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digital.ahrq.gov/ahrq-funded-projects/evaluation-computerized-clinical-decision-support-system-and-electronic-health/annual-summary/2010
January 01, 2010 - Evaluation of a computerized clinical decision support system and EHR-linked registry to improve management of hypertension in community-based health centers - 2010
Project Name
Evaluation of a Computerized Clinical Decision Support System and Electronic Health Record (EHR)-linked Registry to Improv…
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psnet.ahrq.gov/issue/zero-harm-health-care
August 12, 2020 - Commentary
Zero harm in health care.
Citation Text:
Gandhi TK, Feeley D, Schummers D. Zero Harm in Health Care. NEJM Catal Innov Care Deliv. 2020;1(2). doi:10.1056/cat.19.1137.
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DOI Google Scholar BibTeX EndNote X3 XML EndNote 7 XML Endnote tagged PubMe…
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psnet.ahrq.gov/issue/case-birth-and-death-high-reliability-healthcare-organisation
June 18, 2013 - Commentary
A case of the birth and death of a high reliability healthcare organisation.
Citation Text:
Roberts KH, Madsen P, Desai V, et al. A case of the birth and death of a high reliability healthcare organisation. Qual Saf Health Care. 2005;14(3):216-20.
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psnet.ahrq.gov/issue/error-rating-tool-identify-and-analyse-technical-errors-and-events-laparoscopic-surgery
October 09, 2013 - Study
Error rating tool to identify and analyse technical errors and events in laparoscopic surgery.
Citation Text:
Bonrath EM, Zevin B, Dedy NJ, et al. Error rating tool to identify and analyse technical errors and events in laparoscopic surgery. Br J Surg. 2013;100(8):1080-8. doi:10.1…
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psnet.ahrq.gov/issue/lost-translation-challenges-and-opportunities-physician-physician-communication-during
April 12, 2011 - Study
Lost in translation: challenges and opportunities in physician-to-physician communication during patient handoffs.
Citation Text:
Solet DJ, Norvell M, Rutan GH, et al. Lost in translation: challenges and opportunities in physician-to-physician communication during patient handoff…
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hcup-us.ahrq.gov/datainnovations/raceethnicitytoolkit/ca20.pdf
January 10, 2012 - New Measures to Access the Quality of Race/Ethnicity Reporting in State Databases
New Measures to Access the
Quality of Race/Ethnicity
Reporting in State Databases
David Zingmond, MD, PhD
AHRQ monthly grantees call
January 10, 2012
Aim
• Develop validated audit measures for
race/ethnicity reporting …
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psnet.ahrq.gov/issue/patient-handoff-comprehensive-curricular-blueprint-resident-education-improve-continuity-care
November 21, 2018 - Commentary
The patient handoff: a comprehensive curricular blueprint for resident education to improve continuity of care.
Citation Text:
Wohlauer M, Arora V, Horwitz LI, et al. The patient handoff: a comprehensive curricular blueprint for resident education to improve continuity of car…
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psnet.ahrq.gov/issue/mindful-workarounds-bar-code-medication-administration
July 20, 2022 - Commentary
Mindful workarounds in bar code medication administration.
Citation Text:
Lichtner V, Dowding D. Mindful workarounds in bar code medication administration. Stud Health Technol Inform. 2022;294:740-744. doi:10.3233/shti220575.
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psnet.ahrq.gov/issue/effect-lean-intervention-improve-safety-processes-and-outcomes-surgical-emergency-unit
January 04, 2010 - Study
Effect of a "Lean" intervention to improve safety processes and outcomes on a surgical emergency unit.
Citation Text:
McCulloch P, Kreckler S, New S, et al. Effect of a "Lean" intervention to improve safety processes and outcomes on a surgical emergency unit. BMJ. 2010;341:c5469.…
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psnet.ahrq.gov/issue/crowd-sourced-hospital-ratings-are-correlated-patient-satisfaction-not-surgical-safety
November 18, 2020 - Study
Crowd-sourced hospital ratings are correlated with patient satisfaction but not surgical safety.
Citation Text:
Synan LT, Eid MA, Lamb CR, et al. Crowd-sourced hospital ratings are correlated with patient satisfaction but not surgical safety. Surgery. 2021;170(3):764-768. doi:10.10…
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psnet.ahrq.gov/issue/tipping-point-relationship-between-volume-and-patient-harm
September 10, 2014 - Study
The tipping point: the relationship between volume and patient harm.
