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psnet.ahrq.gov/issue/using-six-sigma-reduce-medication-errors-home-delivery-pharmacy-service
November 18, 2015 - Study
Using Six Sigma to reduce medication errors in a home-delivery pharmacy service.
Citation Text:
Castle L, Franzblau-Isaac E, Paulsen J. Using Six Sigma to reduce medication errors in a home-delivery pharmacy service. Jt Comm J Qual Patient Saf. 2005;31(6):319-24.
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psnet.ahrq.gov/issue/improving-sepsis-care-through-systems-change-impact-medical-emergency-team
December 02, 2009 - Commentary
Improving sepsis care through systems change: the impact of a medical emergency team.
Citation Text:
Sarani B, Brenner SR, Gabel B, et al. Improving sepsis care through systems change: the impact of a medical emergency team. Jt Comm J Qual Patient Saf. 2008;34(3):179-182, 12…
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psnet.ahrq.gov/issue/quality-improvement-through-implementation-discharge-order-reconciliation
September 23, 2020 - Commentary
Quality improvement through implementation of discharge order reconciliation.
Citation Text:
Lu Y, Clifford P, Bjorneby A, et al. Quality improvement through implementation of discharge order reconciliation. Am J Health Syst Pharm. 2013;70(9):815-20. doi:10.2146/ajhp120050. …
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psnet.ahrq.gov/issue/diagnostic-errors-orthopedic-surgery-evaluation-resident-documentation-neurovascular
December 31, 2014 - Study
Diagnostic errors in orthopedic surgery: evaluation of resident documentation of neurovascular examinations for orthopedic trauma patients.
Citation Text:
Tan EW, Ting BL, Jia X, et al. Diagnostic errors in orthopedic surgery: evaluation of resident documentation of neurovascular …
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www.ahrq.gov/sites/default/files/wysiwyg/nhguide/5_TK2_P3T6-Sample_Vignettes_Phase_3_final.pdf
May 01, 2014 - Sample Vignettes
Advancing Excellence in Health Care www.ahrq.gov
Agency for Healthcare Research and Quality HAIs
Healthcare-
Associated
Infections
PREVENT
Comprehensive Antibiogram Toolkit: Phase 3
Sample Vignettes
The following series of vignettes are similar to cases that a prescribing clinician may be pr…
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www.ahrq.gov/sites/default/files/wysiwyg/antibiotic-use/long-term-care/learning-from-antibiotic-adverse.docx
June 01, 2021 - AHRQ Safety Program for Improving Antibiotic Use
Learning From Antibiotic-Associated Adverse Events
An antibiotic-associated adverse event is any event or situation that you would not want to happen again because it either caused your patient harm or had the potential to cause harm. The purpose of this tool is to provi…
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psnet.ahrq.gov/issue/limited-health-literacy-barrier-medication-reconciliation-ambulatory-care
March 24, 2010 - Study
Limited health literacy is a barrier to medication reconciliation in ambulatory care.
Citation Text:
Persell SD, Osborn CY, Richard R, et al. Limited health literacy is a barrier to medication reconciliation in ambulatory care. J Gen Intern Med. 2007;22(11):1523-6.
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psnet.ahrq.gov/issue/copying-and-pasting-examinations-within-electronic-medical-record
June 12, 2013 - Study
Copying and pasting of examinations within the electronic medical record.
Citation Text:
Thielke S, Hammond K, Helbig S. Copying and pasting of examinations within the electronic medical record. Int J Med Inform. 2007;76 Suppl 1:S122-8.
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Format:
Google …
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www.ahrq.gov/hai/cauti-tools/phys-championsgd/section2.html
October 01, 2015 - Resident Physicians as Champions in Preventing Device-Associated Infections
Epidemiology of Invasive Devices and Complications
Previous Page Next Page
Table of Contents
Resident Physicians as Champions in Preventing Device-Associated Infections
Preamble and Summary
Epidemiology of Invasive Devic…
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psnet.ahrq.gov/issue/improving-safety-and-quality-care-enhanced-teamwork-through-operating-room-briefings
May 11, 2019 - Commentary
Improving safety and quality of care with enhanced teamwork through operating room briefings.
