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psnet.ahrq.gov/issue/are-clinical-instructors-preventing-or-provoking-adverse-events-involving-students
November 15, 2023 - Commentary
Are clinical instructors preventing or provoking adverse events involving students: a contemporary issue.
Citation Text:
Christensen L. Are clinical instructors preventing or provoking adverse events involving students: A contemporary issue. Nurse Educ Today. 2018;70:121-123. …
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psnet.ahrq.gov/issue/disrupting-diagnostic-reasoning-do-interruptions-instructions-and-experience-affect
February 06, 2014 - Study
Disrupting diagnostic reasoning: do interruptions, instructions, and experience affect the diagnostic accuracy and response time of residents and emergency physicians?
Citation Text:
Monteiro SD, Sherbino JD, Ilgen JS, et al. Disrupting diagnostic reasoning: do interruptions, instr…
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psnet.ahrq.gov/issue/supporting-recovery-after-adverse-events-essential-component-surgeon-well-being
February 15, 2023 - Study
Supporting recovery after adverse events: an essential component of surgeon well-being.
Citation Text:
Berman L, Rialon KL, Mueller CM, et al. Supporting recovery after adverse events: an essential component of surgeon well-being. J Pediatr Surg. 2021;56(5):833-838. doi:10.1016/j.j…
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psnet.ahrq.gov/issue/armstrong-institute-residentfellow-scholars-multispecialty-curriculum-train-future-leaders
October 19, 2022 - Commentary
The Armstrong Institute Resident/Fellow Scholars: a multispecialty curriculum to train future leaders in patient safety and quality improvement.
Citation Text:
Rinke ML, Mock CK, Persing NM, et al. The Armstrong Institute Resident/Fellow Scholars: A Multispecialty Curriculum t…
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psnet.ahrq.gov/issue/team-communication-during-patient-handover-operating-room-more-facts-and-figures
December 16, 2009 - Study
Team communication during patient handover from the operating room: more than facts and figures.
Citation Text:
Manser T, Foster S, Flin R, et al. Team communication during patient handover from the operating room: more than facts and figures. Hum Factors. 2013;55(1):138-56.
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psnet.ahrq.gov/issue/evaluation-registered-nurse-competency-processes-veterans-health-administration-facilities
April 26, 2006 - Book/Report
Evaluation of Registered Nurse Competency Processes in Veterans Health Administration Facilities.
Citation Text:
Evaluation of Registered Nurse Competency Processes in Veterans Health Administration Facilities. Washington, DC: VA Office of Inspector General; April 20, 201…
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psnet.ahrq.gov/issue/white-paper-recommendation-systems-based-practice-competency
December 18, 2017 - Commentary
White paper on recommendation for systems-based practice competency.
Citation Text:
Stalter AM, Phillips JM, Dolansky MA. QSEN Institute RN-BSN Task Force: White Paper on Recommendation for Systems-Based Practice Competency. J Nurs Care Qual. 2017;32(4):354-358. doi:10.1097/NC…
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psnet.ahrq.gov/issue/practice-medicine-understanding-diagnostic-error
July 22, 2020 - Commentary
The practice of medicine: understanding diagnostic error.
Citation Text:
Cantey C. The practice of medicine: understanding diagnostic error. J Nurs Pract. 2020;16(8):582-585. doi:10.1016/j.nurpra.2020.05.014.
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psnet.ahrq.gov/issue/defining-patient-safety-events-inpatient-psychiatry
January 30, 2019 - Study
Defining patient safety events in inpatient psychiatry.
Citation Text:
Marcus SC, Hermann R, Cullen SW. Defining Patient Safety Events in Inpatient Psychiatry. J Patient Saf. 2018;17(8):e1452-e1457. doi:10.1097/PTS.0000000000000520.
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psnet.ahrq.gov/issue/use-who-surgical-safety-checklist-trauma-and-orthopaedic-patients
August 30, 2017 - Study
Use of the WHO surgical safety checklist in trauma and orthopaedic patients.
