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  1. digital.ahrq.gov/program-overview/research-stories/safer-inter-hospital-transfers-improving-access-health
    January 01, 2023 - Safer Inter-Hospital Transfers by Improving Access to Health Information Theme: Supporting Health Systems in Advancing Care Delivery Subtheme: Using Digital Healthcare Tools to Improve Patient Safety An enhanced health information exchange platform that improves workflow, interoperability,…
  2. digital.ahrq.gov/organization/university-washington
    January 01, 2023 - University of Washington Preventing Medication-Related Problems in Care Transitions to Skilled Nursing Facilities Description This research aims to determine the effectiveness of a program designed to reduce medication-related issues among patients during the hospital-to-skill…
  3. psnet.ahrq.gov/issue/swift-new-tool-identifying-prospective-hazards
    February 03, 2021 - Commentary Beyond FMEA: the structured what-if technique (SWIFT). Citation Text: Card AJ, Ward JR, Clarkson PJ. Beyond FMEA: The structured what-if technique (SWIFT). J Healthc Risk Manag. 2012;31(4):23-29. doi:10.1002/jhrm.20101. Copy Citation Format: DOI Google Scholar Bi…
  4. psnet.ahrq.gov/issue/spectrum-medical-errors-when-patients-sue
    October 28, 2020 - Review The spectrum of medical errors: when patients sue. Citation Text: Grant-Kels J, Kels B. The spectrum of medical errors: when patients sue. Int J Gen Med. 2012. doi:10.2147/ijgm.s24257. Copy Citation Format: DOI Google Scholar BibTeX EndNote X3 XML EndNote 7 XML End…
  5. www.ahrq.gov/practiceimprovement/systemdesign/leancasestudies/lean-exhibit6-2.html
    November 01, 2014 - Improving Care Delivery Through Lean: Implementation Case Studies Exhibit 6.2. Horizon Hospital—Lakeview Healthcare Previous Page Next Page Table of Contents Improving Care Delivery Through Lean: Implementation Case Studies Introduction to the Case Studies Case 1. Lakeview Healthcare Case 2. C…
  6. www.ahrq.gov/news/blog/ahrqviews/shaping-the-future-through-dhr.html
    September 01, 2024 - AHRQ Views: Blog posts from AHRQ leaders Shaping the Future of Patient Empowerment and Care Delivery Through Digital Healthcare Research SEP 24 2024 By Chris Dymek, Ed.D.          Chris Dymek, Ed.D. Providing healthcare consumers with evidence-based insights and p…
  7. psnet.ahrq.gov/issue/incidence-diagnostic-error-medicine
    July 15, 2015 - Review The incidence of diagnostic error in medicine. Citation Text: Graber ML. The incidence of diagnostic error in medicine. BMJ Qual Saf. 2013;22 Suppl 2:ii21-ii27. doi:10.1136/bmjqs-2012-001615. Copy Citation Format: DOI Google Scholar PubMed BibTeX EndNote X3 XML End…
  8. digital.ahrq.gov/location/usa-ct-new-haven
    January 01, 2023 - USA, CT, New Haven Using Electronic Health Records to Support Decision-Making in Pediatric Obesity Care Description This project will evaluate and compare different tools within electronic health records to assist pediatric primary care clinicians with providing higher quality…
  9. psnet.ahrq.gov/issue/senior-staff-safety-rounds-commitment-ensure-safety-top-priority
    May 30, 2018 - Commentary Senior staff safety rounds: a commitment to ensure safety is the top priority. Citation Text: Senior staff safety rounds: a commitment to ensure safety is the top priority. O'Connell RT, Ivy ME. NEJM Catalyst. May 1, 2018. Copy Citation Save Save to you…
  10. psnet.ahrq.gov/issue/root-cause-analysis-core-problem-solving-and-corrective-action-second-edition
    June 09, 2011 - Book/Report Classic Root Cause Analysis: The Core of Problem Solving and Corrective Action, Second Edition. Citation Text: Root Cause Analysis: The Core of Problem Solving and Corrective Action, Second Edition. Oakes D. Milwaukee, WI: ASQ Quality Press; 2019. IS…
  11. psnet.ahrq.gov/issue/major-congenital-malformations-after-first-trimester-exposure-ace-inhibitors
