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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/esrd/using-checklists/checklistandauditslides.pptx
September 03, 2014 - Tools
SAY:
The six interventions that make up the CHARGE acronym are:
Creating a culture of safety
Safety … culture is local and best sustained when it is accepted and maintained at the facility level. … Making data visible also communicates to staff and patients the importance placed on patient safety. … Centers for Disease Control and Prevention, the Centers for Medicare and Medicaid Services, and the state survey … These materials are available on AHRQ’s Web site at http://www.ahrq.gov/professionals/quality-patient-safety
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psnet.ahrq.gov/issue/high-performance-work-systems-health-care-management-part-1-and-part-2
March 22, 2017 - February 22, 2023
Identifying safety practices perceived as low value: an exploratory survey … Challenges and opportunities from the Agency for Healthcare Research and Quality (AHRQ) research summit on … January 22, 2017
Patient Safety. … December 6, 2011
The English Patient Safety Programme. … February 10, 2010
Patient Safety.
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psnet.ahrq.gov/perspective/conversation-gordon-schiff-md
February 26, 2025 - On the other hand, take the case of Linda McDougal , whose breast biopsy was switched between two patients … Increasingly with OpenNotes , patients are reading my notes (all of my patient now are able to). … Perhaps the patient should have called me, as I encourage them to do if I don't get back to them on key … Based on new screening recommendations for high-risk patients, we're ordering many imaging tests to screen … The Betsy Lehman Center and NSPF/IHI have recently done surveys of patients showing diagnostic errors
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psnet.ahrq.gov/node/49698/psn-pdf
December 01, 2013 - On arrival to the SNF, the patient
was on 14 medications for her various conditions and remained mildly … The SNF physician saw the patient on the first day but not
after that time. … , present in up to 40% of post-acute patients and
associated with poor outcomes.(3) This patient is … Strategies to Improve Patient Safety in Managing Complex Post-Acute Patients in the SNF
Setting.
… on
Patient Safety
Culture allows
facilities to enter
and benchmark
data on safety
culture
http
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psnet.ahrq.gov/issue/toward-learning-patient-safety-reporting-systems
January 02, 2017 - developed through funding by the Agency for Healthcare Research and Quality (AHRQ), collected data on … June 29, 2009
Intensive care unit safety incidents for medical versus surgical patients … June 15, 2011
How will we know patients are safer? … April 13, 2022
The effect of an electronic SBAR communication tool on documentation of … November 17, 2010
Adverse drug event reporting in intensive care units: a survey of current
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psnet.ahrq.gov/issue/barriers-nurses-reporting-medication-administration-errors-taiwan
May 01, 2006 - January 20, 2021
Using incident reports to assess communication failures and patient … July 10, 2013
A plan for achieving significant improvement in patient safety. … January 19, 2011
Nursing 2006 Patient-safety survey report. … July 26, 2010
A nurse-driven system for improving patient quality outcomes. … July 21, 2010
Professional commitment, patient safety, and patient-perceived care quality
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psnet.ahrq.gov/issue/radiation-risks-diagnostic-imaging
June 18, 2021 - specific strategies organizations should take to minimize radiation risks, including educating physicians on … contribute to overutilization of diagnostic imaging, with consequent short- and long-term risks to patients … May 14, 2018
Survey suggests disrespectful behaviors persist in healthcare: practitioners … Eliminating racial and ethnic disparities causing mortality and morbidity in pregnant and postpartum patients … December 23, 2016
View More
Related Resources
Factors impacting on
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psnet.ahrq.gov/issue/creating-web-based-intensive-care-unit-safety-reporting-system
October 13, 2018 - They report on the system's early success in 18 ICUs and express their commitment to expanding the application … of this tool to improve patient safety. … August 6, 2014
Evaluation of the culture of safety: survey of clinicians and managers … September 28, 2010
Operating room briefings: working on the same page. … January 2, 2017
Patient safety event reporting in a large radiology department.
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psnet.ahrq.gov/perspective/conversation-rebecca-lawton-phd
March 24, 2025 - We focused on how patients could provide feedback on patient safety. … Some studies in the States had looked at whether patients were able to report on patient safety incidents … Patients have a unique perspective on the care environment and provide feedback on that, which can be … We developed a questionnaire that asked patients about the factors that contribute to patient safety … As you said, this might be measurements of staff safety culture or it might be a measure of incident
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www.ahrq.gov/sites/default/files/2025-02/feeney-report.pdf
January 01, 2025 - Other duties will include working with
NQF staff on council survey mechanisms to determine Member
preferences … The program is based on the
premise that doctors want more patients. … Thomas was
awarded funding from the Robert Wood Johnson Foundation to translate a
safety culture survey … This grant funded
initial development of the Safety Attitudes Questionnaire, now one of the most
widely … used safety culture assessment tools in the world.
