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digital.ahrq.gov/ahrq-funded-projects/past-initiatives/state-and-regional-demonstration-projects/delaware
January 01, 2023 - Delaware
Project Overview | Data and Functionality | Technical Design and Architecture
Project Overview
The goal of this initiative is to facilitate the design and implementation of an integrated, statewide health data system to support the information needs of healthcare provide…
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digital.ahrq.gov/health-care-theme/human-factors
January 01, 2023 - Human Factors
Artificial Intelligence and Human Factors in Healthcare Quality & Safety
Description
Using a conference model, this study convenes a multidisciplinary group of experts to explore the integration of human factors engineering approaches in the implementation of art…
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psnet.ahrq.gov/issue/missed-nursing-care-concept-analysis
January 19, 2022 - Commentary
Missed nursing care: a concept analysis.
Citation Text:
Kalisch BJ, Landstrom GL, Hinshaw AS. Missed nursing care: a concept analysis. J Adv Nurs. 2009;65(7):1509-17. doi:10.1111/j.1365-2648.2009.05027.x.
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psnet.ahrq.gov/issue/technical-mistakes-during-acquisition-electrocardiogram
March 09, 2022 - Review
Technical mistakes during the acquisition of the electrocardiogram.
Citation Text:
García-Niebla J, Llontop-García P, Valle-Racero JI, et al. Technical mistakes during the acquisition of the electrocardiogram. Ann Noninvasive Electrocardiol. 2009;14(4):389-403. doi:10.1111/j.154…
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psnet.ahrq.gov/issue/nursing-strategies-increase-medication-safety-inpatient-settings
September 21, 2016 - Study
Nursing strategies to increase medication safety in inpatient settings.
Citation Text:
Bravo K, Cochran GL, Barrett R. Nursing Strategies to Increase Medication Safety in Inpatient Settings. J Nurs Care Qual. 2016;31(4):335-41. doi:10.1097/NCQ.0000000000000181.
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psnet.ahrq.gov/issue/improving-acceptance-computerized-prescribing-alerts-ambulatory-care
July 10, 2008 - Study
Improving acceptance of computerized prescribing alerts in ambulatory care.
Citation Text:
Shah N, Seger AC, Seger DL, et al. Improving acceptance of computerized prescribing alerts in ambulatory care. J Am Med Inform Assoc. 2006;13(1):5-11.
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psnet.ahrq.gov/issue/improving-diagnostic-decision-support-through-deliberate-reflection-proposal
September 23, 2020 - Commentary
Improving diagnostic decision support through deliberate reflection: a proposal.
Citation Text:
Schmidt HG, Mamede S. Improving diagnostic decision support through deliberate reflection: a proposal. Diagnosis (Berl). 2023;10(1):38-42. doi:10.1515/dx-2022-0062.
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psnet.ahrq.gov/issue/economics-patient-safety-primary-and-ambulatory-care-flying-blind
April 12, 2017 - Book/Report
Emerging Classic
The Economics of Patient Safety in Primary and Ambulatory Care: Flying Blind.
Citation Text:
The Economics of Patient Safety in Primary and Ambulatory Care: Flying Blind. Slawomirski L, Auraaen A, Klazinga N. Paris, France: Organisat…
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psnet.ahrq.gov/issue/new-cms-hospital-quality-star-ratings-stars-are-not-aligned
May 26, 2021 - Commentary
The new CMS hospital quality star ratings: the stars are not aligned.
Citation Text:
Bilimoria KY, Barnard C. The New CMS Hospital Quality Star Ratings: The Stars Are Not Aligned. JAMA. 2016;316(17):1761-1762. doi:10.1001/jama.2016.13679.
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psnet.ahrq.gov/issue/diagnostic-reasoning-and-cognitive-biases-nurse-practitioners
October 19, 2022 - Review
Diagnostic reasoning and cognitive biases of nurse practitioners.
Citation Text:
Lawson TN. Diagnostic Reasoning and Cognitive Biases of Nurse Practitioners. J Nurs Educ. 2018;57(4):203-208. doi:10.3928/01484834-20180322-03.
