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4481. Final Progress Report: Validity assessment of a real-time indicator of attentional load and task-induced fatigue in the MIS environment (pdf file)
      www.ahrq.gov/sites/default/files/2024-10/klein-report.pdf
      January 01, 2024 - Final Progress Report: Validity assessment of a real-time indicator of attentional load and task-induced fatigue in the MIS environment Final Progress Report to the Agency for Healthcare Research and Quality Title of Project Validity assessment of a real-time indicator of attentional load and task-induced fatigue i…

4482. Final progress report: Developing Evidence for Safety Surveillance from Device Adverse Event Reports (pdf file)
      www.ahrq.gov/sites/default/files/2025-02/mao-report.pdf
      January 01, 2025 - Final progress report: Developing Evidence for Safety Surveillance from Device Adverse Event Reports Final progress report Developing Evidence for Safety Surveillance from Device Adverse Event Reports Grant number: 1R03HS026291-01 Supported by AGENCY FOR HEALTHCARE RESEARCH AND QUALITY Research Team Principal invest…

4483. Final Progress Report: Creating Learning Cultures Around Mistakes for Residents (pdf file)
      www.ahrq.gov/sites/default/files/2024-02/hoff-report.pdf
      January 01, 2024 - Final Progress Report: Creating Learning Cultures Around Mistakes for Residents 1 Project Title: Creating Learning Cultures Around Mistakes for Residents Timothy J. Hoff, PhD, Principal Investigator University at Albany, SUNY School of Public Health Henry Pohl, MD, Co-Investigator Joel Bartfield, MD, Co-Investi…

4484. Final Progress Report: Evaluating and Improving Present-On-Admission for Performance Reporting (pdf file)
      www.ahrq.gov/sites/default/files/2025-02/goldman-report.pdf
      January 01, 2025 - Final Progress Report: Evaluating and Improving Present-On-Admission for Performance Reporting Evaluating and Improving Present-On-Admission for Performance Reporting L. E lizabeth Goldman, MD, MCR, Principal Investigator Andrew Bindman, MD, Peter Bacchetti, PhD, Co-Investigators University of California, San …

4485. Fillmore (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/prevention-chronic-care/improve/system/pfcasestudies/fillmore.pdf
      August 01, 2014 - c Case Studies of EXEMPLARY PRIMARY CARE PRACTICE FACILITATION TRAINING PROGRAMS Agency for Healthcare Research and Quality Advancing Excellence in Health Care www.ahrq.gov The PCM Portfolio graphic element is intended to be closely aligned with AHRQ's overall brand,…

4486. Final Progress Report: ED Staffing and Patient Outcomes (pdf file)
      www.ahrq.gov/sites/default/files/2024-09/bickell-report.pdf
      January 01, 2024 - Final Progress Report: ED Staffing and Patient Outcomes ED Staffing and Patient Outcomes Final Report Nina A. Bickell, MD, MPH, Principal Investigator Team Members: Rebecca Anderson, MPH, Project Manager Carol Barsky, MD, Co-Investigator Mary Rojas, PhD, Co-Investigator Department of Health Policy Moun…

4487. Final Progress report: Creating High Reliability Organizations (pdf file)
      www.ahrq.gov/sites/default/files/2024-03/small-report.pdf
      January 01, 2024 - Final Progress report: Creating High Reliability Organizations Creating High Reliability Organizations Principal Investigator: Stephen D. Small, MD Key Team Members: Kay Metis, MS, MA Bobbie J. Sweitzer, MD Paul Barach, MD (2001-2002) Additional funded collaborators: Julie Mohr, PhD David Meltzer, MD, …

4488. Final Progress Report: Are Volume Standards Accurate Measures? (pdf file)
      www.ahrq.gov/sites/default/files/2024-10/glance-report.pdf
      January 01, 2024 - Final Progress Report: Are Volume Standards Accurate Measures? FINAL PROGRESS REPORT: ARE VOLUME STANDARDS ACCURATE MEASURES? Principal Investigator: Laurent G. Glance, M.D. Co-Investigators: Andrew W. Dick, Ph.D. Turner M. Osler, M.D. Dana B. Mukamel, Ph.D. Organization: University of Rochester School of Medic…

4489. Final Progress Report: Oral Chemotherapy Safety in Ambulatory Oncology: A Proactive Risk Assessment (pdf file)
      www.ahrq.gov/sites/default/files/2024-01/weingart-report.pdf
      January 01, 2024 - Final Progress Report: Oral Chemotherapy Safety in Ambulatory Oncology: A Proactive Risk Assessment Final Progress Report 1.0 TITLE PAGE Oral Chemotherapy Safety in Ambulatory Oncology: A Proactive Risk Assessment Principal Investigator Saul N. Weingart, MD, PhD Co-Investigators Maureen Connor, RN, MPH Syl…

4490. Presentation: Building Your SSI Prevention Bundle
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/surgery/modules/onboarding/onboarding_build_ssibundle.pptx
      December 01, 2017 - Presentation: Building Your SSI Prevention Bundle Building Your SSI Prevention Bundle AHRQ Safety Program for Surgery Onboarding AHRQ Pub No. 16(18)-0004-15-EF December 2017 SAY: In this module, you’ll learn about using building a local bundle to reduce surgical site infections. 1 Learning Objectives After this se…

