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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety-2/vol1/Advances-woods_79.pdf
May 30, 2008 - identifying, assessing, and addressing risks in many life-critical industries that must
function with high reliability
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety-2/vol1/Advances-November_45.pdf
January 01, 2007 - Statistics
We used the kappa statistic to calculate inter-rater reliability among coders, which was
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www.ahrq.gov/patient-safety/reports/engage/results.html
March 01, 2017 - Team huddles and other principles of high-reliability organizations were recommended to reduce the opportunity
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effectivehealthcare.ahrq.gov/sites/default/files/related_files/behavioral-health-screening-disposition-comments.pdf
April 09, 2025 - Peer
Reviewer 1
Methods Was inter-rater reliability of coders who were deciding on article
inclusion … Assessing inter-rater reliability is
not recommended because conflict must
be resolved regardless of … inter-rater
reliability, sometimes with bringing in a third
investigator.
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psnet.ahrq.gov/innovation/i-readi-quality-and-safety-framework-strong-communications-channels-and-effective
February 26, 2025 - The I-READI Quality and Safety Framework: Strong Communications Channels and Effective Practices to Rapidly Update and Implement Clinical Protocols During a Time of Crisis
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Save to your library
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effectivehealthcare.ahrq.gov/sites/default/files/ebc-webinar-slides.pdf
June 01, 2014 - EBC-webinar-slides
Source:
www.effectivehealthcare.ahrq.gov
1
The Evidence-Based Care Challenge for NPs and PAs Webinar
Recorded March 7, 2013
Text Alternatives
Slide
1
The
Evidence-‐Based
Care
(EBC)
Challenge
for
NPs
and
PAs:
Using
Evidence
in…
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effectivehealthcare.ahrq.gov/sites/default/files/cer-239-acute-migraine-evidence-summary.pdf
December 01, 2020 - Evidence Summary for CER 239: Acute Treatments for Episodic Migraine
Comparative Effectiveness Review
Number 239
Acute Treatments for Episodic Migraine
Evidence Summary
Main Points
• Compared with placebo, treatments such as triptans, NSAIDs (nonsteroidal anti-
inflammatory drugs), dihydroergotamine, antieme…
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psnet.ahrq.gov/web-mm/add-case-and-missing-checklist
September 01, 2012 - Add-on Case and the Missing Checklist
Citation Text:
Catchpole K. Add-on Case and the Missing Checklist. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2017.
Copy Citation
Format:
Google Scholar BibTeX EndNote X3 XML En…
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psnet.ahrq.gov/web-mm/medical-devices-wild
March 27, 2024 - Medical Devices in the "Wild"
Citation Text:
Gurses AP, Doyle PA. Medical Devices in the "Wild". PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2014.
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Format:
Google Scholar BibTeX EndNote X3 XML EndNote 7 …
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psnet.ahrq.gov/web-mm/discharge-instructions-pacu-who-remembers
August 05, 2009 - Discharge Instructions in the PACU: Who Remembers?
Citation Text:
Engel KG. Discharge Instructions in the PACU: Who Remembers?. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2013.
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Format:
Google Scholar B…
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psnet.ahrq.gov/node/49419/psn-pdf
October 01, 2003 - The Other Side
October 1, 2003
Vincent CA. The Other Side. PSNet [internet]. 2003.
https://psnet.ahrq.gov/web-mm/other-side
Case Objectives
List the factors contributing to wrong site surgery.
Understand the key components of the Universal Protocol for eliminating wrong site, wrong
procedure, wrong person surger…
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www.ahrq.gov/research/findings/nhqrdr/chartbooks/blackhealth/part2.html
June 01, 2018 - Chartbook on Health Care for Blacks
Part 2: Trends in Priorities of the Heckler Report
Previous Page Next Page
Table of Contents
Chartbook on Health Care for Blacks
Health Care for Blacks
Acknowledgments
Part 1: Overviews of the Report and the Black Population
Part 2: Trends in Priorities of…
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www.ahrq.gov/patient-safety/diagnostic-excellence-grants/index.html
February 01, 2025 - Diagnostic Safety Centers of Excellence
In fiscal year 2022, Congress authorized funding to support AHRQ's research to address failures in the diagnostic process, which may include the establishment of Research Centers of Diagnostic Excellence to develop systems, measures, and new technology solutions to improv…
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psnet.ahrq.gov/sites/default/files/2022-10/spotlight_case_missed_pneumothorax_10.09.2022_-_final.pdf
January 01, 2022 - Spotlight
Spotlight
False Assumptions Result in a Missed
Pneumothorax after Bronchoscopy with
Transbronchial Biopsy
Source and Credits
• This presentation is based on the September 2022 AHRQ WebM&M
Spotlight Case
o See the full article at https://psnet.ahrq.gov/webmm
o CME credit is available
o Commentary by:…
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psnet.ahrq.gov/node/33662/psn-pdf
January 01, 2008 - In Conversation with…Jennifer Daley, MD
January 1, 2008
In Conversation with…Jennifer Daley, MD. PSNet [internet]. 2008.
https://psnet.ahrq.gov/perspective/conversation-withjennifer-daley-md
Editor's note: Jennifer Daley, MD, is the Chief Medical Officer of Partners Community Healthcare Inc., the
organization for …
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psnet.ahrq.gov/node/49475/psn-pdf
March 01, 2005 - Techno Trip
March 1, 2005
Cook RI. Techno Trip. PSNet [internet]. 2005.
https://psnet.ahrq.gov/web-mm/techno-trip
The Case
A 70-year-old woman was admitted to a community hospital after developing confusion and right-sided
weakness. A CT scan of her brain showed an acute subdural hematoma. The hospital arranged a…
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psnet.ahrq.gov/node/49795/psn-pdf
June 01, 2017 - The Perils of Contrast Media
June 1, 2017
Sadat U, Solomon R. The Perils of Contrast Media. PSNet [internet]. 2017.
https://psnet.ahrq.gov/web-mm/perils-contrast-media
Case Objectives
Recognize that contrast media are potentially nephrotoxic.
Identify key risk factors for the development of contrast-induced kidne…
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psnet.ahrq.gov/node/33864/psn-pdf
January 01, 2019 - How Does Health Care Simulation Affect Patient Care?
August 1, 2018
Lopreiato JO. How Does Health Care Simulation Affect Patient Care? PSNet [internet]. 2018.
https://psnet.ahrq.gov/perspective/how-does-health-care-simulation-affect-patient-care
Perspective
Introduction
Health care simulation programs have spread…
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psnet.ahrq.gov/node/60044/psn-pdf
March 16, 2020 - Patient Safety in Medical, Nursing, and Other Clinical
Education
March 16, 2020
Howley LD, Hall KK, Fitall E. Patient Safety in Medical, Nursing, and Other Clinical Education . PSNet
[internet]. 2020.
https://psnet.ahrq.gov/perspective/patient-safety-medical-nursing-and-other-clinical-education
Background
Despit…
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digital.ahrq.gov/sites/default/files/docs/page/buildinghealthitresearchcapacity.pdf
December 01, 2012 - Building Health IT Research Capacity
1
AHRQ Health Information Technology
Dissertation Grants
Building Health IT Research Capacity
The Agency for Healthcare Research and Quality’s
(AHRQ’s) Health Information Technology (IT) Port-
folio uses a variety of mechanisms to fund projects
that further the goals of the A…