    July 10, 2008 - Study Major congenital malformations after first-trimester exposure to ACE inhibitors. Citation Text: Cooper WO, Hernandez-Diaz S, Arbogast PG, et al. Major Congenital Malformations after First-Trimester Exposure to ACE Inhibitors. New England Journal of Medicine. 2006;354(23). doi:10.…
  12. psnet.ahrq.gov/issue/rethinking-rapid-response-teams
    February 23, 2019 - Commentary Rethinking rapid response teams. Citation Text: Litvak E, Pronovost P. Rethinking rapid response teams. JAMA. 2010;304(12):1375-6. doi:10.1001/jama.2010.1385. Copy Citation Format: DOI Google Scholar PubMed BibTeX EndNote X3 XML EndNote 7 XML Endnote tagged Pub…
  13. psnet.ahrq.gov/issue/risk-models-improve-safety-dispensing-high-alert-medications-community-pharmacies
    December 02, 2020 - Study Risk models to improve safety of dispensing high-alert medications in community pharmacies. Citation Text: Cohen MR, Smetzer JL, Westphal JE, et al. Risk models to improve safety of dispensing high-alert medications in community pharmacies. J Am Pharm Assoc (2003). 2012;52(5):584-6…
  14. psnet.ahrq.gov/issue/improving-usability-intravenous-medication-labels-support-safe-medication-delivery
    September 26, 2016 - Study Improving the usability of intravenous medication labels to support safe medication delivery. Citation Text: Bauer DT, Guerlain S. Improving the usability of intravenous medication labels to support safe medication delivery. International journal of industrial ergonomics. 2011;41…
  15. psnet.ahrq.gov/issue/recent-evidence-health-it-improves-patient-safety-issue-brief
    June 29, 2016 - Book/Report Recent Evidence That Health IT Improves Patient Safety: Issue Brief. Citation Text: Recent Evidence That Health IT Improves Patient Safety: Issue Brief. Banger A, Graber ML. Washington, DC: Office of the National Coordinator for Health Information Technology; February 2015. …
  16. psnet.ahrq.gov/issue/patient-safety-20-slaying-dragons-not-just-investigating-them
    September 14, 2016 - Commentary Patient safety 2.0: slaying dragons, not just investigating them. Citation Text: Card AJ. Patient safety 2.0: slaying dragons, not just investigating them. J Patient Saf. 2023;19(6):394-395. doi:10.1097/pts.0000000000001140. Copy Citation Format: DOI Google Schol…
  17. psnet.ahrq.gov/issue/system-related-factors-contributing-diagnostic-errors
    January 11, 2023 - Review System-related factors contributing to diagnostic errors. Citation Text: Thammasitboon S, Thammasitboon S, Singhal G. System-related factors contributing to diagnostic errors. Curr Probl Pediatr Adolesc Health Care. 2013;43(9):242-7. doi:10.1016/j.cppeds.2013.07.004. Copy Citat…
  18. psnet.ahrq.gov/issue/identification-errors-pathology-and-laboratory-medicine
    October 19, 2022 - Commentary Identification errors in pathology and laboratory medicine. Citation Text: Valenstein PN, Sirota RL. Identification errors in pathology and laboratory medicine. Clin Lab Med. 2004;24(4):979-96, vii. Copy Citation Format: Google Scholar PubMed BibTeX EndNote X3 …
  19. www.ahrq.gov/ncepcr/research-transform-primary-care/transform/synthesis-report/conclusions.html
    October 01, 2015 - Findings From the AHRQ Transforming Primary Care Grant Initiative: A Synthesis Report Conclusions and Implications Previous Page Next Page Table of Contents Findings From the AHRQ Transforming Primary Care Grant Initiative: A Synthesis Report Executive Summary Introduction Methods Overview o…
  20. www.ahrq.gov/patient-safety/settings/long-term-care/resource/injuries/fallspx/manapb6.html
    February 01, 2023 - The Falls Management Program: A Quality Improvement Initiative for Nursing Facilities Appendix B11: Fall Interventions Plan Previous Page Next Page Table of Contents The Falls Management Program: A Quality Improvement Initiative for Nursing Facilities Chapter 1. Introduction and Program Overview …