Citation Text:
Hicks CW, Rosen MA, Hobson DB, et al. Improving safety and quality of care with enhanced teamwork through operating room briefings. JAMA Surg. 2014;149(8):863-8. doi:10…
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psnet.ahrq.gov/issue/sleep-and-circadian-misalignment-hospitalist-review
July 15, 2020 - Review
Sleep and circadian misalignment for the hospitalist: a review.
Citation Text:
Schaefer EW, Williams M, Zee PC. Sleep and circadian misalignment for the hospitalist: a review. J Hosp Med. 2012;7(6):489-96. doi:10.1002/jhm.1903.
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Format:
DOI Google Schola…
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psnet.ahrq.gov/issue/health-care-worker-fatigue-and-patient-safety
December 23, 2016 - Sentinel Event Alerts
Health care worker fatigue and patient safety.
Citation Text:
Health care worker fatigue and patient safety. Sentinel Event Alert. December 14, 2011;(48):1-4. (addendum May 14, 2018).
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Do…
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psnet.ahrq.gov/issue/effect-blue-enriched-lighting-medical-error-rate-university-hospital-icu
March 10, 2021 - Study
The effect of blue-enriched lighting on medical error rate in a university hospital ICU.
Citation Text:
Chen Y, Broman AT, Priest G, et al. The Effect of Blue-Enriched Lighting on Medical Error Rate in a University Hospital ICU. Jt Comm J Qual Saf. 2021;47(3):165-175. doi:10.1016/j…
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psnet.ahrq.gov/issue/utilizing-information-technology-mitigate-handoff-risks-caused-resident-work-hour
March 17, 2010 - Commentary
Utilizing information technology to mitigate the handoff risks caused by resident work hour restrictions.
Citation Text:
Bernstein J, MacCourt DC, Jacob DM, et al. Utilizing information technology to mitigate the handoff risks caused by resident work hour restrictions. Clin …
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psnet.ahrq.gov/issue/drug-formulations-require-potentially-inaccurate-volumes-prepare-doses-infants-and-children
April 22, 2011 - Study
Drug formulations that require potentially inaccurate volumes to prepare doses for infants and children.
Citation Text:
Uppal N, Yasseen B, Seto W, et al. Drug formulations that require less than 0.1 mL of stock solution to prepare doses for infants and children. CMAJ. 2011;183(4…
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psnet.ahrq.gov/issue/risk-management-or-just-different-risk-national-survey-newborn-units-following-patient-safety
April 12, 2011 - Study
Risk management, or just a different risk: a national survey of newborn units following a patient safety alert.
Citation Text:
Freer Y. Risk management, or just a different risk? Archives of Disease in Childhood - Fetal and Neonatal Edition. 2006;91(5). doi:10.1136/adc.2005.08954…
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psnet.ahrq.gov/issue/challenges-and-opportunities-agency-healthcare-research-and-quality-ahrq-research-summit
October 04, 2020 - Meeting/Conference Proceedings
Challenges and opportunities from the Agency for Healthcare Research and Quality (AHRQ) research summit on improving diagnosis: a proceedings review.
Citation Text:
Henriksen K, Dymek C, Harrison MI, et al. Challenges and opportunities from the Agency for H…
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hcup-us.ahrq.gov/reports/methods/2019-04.pdf
January 01, 2019 - It is possible that
residents using that P.O. Box for mail service live in a different county. … However, the ED visits for residents of the county were
dispersed across 48 hospitals overall—only 4 … In this case, the inpatient stays for residents of the
county were dispersed across only 22 hospitals … According to Wikipedia, Boulder County lost about 40,000 residents to Broomfield County in 2001
(https
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psnet.ahrq.gov/node/49773/psn-pdf
July 01, 2016 - laboratory findings.(11,12)
In this case, the primary discussion of the management plan focused on the two residents
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hcup-us.ahrq.gov/reports/statbriefs/sb182-Medicaid-Uninsured-Hospitalizations-2012.jsp
October 01, 2014 - residency program, is a member of the Council of Teaching Hospitals, or has 25 or more interns and residents … following:
Urban:
Large Central Metropolitan: includes metropolitan areas with 1 million or more residents … Large Fringe Metropolitan: includes counties of metropolitan areas with 1 million or more residents … Medium and Small Metropolitan: includes areas with 50,000 to 999,999 residents. … Micropolitan and Noncore: includes nonmetropolitan counties (i.e., counties with no town greater than 50,000 residents