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psnet.ahrq.gov/issue/research-nursing-handoffs-medical-and-surgical-settings-integrative-review
October 19, 2011 - Review
Research on nursing handoffs for medical and surgical settings: an integrative review.
Citation Text:
Staggers N, Blaz JW. Research on nursing handoffs for medical and surgical settings: an integrative review. J Adv Nurs. 2013;69(2):247-62. doi:10.1111/j.1365-2648.2012.06087.x. …
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psnet.ahrq.gov/issue/automatic-errors-case-series-errors-inherent-electronic-prescribing
March 14, 2022 - Commentary
Automatic errors: a case series on the errors inherent in electronic prescribing.
Citation Text:
Lourenco LM, Bursua A, Groo VL. Automatic Errors: A Case Series on the Errors Inherent in Electronic Prescribing. J Gen Intern Med. 2016;31(7):808-811. doi:10.1007/s11606-016-3606-…
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psnet.ahrq.gov/issue/there-benefit-multidisciplinary-rounds-open-trauma-intensive-care-unit-regarding-ventilator
January 06, 2010 - Study
Is there a benefit to multidisciplinary rounds in an open trauma intensive care unit regarding ventilator-associated pneumonia?
Citation Text:
Johnson V, Mangram A, Mitchell C, et al. Is there a benefit to multidisciplinary rounds in an open trauma intensive care unit regarding v…
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psnet.ahrq.gov/issue/creating-fair-and-just-culture-one-institutions-path-toward-organizational-change
July 23, 2014 - Commentary
Creating a fair and just culture: one institution's path toward organizational change.
Citation Text:
Connor M, Duncombe D, Barclay E, et al. Creating a fair and just culture: one institution's pat toward organizational change. Jt Comm J Qual Patient Saf. 2007;33(10):617-24.
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psnet.ahrq.gov/issue/failure-report-poor-care-breach-moral-and-professional-expectation
March 05, 2025 - Commentary
Failure to report poor care as a breach of moral and professional expectation.
Citation Text:
Ion R, Olivier S, Darbyshire P. Failure to report poor care as a breach of moral and professional expectation. Nurs Inq. 2019;26(3):e12299. doi:10.1111/nin.12299.
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psnet.ahrq.gov/issue/comprehensive-collaborative-patient-safety-residency-curriculum-address-acgme-core
October 06, 2011 - Commentary
A comprehensive collaborative patient safety residency curriculum to address the ACGME core competencies.
Citation Text:
Singh R, Naughton B, Taylor JS, et al. A comprehensive collaborative patient safety residency curriculum to address the ACGME core competencies. Med Educ.…
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psnet.ahrq.gov/issue/safety-mind-mental-health-services-and-patient-safety
August 07, 2018 - Book/Report
With Safety in Mind: Mental Health Services and Patient Safety.
Citation Text:
With Safety in Mind: Mental Health Services and Patient Safety. Scobie S, Minghella E, Dale C, et al. London, UK: National Patient Safety Agency; 2006.
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psnet.ahrq.gov/issue/complications-surgery-root-cause-analysis-and-preventive-measures
November 24, 2021 - Commentary
Complications in surgery: root cause analysis and preventive measures.
Citation Text:
Chung KC, Kotsis S. Complications in surgery: root cause analysis and preventive measures. Plast Reconstr Surg. 2012;129(6):1421-1427. doi:10.1097/PRS.0b013e31824ecda0.
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psnet.ahrq.gov/issue/problem-5-whys
July 19, 2023 - Commentary
The problem with the '5 whys.'
Citation Text:
Card AJ. The problem with '5 whys'. BMJ Qual Saf. 2017;26(8):671-677. doi:10.1136/bmjqs-2016-005849.
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psnet.ahrq.gov/issue/she-hoped-shine-light-maternal-mortality-among-native-americans-instead-she-became-statistic
July 22, 2020 - Newspaper/Magazine Article
She hoped to shine a light on maternal mortality among Native Americans. Instead, she became a statistic of it.
Citation Text:
She hoped to shine a light on maternal mortality among Native Americans. Instead, she became a statistic of it. Chuck E, Assefa H. N…