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psnet.ahrq.gov/node/45028/psn-pdf
May 25, 2016 - 'Just culture': improving safety by achieving substantive,
procedural and restorative justice.
May 25, 2016
Dekker SWA, Breakey H. ‘Just culture:’ Improving safety by achieving substantive, procedural and
restorative justice. Saf Sci. 2016;85. doi:10.1016/j.ssci.2016.01.018.
https://psnet.ahrq.gov/issue/just-cultu…
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digital.ahrq.gov/ahrq-funded-projects/using-it-improve-quality-cardiovascular-disease-cvd-prevention-and-management/final-report
January 01, 2023 - Using IT to Improve the Quality of Cardiovascular Disease (CVD) Prevention and Management - Final Report
Citation
Williams AE, Vogt TM. Using IT to Improve the Quality of Cardiovascular Disease (CVD) Prevention and Management - Final Report. (Prepared by the Kaiser Permanente Center for Health Researc…
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psnet.ahrq.gov/node/60592/psn-pdf
June 17, 2020 - African American COVID-19 mortality: a sentinel event.
June 17, 2020
Ferdinand KC, Nasser SA. African American COVID-19 mortality: a sentinel event. J Am Coll Cardiol.
2020;75(21):2746-2748. doi:10.1016/j.jacc.2020.04.040.
https://psnet.ahrq.gov/issue/african-american-covid-19-mortality-sentinel-event
The authors …
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psnet.ahrq.gov/node/34885/psn-pdf
February 07, 2019 - Doctor’s orders killed cancer patient: Dana-Farber admits
drug overdose caused death of Globe columnist, damage
to second woman.
February 7, 2019
Knox RA. Boston Globe. March 23, 1995; metro/region:1.
https://psnet.ahrq.gov/issue/doctors-orders-killed-cancer-patient-dana-farber-admits-drug-overdose-
caused-death-…
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psnet.ahrq.gov/node/61097/psn-pdf
November 04, 2020 - Obstetrician-gynecologist views of pregnancy-related
medication safety.
November 4, 2020
SteelFisher GK, Hero JO, Caporello HL, et al. Obstetrician-gynecologist views of pregnancy-related
medication safety. J Womens Health (Larchmt). 2020;29(8):1113-1121. doi:10.1089/jwh.2019.8007.
https://psnet.ahrq.gov/issue/obs…
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digital.ahrq.gov/sites/default/files/docs/publication/r18hs017151-fischer-final-report-2011.pdf
January 01, 2011 - Length of Report
1
FINAL REPORT
Impact of office-based e-prescribing on prescribing
processes and outcomes
PI: Michael Fischer, MD, MS
Team members: Catherine DesRoches, Corey Angst, Ritu Agarwal, Joel Weissman,
Paola Miralles, Jennifer Lee, Shirley Wang, Niteesh Choudhry, Jerry Avorn
…
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www.ahrq.gov/sites/default/files/2025-03/greenes-report.pdf
January 01, 2025 - Final Progress Report: Automated Lab Test Followup To Reduce Medical Errors
Principal Investigator/Program Director (Last, first, middle): Greenes, David S.
