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psnet.ahrq.gov/node/73429/psn-pdf
June 23, 2021 - Wrong Site Surgery - Wrong Patient: Invasive Procedures
in Outpatient Settings.
June 23, 2021
Farnborough, UK: Healthcare Safety Investigation Branch; June 2021.
https://psnet.ahrq.gov/issue/wrong-site-surgery-wrong-patient-invasive-procedures-outpatient-settings
Wrong site/wrong patent surgery is a persisten…
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psnet.ahrq.gov/node/45952/psn-pdf
May 31, 2017 - Surgeon, Heal Thyself: Optimising Surgical Performance
by Managing Stress.
May 31, 2017
Shiralkar U. Boca Raton, FL: CRC Press; 2017. ISBN: 9781498724036.
https://psnet.ahrq.gov/issue/surgeon-heal-thyself-optimising-surgical-performance-managing-stress
Stress, information overload, and high-risk decisions are prev…
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psnet.ahrq.gov/node/45948/psn-pdf
January 01, 2021 - Preoperative site marking: are we adhering to good
surgical practice?
July 26, 2017
Bathla S, Chadwick M, Nevins EJ, et al. Preoperative Site Marking. J Patient Saf. 2021;17(6):e503-e508.
doi:10.1097/pts.0000000000000398.
https://psnet.ahrq.gov/issue/preoperative-site-marking-are-we-adhering-good-surgical-practice…
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psnet.ahrq.gov/node/47021/psn-pdf
May 02, 2018 - The impact of improving teamwork on patient outcomes
in surgery: a systematic review.
May 2, 2018
Sun R, Marshall DC, Sykes MC, et al. The impact of improving teamwork on patient outcomes in surgery: A
systematic review. Int J Surg. 2018;53:171-177. doi:10.1016/j.ijsu.2018.03.044.
https://psnet.ahrq.gov/issue/impa…
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psnet.ahrq.gov/node/845276/psn-pdf
March 01, 2023 - Cognitive biases in surgery: systematic review.
March 1, 2023
Armstrong BA, Dutescu IA, Tung A, et al. Cognitive biases in surgery: systematic review. Br J Surg.
2023;110(6):645-654. doi:10.1093/bjs/znad004.
https://psnet.ahrq.gov/issue/cognitive-biases-surgery-systematic-review
Cognitive biases are a known source…
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psnet.ahrq.gov/node/46682/psn-pdf
January 24, 2018 - AHRQ Safety Program for Surgery.
January 24, 2018
Rockville, MD: Agency for Healthcare Research and Quality. December 2017. AHRQ Publication No.
16(18)-0004-1-EF.
https://psnet.ahrq.gov/issue/ahrq-safety-program-surgery
Large-scale collaboratives have achieved success in implementing patient safety improvements. T…
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www.ahrq.gov/hai/tools/ambulatory-surgery/sections/implementation.html
May 01, 2017 - Implementation
The Implementation Guide takes users step by step through the execution of technical and cultural interventions surrounding the safe surgery checklist. The tools referenced throughout the guide include items such as checklist templates, quality improvement study frameworks, and coaching materials…
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psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.37_slideshow.ppt
November 01, 2003 - Spotlight Case [MONTH] 2003
Spotlight Case November 2003
The Missing Suction Tip
Source and Credits
This presentation is based on the Nov. 2003
AHRQ WebM&M Spotlight Case in Surgery
See the full article at http://webmm.ahrq.gov
CME credit is available through the Web site
Commentary by: Eric J. Thomas, MD,…
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www.ahrq.gov/research/findings/final-reports/environmental-scan-programs/envscan-program-ape.html
April 01, 2018 - Environmental Scan of Patient Safety Education and Training Programs
Appendix E
Previous Page
Table of Contents
Environmental Scan of Patient Safety Education and Training Programs
Introduction
Chapter 1. Environmental Scan
Chapter 2. Electronic Searchable Catalog
Chapter 3. Qualitative An…
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effectivehealthcare.ahrq.gov/sites/default/files/10_obesity_potential_high_impact_2012-12-11.pdf
January 01, 2012 - potential to increase scientific understanding of the GI system and the mechanism of action of
bariatric surgeries
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www.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/acute/chipra-194-section-1-tables-1-5.pdf
June 02, 2025 - CHIPRA 194: Section 1, Tables 1-5
1
Table 1 [=IMG1]: Codes to Identify Neuroimaging in Administrative Claims
Imaging Modality
Code Type
Codes
Computerized
Tomography (CT) of
Brain/Head
Revenue (UB-92)
350, 351, 352, 353, 354, 355, 356, 357, 358, 359
CPT 70450, 70460, 70470, 70480, 70481,70…
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/surgery/tools/surgical-complication-prevention/glucose_control_audit.docx
December 01, 2017 - Tool: Glucose Control Audit
Glucose Control Audit Tool
Introduction
Problem Statement
While debate continues about its exact numeric value, euglycemia should be maintained perioperatively to prevent surgical site infection. Research suggests an association between hyperglycemia and post-operative complications. Perio…
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psnet.ahrq.gov/node/837065/psn-pdf
May 11, 2022 - Fast tracking in cardiac surgery: is it safe?