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/surgery/modules/implementation/imp_opt_briefings_facnotes.docx
December 01, 2017 - Both safety culture and technical interventions must be managed to sustain progress. … But an organization with a relatively poor safety culture saw minimal improvement from the checklist … Building mindfulness and improving the overall safety culture is the tough but necessary part of any … Slide 42
Adapting to Local Context
SAY:
Over time, effective briefings also improve safety culture … Slide 43
Lessons Learned
SAY:
Reshaping safety culture takes time, commitment, energy, and focus.
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www.ahrq.gov/prevention/resources/chronic-care/clinical-community-relationships-measures-atlas/ccrm-atlas-table32.html
March 01, 2013 - Clinical-Community Relationships Measures Instruments
Safety Check Practitioner Post-Visit Survey … Wrap-Around Observation Manual—Second Version
Continuity of Care Practices Survey—Practice Level [ … of action and effort taken by a community resource to share information with clinics/clinicians and patients … The level of intensity of a relationship between a clinic/clinician and community resource (based on … aimed at helping patients stay informed about recommended clinical preventive services, and overcoming
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psnet.ahrq.gov/issue/quality-improvement-medical-education-current-state-and-future-directions
June 09, 2015 - June 9, 2015
Teaching quality improvement and patient safety to trainees: a systematic … July 13, 2016
Learning through experience: influence of formal and informal training on … and postgraduate trainees: a cross-sectional survey. … July 2, 2014
Teaching quality improvement and patient safety to trainees: a systematic … July 2, 2014
Graduate medical education and patient safety: a busy--and occasionally
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www.ahrq.gov/hai/tools/mrsa-prevention/toolkit/learning-from-defects.html
October 01, 2024 - Tools & Resources for Decolonization: Staff Training Materials
Tools & Resources for Decolonization: Patient … CUSP recognizes that patient safety and quality is a part of the system and provides a structure to facilitate … Resources CUSP Tool: Staff Safety Assessment (DOCX, 388 KB) This form is intended to be used as a survey … Identify Defects Through Sensemaking (AHRQ Core CUSP Toolkit) To learn more on the Learning From Defects
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psnet.ahrq.gov/issue/organisational-readiness-exploring-preconditions-success-organisation-wide-patient-safety
February 01, 2011 - The Safer Patients Initiative was implemented at four United Kingdom sites in 2004 in collaboration … evaluated the readiness of each organization to undertake this initiative, and found that a positive safety … culture , a history of organizational leadership and involvement in safety initiatives, and availability … From the Same Author(s)
Improving reliability of clinical care practices for ventilated patients … safety collaborative: a longitudinal survey study.
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psnet.ahrq.gov/issue/promoting-engagement-patients-and-families-reduce-adverse-events-acute-care-settings
July 02, 2014 - Review
Promoting engagement by patients and families to reduce adverse events in … Health Organization Trauma Care Checklist Program in 11 centers across multiple economic strata: effect on … September 20, 2011
Patient centred diagnosis: sharing diagnostic decisions with patients … Hospital staff views on patient involvement. … NHS: an online survey study.
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psnet.ahrq.gov/issue/patients-teachers-randomised-controlled-trial-use-personal-stories-harm-raise-awareness
September 04, 2013 - Study
Patients as teachers: a randomised controlled trial on the use of personal … Patients as teachers: a randomised controlled trial on the use of personal stories of harm to raise awareness … Using the Attitude to Patient Safety Questionnaire , researchers found no differences in the two groups … Patients as teachers: a randomised controlled trial on the use of personal stories of harm to raise awareness … Findings from a UK multicentre survey study.
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psnet.ahrq.gov/issue/physicians-needs-coping-emotional-stressors-case-peer-support
September 09, 2008 - July 6, 2022
Association of anesthesiologist staffing ratio with surgical patient morbidity … Analysis of hospital-level readmission rates and variation in adverse events among patients … March 24, 2021
Are dental patients concerned about safety? … February 4, 2016
Improving teamwork: impact of structured interdisciplinary rounds on … Interprofessional conflict and medical errors: results of a national multi-specialty survey
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psnet.ahrq.gov/issue/patient-safety-operating-room-part-1-and-part-2
October 19, 2022 - Patient safety in the operating room: II. Intraoperative and postoperative. … These articles review preoperative, intraoperative, and postoperative safety risks for plastic surgery patients … : results of a survey of chairs of departments of internal medicine in North America. … November 9, 2015
Discussing harm-causing errors with patients: an ethics primer for plastic … April 9, 2013
Patient safety in plastic surgery.
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psnet.ahrq.gov/issue/duration-anesthesia-indicator-morbidity-and-mortality-office-based-facial-plastic-surgery
March 19, 2018 - The investigators reviewed records of patients having greater or less than 4 hours of anesthesia in an … Opportunities and challenges for quality and safety applications in ICD-11: an international survey … March 27, 2019
Patient safety in the office-based setting. … May 28, 2015
Discussing harm-causing errors with patients: an ethics primer for plastic … January 12, 2012
Time of day effects on the incidence of anesthetic adverse events.