Citation Text:
Sewell M, Adebibe M, Jayakumar P, et al. Use of the WHO surgical safety checklist in trauma and orthopaedic patients. Int Orthop. 2011;35(6):897-901. doi:10.1007/s00264-010-1112-7.
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psnet.ahrq.gov/issue/medical-error-disclosure-training-evidence-values-based-ethical-environments
October 15, 2016 - Study
Medical error disclosure training: evidence for values-based ethical environments.
Citation Text:
Rathert C, Phillips W. Medical Error Disclosure Training: Evidence for Values-Based Ethical Environments. Journal of Business Ethics. 2010;97(3). doi:10.1007/s10551-010-0520-3.
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psnet.ahrq.gov/issue/non-clinical-errors-using-voice-recognition-dictation-software-radiology-reports
December 29, 2014 - Study
Non-clinical errors using voice recognition dictation software for radiology reports: a retrospective audit.
Citation Text:
Chang CA, Strahan R, Jolley D. Non-clinical errors using voice recognition dictation software for radiology reports: a retrospective audit. J Digit Imaging. …
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psnet.ahrq.gov/issue/silent-treatment-why-safety-tools-and-checklists-arent-enough-save-lives
April 03, 2009 - Book/Report
Classic
The Silent Treatment: Why Safety Tools and Checklists Aren't Enough to Save Lives.
Citation Text:
The Silent Treatment: Why Safety Tools and Checklists Aren't Enough to Save Lives. Maxfield D, Grenny J, Lavandero R, et al. Provo, UT: VitalS…
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psnet.ahrq.gov/issue/disseminating-innovations-health-care
August 04, 2021 - Commentary
Classic
Disseminating innovations in health care.
Citation Text:
Berwick DM. Disseminating Innovations in Health Care. JAMA. 2003;289(15):1969-1975. doi:10.1001/jama.289.15.1969.
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www.ahrq.gov/research/findings/final-reports/environmental-scan-programs/envscan-program2.html
April 01, 2018 - specifically, it can measure changes in trainee attitudes, improvements in knowledge, or increases in skill … Programs that include opportunities to practice a new skill typically also provide feedback to reinforce
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www.ahrq.gov/pqmp/implementation-qi/toolkit/asthma/qi-strategies.html
July 01, 2021 - Pediatric Asthma Emergency Department Use Toolkit
Quality Improvement Strategies
Previous Page
Table of Contents
Pediatric Asthma Emergency Department Use Toolkit
Introduction
Overview
About the Measure
Key Driver Diagram
Quality Improvement Strategies
This section of the…
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www.ahrq.gov/cahps/quality-improvement/improvement-guide/3-are-you-ready/index.html
February 01, 2020 - The key is to carefully select people with the right skill set and mindset for quality improvement: people
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psnet.ahrq.gov/perspective/diagnostic-errors-medicine-what-do-doctors-and-umpires-have-common
February 01, 2007 - the ability of movie producers to select just the right actor from the hundreds of potentials, or the skill
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psnet.ahrq.gov/node/72551/psn-pdf
December 09, 2020 - Bundle interventions including nontechnical skills for
surgeons can reduce operative time and improve patient
safety.
December 9, 2020
Koike D, Nomura Y, Nagai M, et al. Bundle interventions including nontechnical skills for surgeons can
reduce operative time and improve patient safety. Int J Qual Health Care. 202…
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psnet.ahrq.gov/node/60020/psn-pdf
March 04, 2020 - The eNOTSS platform for surgeons’ nontechnical skills
performance improvement.
March 4, 2020
Pradarelli JC, Yule S, Smink DS. The eNOTSS Platform for Surgeons’ Nontechnical Skills Performance
Improvement. JAMA Surg. 2020;155(5):438-439. doi:10.1001/jamasurg.2019.5880.
https://psnet.ahrq.gov/issue/enotss-platform-s…