4491. 2025 AHRQ Surveys on Patient Safety Culture® (SOPS®) Nursing Home Survey Version 2.0 Pilot Test Results (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/sops/surveys/nursing-home/2025-nursing-home-20-pilot-test-results.pdf
      January 01, 2025 - 2025 AHRQ Surveys on Patient Safety Culture® (SOPS®) Nursing Home Survey Version 2.0 Pilot Test Results 2025 AHRQ Surveys on Patient Safety Culture® (SOPS®) Nursing Home Survey Version 2.0 Pilot Test Results Prepared for: Agency for Healthcare Research and Quality U.S. Department of Health and Human Services …

4492. Improving Workplace Safety in Hospitals: A Resource List for Users of the AHRQ Workplace Safety Supplemental Item Set (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/sops/surveys/nursing-home/workplace-safety-resources.pdf
      May 01, 2023 - Improving Workplace Safety in Hospitals: A Resource List for Users of the AHRQ Workplace Safety Supplemental Item Set SOPS Workplace Safety for Hospitals Supplemental Item Set Resource List 1 Improving Workplace Safety in Hospitals: A Resource List for Users of the AHRQ Workplace Safety Supplemental Item Set I…

4493. National Advisory Council Meeting, July 14, 2020: Minutes (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/news/events/nac/2020-07-nac/nacminutes-071420.pdf
      January 01, 2020 - National Advisory Council Meeting, July 14, 2020: Minutes National Advisory Council, July 14, 2020 Page 1 Agency for Healthcare Research and Quality National Advisory Council Meeting (Virtual Meeting) July 14, 2020 SUMMARY NAC Members Present Tina M. Hernandez-Boussard, Ph.D., M.…

4494. Meeting Minutes, July 2020 | Agency for Healthcare Research and Quality
      www.ahrq.gov/news/events/nac/2020-07-nac/nacmtg071420-minutes.html
      November 01, 2020 - Meeting Minutes, July 2020 National Advisory Council Minutes from the July 14, 2020, meeting of the Agency for Healthcare Research and Quality's National Advisory Council. ( Virtual Meeting ) Contents Summary Call to Order and Approval of March 26, 2020, Meeting Summary Overview and Recent Accomplis…

4495. Meeting Minutes (Draft), November 2023 | Agency for Healthcare Research and Quality
      www.ahrq.gov/news/events/nac/2023-11-nac/nacmtg111623-minutes.html
      January 01, 2024 - Meeting Minutes (Draft), November 2023 Minutes from the November 16, 2023, meeting of the Agency for Healthcare Research and Quality's National Advisory Council. Contents Summary Call to Order and Approval of July 12, 2023, Meeting Summary AHRQ Director’s Highlights Consumer Experience Measurement: C…

4496. An Analysis of Nurses' Cognitive Work: A New Perspective for Understanding Medical Errors (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol1/Potter.pdf
      January 01, 2003 - An Analysis of Nurses' Cognitive Work: A New Perspective for Understanding Medical Errors 39 An Analysis of Nurses’ Cognitive Work: A New Perspective for Understanding Medical Errors Patricia Potter, Laurie Wolf, Stuart Boxerman, Deborah Grayson, Jennifer Sledge, Clay Dunagan, Bradley Evanoff Abstract He…

4497. The Contribution of Diagnostic Errors to Maternal Morbidity and Mortality During and Immediately After Childbirth: State of the Science (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/patient-safety/reports/issue-briefs/dxsafety-issuebrief-maternal-morbidity.pdf
      September 01, 2021 - The Contribution of Diagnostic Errors to Maternal Morbidity and Mortality During and Immediately After Childbirth: State of the Science PATIENT SAFETY e Issue Brief 6 The Contribution of Diagnostic Errors to Maternal Morbidity and Mortality During and Immediately After Childbirth: State of the Science This…

4498. Usability Testing and the Relation of Clinical Information Systems to Patient Safety (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol2/Rogers.pdf
      January 01, 2003 - Usability Testing and the Relation of Clinical Information Systems to Patient Safety 365 Usability Testing and the Relation of Clinical Information Systems to Patient Safety Michelle L. Rogers, Emily Patterson, Roger Chapman, Marta Render Abstract Background: The success of clinical information systems depend…

4499. Validation of AHRQ’s Patient Safety Indicator for Accidental Puncture or Laceration (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol2/Gallagher1.pdf
      January 01, 2004 - Validation of AHRQ’s Patient Safety Indicator for Accidental Puncture or Laceration 27 Validation of AHRQ’s Patient Safety Indicator for Accidental Puncture or Laceration Brian Gallagher, Liyi Cen, Edward L. Hannan Abstract Objectives: This study examined whether clinical evidence in medical records confirms…

4500. Readmissions for Selected Infections Due to Medical Care: Expanding the Definition of a Patient Safety Indicator (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol2/Gallagher2.pdf
      January 01, 2016 - Readmissions for Selected Infections Due to Medical Care: Expanding the Definition of a Patient Safety Indicator 39 Readmissions for Selected Infections Due to Medical Care: Expanding the Definition of a Patient Safety Indicator Brian Gallagher, Liyi Cen, Edward L. Hannan Abstract Objective: Evaluate the A…