medication Ordering…