May 11, 2022
MacLeod JB, D’Souza K, Aguiar C, et al. Fast tracking in cardiac surgery: is it safe? J Cardiothorac Surg.
2022;17(1):69. doi:10.1186/s13019-022-01815-9.
https://psnet.ahrq.gov/issue/fast-tracking-cardiac-surgery-it-safe
Post-operative complications can le…
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psnet.ahrq.gov/node/840144/psn-pdf
November 16, 2022 - Dedicated teams to optimize quality and safety of
surgery: a systematic review.
November 16, 2022
Lentz CM, De Lind Van Wijngaarden RAF, Willeboordse F, et al. Dedicated teams to optimize quality and
safety of surgery: a systematic review. Int J Qual Health Care. 2022;34(4):mzac078.
doi:10.1093/intqhc/mzac078.
ht…
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psnet.ahrq.gov/node/861294/psn-pdf
January 24, 2024 - Shining a glaring light on surgery: technology that
records every move aims to improve safety.
January 24, 2024
Freyer FJ. Boston Globe. January 13, 2024.
https://psnet.ahrq.gov/issue/shining-glaring-light-surgery-technology-records-every-move-aims-improve-
safety
The surgical black box uses cameras and microphon…
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psnet.ahrq.gov/node/34779/psn-pdf
December 21, 2014 - Measuring and managing quality of surgery. Statistical vs
incidental approaches.
December 21, 2014
McGuire HH, Horsley JS, Salter DR, et al. Measuring and managing quality of surgery. Statistical vs
incidental approaches. Arch Surg. 1992;127(6):733-7; discussion 738.
https://psnet.ahrq.gov/issue/measuring-and-mana…
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psnet.ahrq.gov/node/43260/psn-pdf
June 11, 2014 - 10 years in, why time out still matters.
June 11, 2014
Guglielmi CL, Canacari EG, DuPree ES, et al. 10 years in, why time out still matters. AORN J.
2014;99(6):783-794. doi:10.1016/j.aorn.2014.04.009.
https://psnet.ahrq.gov/issue/10-years-why-time-out-still-matters
The Universal Protocol has been widely adopted in…
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psnet.ahrq.gov/node/46828/psn-pdf
August 08, 2018 - Implementation of a colour-coded universal protocol
safety initiative in Guatemala.
August 8, 2018
Taicher BM, Tew S, Figueroa L, et al. Implementation of a colour-coded universal protocol safety initiative
in Guatemala. BMJ Qual Saf. 2018;27(8). doi:10.1136/bmjqs-2017-007217.
https://psnet.ahrq.gov/issue/implemen…
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www.ahrq.gov/research/findings/final-reports/ssi/ssiexh47.html
April 01, 2018 - Improving the Measurement of Surgical Site Infection Risk Stratification/Outcome Detection
Exhibit 47. Surgeon specialties and health system affiliations
Previous Page Next Page
Table of Contents
Improving the Measurement of Surgical Site Infection Risk Stratification/Outcome Detection
Executive S…
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hcup-us.ahrq.gov/reports/methods/2008_03.pdf
January 01, 2008 - and anesthesia, as well as
payment incentives [Kozak, McCarthy and Pokras, 1999] In 2005, 63.5% of surgeries … In 2005, 63.5% of surgeries in community hospitals were for
ambulatory patients (American Hospital