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psnet.ahrq.gov/issue/classifying-errors-preventable-and-potentially-preventable-trauma-deaths-9-year-review-using
November 27, 2012 - Study
Classifying errors in preventable and potentially preventable trauma deaths: a 9-year review using the Joint Commission's standardized methodology.
Citation Text:
Vioque SM, Kim PK, McMaster J, et al. Classifying errors in preventable and potentially preventable trauma deaths: a 9-…
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psnet.ahrq.gov/issue/physician-transition-care-benefits-i-pass-and-electronic-handoff-system-community-pediatric
November 02, 2022 - Study
Physician transition of care: benefits of I-PASS and an electronic handoff system in a community pediatric residency program.
Citation Text:
Walia J, Qayumi Z, Khawar N, et al. Physician Transition of Care: Benefits of I-PASS and an Electronic Handoff System in a Community Pediatri…
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psnet.ahrq.gov/issue/decreasing-prescribing-errors-antimicrobial-stewardship-program-restricted-medications
September 25, 2024 - Study
Decreasing prescribing errors in antimicrobial stewardship program-restricted medications.
Citation Text:
Tang KM, Lee P, Anosike BI, et al. Decreasing prescribing errors in antimicrobial stewardship program-restricted medications. Hosp Pediatr. 2024;14(4):281-290. doi:10.1542/hped…
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psnet.ahrq.gov/issue/randomized-clinical-trial-compare-use-safety-net-enclosures-standard-restraints-agitated
September 07, 2022 - Study
A randomized clinical trial to compare the use of safety net enclosures with standard restraints in agitated hospitalized patients.
Citation Text:
Nawaz H, Abbas A, Sarfraz A, et al. A randomized clinical trial to compare the use of safety net enclosures with standard restrain…
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psnet.ahrq.gov/issue/communication-vital-signs-emergency-department-handoff-opportunities-improvement
May 16, 2012 - Study
Communication of vital signs at emergency department handoff: opportunities for improvement.
Citation Text:
Venkatesh AK, Curley D, Chang Y, et al. Communication of Vital Signs at Emergency Department Handoff: Opportunities for Improvement. Ann Emerg Med. 2015;66(2):125-30. doi:10.…
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psnet.ahrq.gov/issue/stakeholder-perceptions-smart-infusion-pumps-and-drug-library-updates-multisite
March 13, 2019 - Study
Stakeholder perceptions of smart infusion pumps and drug library updates: a multisite, interdisciplinary study.
Citation Text:
DeLaurentis P, Walroth TA, Fritschle AC, et al. Stakeholder perceptions of smart infusion pumps and drug library updates: A multisite, interdisciplinary st…
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psnet.ahrq.gov/issue/breast-cancer-missed-screening-hindsight-or-mistakes
November 15, 2023 - Study
Breast cancer missed at screening; hindsight or mistakes?
Citation Text:
Hovda T, Larsen M, Romundstad L, et al. Breast cancer missed at screening; hindsight or mistakes? Eur J Radiol. 2023;165:110913. doi:10.1016/j.ejrad.2023.110913.
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psnet.ahrq.gov/issue/anaesthesia-clinicians-perception-safety-workload-anxiety-and-stress-remote-hybrid-suite
March 20, 2024 - Study
Anaesthesia clinicians' perception of safety, workload, anxiety, and stress in a remote hybrid suite compared with the operating room.
Citation Text:
Schroeck H, Whitty MA, Martinez-Camblor P, et al. Anaesthesia clinicians' perception of safety, workload, anxiety, and stress in a r…
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psnet.ahrq.gov/issue/impact-standardized-incident-reporting-system-perioperative-setting-single-center-experience
February 09, 2022 - Study
The impact of a standardized incident reporting system in the perioperative setting: a single center experience on 2,563 'near-misses' and adverse events.
