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psnet.ahrq.gov/issue/patterns-unexpected-hospital-deaths-root-cause-analysis
March 13, 2019 - February 18, 2011
Physicians and electronic health records: a statewide survey. … February 15, 2011
The effect of medical emergency teams on patient outcome: a review … , 2011
A prospective controlled trial of the effect of a multi-faceted intervention on … early recognition and intervention in deteriorating hospital patients. … on the ward.
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psnet.ahrq.gov/issue/conversations-diagnostic-uncertainty-and-its-management-among-pediatric-acute-care-physicians
March 17, 2021 - Leveraging a safety event management system to improve organizational learning and safety … culture. … March 30, 2022
Diagnostic error experiences of patients and families with limited English-language … health literacy or disadvantaged socioeconomic position in a cross-sectional US population-based survey … for Quality and Safety (FIQS): using mobile technology for in-hospital reporting from families and patients
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psnet.ahrq.gov/issue/support-opportunities-second-victims-lessons-learned-qualitative-study-top-20-us-news-and
May 19, 2021 - November 17, 2021
Prescribers' perspectives on including reason for use information on … June 23, 2021
Fidelity and the impact of patient safety huddles on teamwork and safety … culture: an evaluation of the Huddle Up for Safer Healthcare (HUSH) project. … July 14, 2021
Patients and relatives as auditors of safe practices in oncology and hematology … February 1, 2023
Multispecialty physician online survey reveals that burnout related
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psnet.ahrq.gov/issue/patient-safety-adoption-framework-practical-framework-bridge-know-do-gap
May 26, 2021 - delivery units: findings from the LaborRNs survey. … April 12, 2023
Evaluation of policies limiting opioid exposure on opioid prescribing … and patient pain in opioid-naive patients undergoing elective surgery in a large American health system … March 22, 2023
Identifying safety practices perceived as low value: an exploratory survey … August 31, 2022
Lessons learned from a systems approach to engaging patients and families
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psnet.ahrq.gov/issue/physician-burnout-well-being-and-work-unit-safety-grades-relationship-reported-medical-errors
June 01, 2022 - Physician burnout is a highly prevalent patient safety concern. … Of 6586 respondents, 54% reported burnout symptoms, consistent with prior studies . … More than 10% of respondents reported a major medical error in the prior 3 months, and these rates … From the Same Author(s)
Physicians' experiences with mistreatment and discrimination by patients … March 19, 2018
A multilevel analysis of U.S. hospital patient safety culture relationships
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psnet.ahrq.gov/issue/clinicians-satisfaction-cpoe-ease-use-and-effect-clinicians-workflow-efficiency-and
August 10, 2022 - October 18, 2023
Recognition of adverse drug events in older hospitalized medical patients … February 9, 2011
Patient safety in developing countries: retrospective estimation of … scale and nature of harm to patients in hospital. … computer-based provider order entry at three community hospitals using an open-ended, semi-structured survey … May 26, 2011
Comparison of methods for identifying patients at risk of medication-related
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psnet.ahrq.gov/issue/serious-adverse-drug-events-reported-food-and-drug-administration-1998-2005
June 07, 2016 - June 7, 2016
Optimizing Pediatric Patient Safety in the Emergency Care Setting. … December 15, 2011
Opioid prescribing for opioid-naive patients in emergency departments … Safety Initiatives
July 10, 2024
Perspectives on Safety … Health Plan Patient Safety Initiatives
July 10, 2024
Lessons from … May 10, 2023
Purchase of prescription medicines via social media: a survey-based study
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psnet.ahrq.gov/issue/hidden-medication-loss-when-using-primary-administration-set-small-volume-intermittent
December 14, 2022 - December 15, 2021
Eric Cropp weighs in on the error that sent him to prison. … February 1, 2023
Patient Safety Primers
Debriefing for … October 20, 2021
Leaving a discontinued FentaNYL infusion attached to the patient leads … June 30, 2021
ISMP Survey provides insights into preparation and admixture practices … May 20, 2020
IV push medications survey results—part 1 and part 2.