Citation Text:
Pedroja AT. The tipping point: the relationship between volume and patient harm. Am J Med Qual. 2008;23(5):336-41. doi:10.1177/1062860608320628.
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psnet.ahrq.gov/issue/patient-preferences-cases-inter-system-medical-error-discovery-imed
November 02, 2018 - Study
Patient preferences in cases of Inter-system Medical Error Discovery (IMED).
Citation Text:
Antunez AG, Saari A, Miller J, et al. Patient Preferences in Cases of Inter-system Medical Error Discovery (IMED). Ann Surg. 2021;273(3):516-522. doi:10.1097/SLA.0000000000003507.
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psnet.ahrq.gov/issue/building-safer-systems-through-critical-occurrence-reviews-nine-years-learning
July 05, 2017 - Study
Building safer systems through critical occurrence reviews: nine years of learning.
Citation Text:
Stevens P, Campbell J, Urmson L, et al. Building safer systems through critical occurrence reviews: nine years of learning. Healthc Q. 2010;13 Spec No:74-80.
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psnet.ahrq.gov/issue/timely-follow-abnormal-outpatient-test-results-perceived-barriers-and-impact-patient-safety
August 02, 2010 - Study
Timely follow-up of abnormal outpatient test results: perceived barriers and impact on patient safety.
Citation Text:
Moore C, Saigh O, Trikha A, et al. Timely Follow-Up of Abnormal Outpatient Test Results. J Patient Saf. 2008;4(4):241-244. doi:10.1097/pts.0b013e31818d1ca4.
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psnet.ahrq.gov/issue/see-one-sim-one-do-one-national-pre-internship-boot-camp-ensure-safer-student-doctor
February 16, 2011 - Study
"See One, Sim One, Do One"—a national pre-internship boot-camp to ensure a safer "student to doctor" transition.
Citation Text:
Minha S'ar, Shefet D, Sagi D, et al. "See One, Sim One, Do One"- A National Pre-Internship Boot-Camp to Ensure a Safer "Student to Doctor" Transition. PLo…
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psnet.ahrq.gov/issue/uncharted-territory-measuring-costs-diagnostic-errors-outside-medical-record
September 20, 2011 - Study
Uncharted territory: measuring costs of diagnostic errors outside the medical record.
Citation Text:
Schwartz A, Weiner SJ, Weaver FM, et al. Uncharted territory: measuring costs of diagnostic errors outside the medical record. BMJ Qual Saf. 2012;21(11):918-24. doi:10.1136/bmjqs-…
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psnet.ahrq.gov/issue/decoding-laboratory-test-names-major-challenge-appropriate-patient-care
April 24, 2018 - Study
Decoding laboratory test names: a major challenge to appropriate patient care.
Citation Text:
Passiment E, Meisel JL, Fontanesi J, et al. Decoding laboratory test names: a major challenge to appropriate patient care. J Gen Intern Med. 2013;28(3):453-8. doi:10.1007/s11606-012-2253-8…
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psnet.ahrq.gov/issue/pilot-study-examining-undesirable-events-among-emergency-department-boarded-patients-awaiting
August 04, 2021 - Study
A pilot study examining undesirable events among emergency department–boarded patients awaiting inpatient beds.
Citation Text:
Liu SW, Thomas SH, Gordon JA, et al. A pilot study examining undesirable events among emergency department-boarded patients awaiting inpatient beds. Ann E…
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psnet.ahrq.gov/issue/what-are-covering-doctors-told-about-their-patients-analysis-sign-out-among-internal-medicine
February 15, 2011 - Study
What are covering doctors told about their patients? Analysis of sign-out among internal medicine house staff.
Citation Text:
Horwitz LI, Moin T, Krumholz HM, et al. What are covering doctors told about their patients? Analysis of sign-out among internal medicine house staff. Qua…
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psnet.ahrq.gov/issue/biopsy-site-selfies-quality-improvement-pilot-study-assist-correct-surgical-site
August 02, 2015 - Study
Biopsy site selfies—a quality improvement pilot study to assist with correct surgical site identification.
Citation Text:
Nijhawan RI, Lee EH, Nehal KS. Biopsy site selfies--a quality improvement pilot study to assist with correct surgical site identification. Dermatol Surg. 2015;4…