Citation Text:
Heideveld-Chevalking AJ, Calsbeek H, Damen J, et al. The impact of a standardized incident reporting system in t…
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www.ahrq.gov/hai/quality/tools/cauti-ltc/modules/resources/tools/implement/team-roster.html
March 01, 2017 - Appendix A. Team Roster
AHRQ Safety Program for Long-Term Care: HAIs/CAUTI
This template provides suggestions about roles, characteristics, and responsibilities for members of your improvement team. Develop your team and document influential and respected leaders, clinicians, frontline staff, and …
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/ambulatory-surgery/sections/sustainability/management/problem-solving/problem-solving.pptx
May 01, 2017 - Module 3: PowerPoint Presentation
Management Practices for Sustainability
Module 3: Problem Solving
and Escalation
AHRQ Safety Program for Ambulatory Surgery
AHRQ Pub. No. 16(17)-0019-4-EF
May 2017
Module 3: Problem Solving and Escalation | ‹#›
AHRQ Safety Program for Ambulatory Surgery
Management Practices for…
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www.ahrq.gov/patient-safety/settings/hospital/candor/modules/guide4/apd.html
August 01, 2022 - Event Investigation and Analysis Guide: Appendix D
CANDOR Tool
PROCESS
QUESTIONS TO REVIEW
Y/N
CONTRIBUTING OR CAUSAL FACTOR Y/N
FINDINGS /
COMMENTS
COMMUNICATION
Did all caregivers have access to all pertinent information needed to make the best decisions for the patient? (e.g.,…
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psnet.ahrq.gov/issue/top-six-standardized-safety-practices-us-army-medical-department-treatment-facilities
March 18, 2020 - Study
The Top Six: standardized safety practices in U.S. Army Medical Department treatment facilities worldwide.
Citation Text:
Hartstein B, Munante M, Toor PA. The Top Six: Standardized safety practices in U.S. Army Medical Department treatment facilities worldwide. NEJM Catal Innov Car…
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www.ahrq.gov/cahps/consumer-reporting/research/index.html
September 01, 2025 - Research on Reporting Information to Consumers
The ability to report CAHPS ® survey results in a way that supports consumers in making informed decisions has been a key element of the CAHPS project since its inception in the mid-1990s. 1 Over the years, the CAHPS grantees have conducted numerous studies to an…
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psnet.ahrq.gov/issue/standardized-multidisciplinary-protocol-improves-handover-cardiac-surgery-patients-intensive
July 14, 2010 - Study
Standardized multidisciplinary protocol improves handover of cardiac surgery patients to the intensive care unit.
Citation Text:
Joy BF, Elliott E, Hardy C, et al. Standardized multidisciplinary protocol improves handover of cardiac surgery patients to the intensive care unit*. P…
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digital.ahrq.gov/ahrq-funded-projects/examining-feasibility-and-effectiveness-mhealth-solution-designed-enhance
August 01, 2024 - Examining the Feasibility and Effectiveness of an mHealth Solution Designed to Enhance Clinical Outcomes Among Patients Attending Physical Therapy for Musculoskeletal Pain
Project Description
Improving patient engagement in physical therapy (PT) through remote therapeutic monit…
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psnet.ahrq.gov/node/37874/psn-pdf
April 18, 2011 - Interprofessional handover and patient safety in
anaesthesia: observational study of handovers in the
recovery room.
April 18, 2011
Smith AF, Pope C, Goodwin D, et al. Interprofessional handover and patient safety in anaesthesia:
observational study of handovers in the recovery room. Br J Anaesth. 2008;101(3):332-…
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psnet.ahrq.gov/node/60887/psn-pdf
September 09, 2020 - Human-based errors involving smart infusion pumps: a
catalog of error types and prevention strategies.
September 9, 2020
Kirkendall ES, Timmons K, Huth H, et al. Human-based errors involving smart infusion pumps: a catalog of
error types and prevention strategies. Drug Saf. 2020;43(11):1073-1087. doi:10.1007/s40264…
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psnet.ahrq.gov/node/40526/psn-pdf
June 15, 2011 - Critical drug–drug interactions for use in electronic health
records systems with computerized physician order
entry: review of leading approaches.
June 15, 2011
Classen DC, Phansalkar S, Bates DW. Critical Drug-Drug Interactions for Use in Electronic Health Records
Systems With Computerized Physician Order Entry.…
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psnet.ahrq.gov/node/41863/psn-pdf
November 21, 2012 - How reliable are patient-completed medication
reconciliation forms compared with pharmacy lists?
November 21, 2012
Meyer C, Stern M, Woolley W, et al. How reliable are patient-completed medication reconciliation forms
compared with pharmacy lists? Am J Emerg Med. 2012;30(7):1048-54. doi:10.1016/j.ajem.2011.06.038.
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