Automated Lab Test Follow-up to Reduce Medical Errors
Principal Investigator: David S. Greenes, MD
Department of Medicine, Children’s Hospital Boston
Team …
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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-Conlon_50.pdf
May 06, 2008 - Using an Anonymous Web-Based Incident Reporting Tool to Embed the Principles of a High-Reliability Organization
Using an Anonymous Web-Based
Incident Reporting Tool to Embed the
Principles of a High-Reliability Organization
Paul Conlon, PharmD, JD; Rebecca Havlisch, RN, JD; Narendra Kini, MD, MSHA;
Christine P…
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effectivehealthcare.ahrq.gov/sites/default/files/pdf/methods-guidance-tests-decision-models_methods.pdf
July 01, 2012 - Methods Guide for Medical Test Reviews Chapter 10
10-1
Chapter 10
Deciding Whether To Complement a Systematic
Review of Medical Tests With Decision Modeling
Thomas A. Trikalinos, M.D., Tufts Evidence-based Practice Center, Boston, MA
Shalini Kulasingam, Ph.D., University of Minnesota School of Public He…
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www.uspreventiveservicestaskforce.org/uspstf/recommendation/depression-in-children-and-adolescents-screening
February 08, 2016 - Share to Facebook
Share to X
Share to WhatsApp
Share to Email
Print
archived
Final Recommendation Statement
Depression in Children and Adolescents: Screening
February 08, 2016
Recommendations made by the USPSTF are independent of the U.S…
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effectivehealthcare.ahrq.gov/sites/default/files/dementia-horizon-scan-high-impact-1406.pdf
February 01, 2015 - DEMENTIA INCLUDING ALZHEIMER'S #04
AHRQ Healthcare Horizon Scanning System – Potential
High-Impact Interventions Report
Priority Area 04: Dementia (Including Alzheimer’s
Disease)
Prepared for:
Agency for Healthcare Research and Quality
U.S. Department of Health and Human Services
540 Gaither Road
…
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www.ahrq.gov/sites/default/files/2024-01/schnipper-report.pdf
January 01, 2024 - histories was shown to increase potentially harmful discrepancies, perhaps because it led to
diffusion of responsibility
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/pressureulcertoolkit/putoolssect7.pdf
January 01, 2004 - In the past, pressure ulcer care has sometimes been
seen as solely a nursing unit responsibility. … In the last two columns, determine who will have lead responsibility for completing each
task, and
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www.ahrq.gov/sites/default/files/wysiwyg/takeheart/training/expanding-cardiac-rehab-implementation-guide.pdf
December 01, 2022 - Hybrid Cardiac Rehabilitation (HYCR) Expanding Capacity Implementation Guide
Expanding Capacity Implementation Guide
December 2022
…
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www.ahrq.gov/sites/default/files/wysiwyg/cahps/news-and-events/events/webinars/cahps-cancer-care-transcript.pdf
June 01, 2017 - Introducing the CAHPS Cancer Care Survey" Transcript
Introducing the CAHPS® Cancer Care Survey
June 2017 Webcast
Speakers
Caren Ginsberg, PhD, Director, CAHPS Division, Center for Quality Improvement and Patient Safety, Agency
for Healthcare Research and Quality
Ashley Wilder Smith, PhD, MPH, Chief of t…
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www.ahrq.gov/sops/events/webinars/just-culture.html
December 01, 2018 - Webcast: Using Just Culture To Improve Hospital SOPS Results
November 9, 2016
Summary
Speakers and Presentation Slides
Recordings
Transcript
Summary
On November 9, 2016, the Agency for Healthcare Research and Quality (AHRQ) hosted a webcast featuring Just Culture initiatives that helped improve …
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psnet.ahrq.gov/node/837733/psn-pdf
July 27, 2022 - From COVID-19 pandemic to patient safety: a new
"spring" for telemedicine or a boomerang effect?
July 27, 2022
De Micco F, Fineschi V, Banfi G, et al. From COVID-19 pandemic to patient safety: a new "spring" for
telemedicine or a boomerang effect? Front Med (Lausanne). 2022;9:901788.
doi:10.3389/fmed.2022.901788.
…
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psnet.ahrq.gov/node/60840/psn-pdf
August 26, 2020 - Role of artificial intelligence in patient safety outcomes:
systematic literature review.
August 26, 2020
Choudhury A, Asan O. Role of artificial intelligence in patient safety outcomes: systematic literature review.
JMIR Med Inform. 2020;8(7):e18599. doi:10.2196/18599.
https://psnet.ahrq.gov/issue/role-artificial…
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psnet.ahrq.gov/node/72854/psn-pdf
March 17, 2021 - Enabling sustained communication with patients for safe
and effective management of oral chemotherapy: a
longitudinal ethnography.
March 17, 2021
Mitchell G, Porter S, Manias E. Enabling sustained communication with patients for safe and effective
management of oral chemotherapy: a longitudinal ethnography. J Adv …
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psnet.ahrq.gov/node/73478/psn-pdf
July 07, 2021 - Medical malpractice claims by members of the uniformed
services.
July 7, 2021
Department of Defense Office of General Counsel. 32 CFR Part 45. Fed Register. 86(115); June 17,
2021:32194-32215.
https://psnet.ahrq.gov/issue/medical-malpractice-claims-members-uniformed-services
Organizations with safety culture…