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psnet.ahrq.gov/issue/nurse-staffing-nursing-assistants-and-hospital-mortality-retrospective-longitudinal-cohort
July 11, 2018 - There is a clear link between nurse staffing ratios and patient safety. … This study corroborates the finding that lower registered nurse staffing and higher numbers of patients … 2014
Work–life balance behaviours cluster in work settings and relate to burnout and safety … culture: a cross-sectional survey analysis. … May 3, 2023
Patient Safety Primers
Nursing and Patient
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www.ahrq.gov/sites/default/files/wysiwyg/hai/tools/clabsi-cauti-icu/qi-action-notes.docx
April 01, 2022 - They also look at their ICU Assessment results and review unit-level patient safety culture survey results … from the Hospital Survey on Patient Safety (HSOPS) that they completed 6 months ago. … culture both at the aggregate (or hospital) level and the unit level. … on where they see patients could be harmed in any way from what is happening on the unit. … Slide 14
Based on the data from NHSN, ICU Assessment results, the patient safety culture results,
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psnet.ahrq.gov/issue/pharmacist-physician-relationship-detection-ambulatory-medication-errors
September 30, 2020 - The investigators conducted focus groups with pharmacists and patients in order to better understand … January 9, 2008
Patient safety and quality improvement adaptation during the COVID-19 … February 12, 2020
"Some version, most of the time": the surgical safety checklist, patient … June 29, 2011
Medication error in the care of HIV/AIDS patients: electronic surveillance … July 14, 2009
The influence of the structure and culture of medical group practices on
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psnet.ahrq.gov/issue/interprofessional-conflict-and-medical-errors-results-national-multi-specialty-survey
July 10, 2017 - Interprofessional conflict and medical errors: results of a national multi-specialty survey … Interprofessional conflict and medical errors: results of a national multi-specialty survey of hospital … Interprofessional conflict and medical errors: results of a national multi-specialty survey of hospital … Related Resources
Interventions to reduce burnout and improve resilience: impact on … June 12, 2019
Managing disruptive behaviors in the health care setting: focus on obstetrics
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psnet.ahrq.gov/issue/intervention-decrease-catheter-related-bloodstream-infections-icu
June 16, 2011 - The project focused on changing provider behavior through addressing safety culture , incorporating … June 24, 2020
Effect of patient- and medication-related factors on inpatient medication … 27, 2021
Effects of healthcare organization actions and policies related to COVID-19 on … device-associated infections during the coronavirus disease 2019 (COVID-19) pandemic: results from a national survey … June 21, 2023
AHRQ patient safety project reduces bloodstream infections by 40 percent
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psnet.ahrq.gov/issue/lack-emergency-medical-services-documentation-associated-poor-patient-outcomes-validation
June 14, 2017 - Health Organization Trauma Care Checklist Program in 11 centers across multiple economic strata: effect on … January 17, 2018
A national survey assessing the number of records allowed open in electronic … Effect of restriction of the number of concurrently open records in an electronic health record on … June 15, 2012
The association between EMS workplace safety culture and safety outcomes … ambulance: effect on prescribing accuracy when these patients are admitted to hospital.
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psnet.ahrq.gov/issue/education-predictably-disappointing-and-should-never-be-relied-upon-alone-improve-safety
June 15, 2022 - February 24, 2016
Results of survey on pediatric medication safety—part 1 and part 2. … July 8, 2015
Drug shortages continue to compromise patient care. … Please take our survey! … May 19, 2021
ISMP Survey provides insights into preparation and admixture practices OUTSIDE
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psnet.ahrq.gov/issue/when-systems-fail
February 10, 2011 - August 10, 2022
Society of Interventional Radiology IR Pre-Procedure Patient Safety Checklist … June 15, 2016
Nurse work environment and its impact on reasons for missed care, safety … July 27, 2011
Development and validation of a brief culture-of-safety survey. … September 12, 2016
Speaking up: factors and issues in nurses advocating for patients … when patients are in jeopardy.
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psnet.ahrq.gov/issue/oral-chemotherapy-we-simply-must-do-better
February 13, 2019 - practices, dispensing only single doses, and providing medication counseling and written instructions for patients … Related Resources From the Same Author(s)
Just Culture and its critical link to patient … May 7, 2014
Survey suggests possible downward trend in identifying key drugs/drug classes … August 9, 2023
Results of survey on pediatric medication safety—part 1 and part 2. … July 8, 2015
Drug shortages threaten patient safety.
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/qitoolkit/pdi/d1_pdi_improvementmethodsoverview.pptx
June 02, 2025 - These slides may be useful earlier on in the process than during implementation; feel free to use them … Organizational Readiness for Change related to the Pediatric Quality Indicators (Section A tools or AHRQ Survey … on Patient Safety Culture)
Review current performance on each of the metrics (Section B tools)
Determine … Plan (Tool D.6)
Step 3
Measure Results and Analyze
Implementation Measurement (Tool D.7)
Collect data on … and Select Best Practices (Tools D.3, D.4)
Conduct a Gap Analysis (Tool D.5)
Select Best Practices on
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psnet.ahrq.gov/issue/quality-and-economic-impact-disruptive-behaviors-clinical-outcomes-patient-care
February 03, 2010 - of patient care. … The quality and economic impact of disruptive behaviors on clinical outcomes of patient care. … The quality and economic impact of disruptive behaviors on clinical outcomes of patient care. … December 14, 2012
A survey of the impact of disruptive behaviors and communication defects … on patient safety.
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psnet.ahrq.gov/issue/managing-disruptive-behaviors-health-care-setting-focus-obstetrics-services
February 03, 2010 - December 14, 2012
A survey of the impact of disruptive behaviors and communication defects … on patient safety. … of patient care. … Manage Problem Behaviors
December 1, 2009
Evaluation of the culture of safety: survey … of patient care.