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psnet.ahrq.gov/issue/its-two-worlds-apart-analysis-vulnerable-patient-handover-practices-discharge-hospital
January 15, 2025 - This qualitative study from Spain used in-depth interviews with patients, hospital staff, and primary … processes are often haphazard and a major source of frustration for hospital providers, and that patients … -Routine measurement of patient experience with patient safety in ambulatory care: a mixed-mode survey … September 24, 2016
The effects of patient handoff characteristics on subsequent care: … and delivery: development, validation, and application of the Coordination of Handoff Effectiveness Questionnaire
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psnet.ahrq.gov/perspective/adverse-events-dentistry
December 22, 2020 - Dental patients receive medications, tests, and procedures and many of the same patient safety risks … We have data on about 4-4.5 million patients now. … and a module on patient safety in dentistry. … safety culture in primary dental care. … May 6, 2020
Factors affecting patient safety culture among dental healthcare workers:
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psnet.ahrq.gov/issue/using-evidence-rigorous-measurement-and-collaboration-eliminate-central-catheter-associated
January 15, 2014 - program report highlights the implementation processes of the AHRQ-funded CUSP initiative that builds on … Same Author(s)
Eliminating central line-associated bloodstream infections: a national patient … device-associated infections during the coronavirus disease 2019 (COVID-19) pandemic: results from a national survey … May 22, 2019
AHRQ patient safety project reduces bloodstream infections by 40 percent … April 21, 2015
Tennessee Center for Patient Safety.
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psnet.ahrq.gov/issue/preventable-harm-canadian-organ-donation-and-transplantation-system-descriptive-study-missed
October 19, 2022 - July 5, 2023
Postoperative opioid prescribing and the pain scores on Hospital Consumer … Assessment of Healthcare Providers and Systems survey. … Safety Initiatives
July 10, 2024
Perspectives on Safety … Health Plan Patient Safety Initiatives
July 10, 2024
Structural … March 1, 2023
Healthcare-associated adverse events in alternate level of care patients
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psnet.ahrq.gov/periodic-issue/weekly-resource
March 25, 2025 - This methodology ensured the audit was patient-centered and focused on the patient's journey through … Findings from this cross-sectional survey with 255 nurse leaders highlight the important role of authentic … Survey respondents also endorsed the importance of formal support programs, including peer support, education … Patients presenting with non-specific symptoms (NSSs) suggestive of cancer may experience diagnostic … Updates, WebM&M, and Perspectives on Safety.
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psnet.ahrq.gov/issue/empirically-derived-taxonomy-factors-affecting-physicians-willingness-disclose-medical-errors
February 15, 2011 - In this study, researchers reviewed the medical literature on error disclosure and conducted focus groups … The authors were able to identify four facilitating factors, which primarily centered on physicians' … safety: a survey of physicians in teaching hospitals. … April 12, 2023
Impact of providing patients access to electronic health records on quality … Disclosure
Provider-Patient Communication
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psnet.ahrq.gov/issue/has-improved-hand-hygiene-compliance-reduced-risk-hospital-acquired-infections-among
July 10, 2024 - Analysis of publicly reported patient safety data from 2008 to 2011. … Analysis of publicly reported patient safety data from 2008 to 2011. … attitudes and barriers to a medical emergency team among nurses and medical doctors: a multi-centre survey … April 21, 2015
Impact of a hospital-wide hand hygiene initiative on healthcare-associated … December 30, 2014
The effect of hospital-acquired Clostridium difficile infection on
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psnet.ahrq.gov/issue/implementation-josie-king-care-journal-pediatric-intensive-care-unit-quality-improvement
November 21, 2016 - This study reports on the implementation of the journal in a pediatric intensive care unit. … December 6, 2017
Parents' perspective on safety in neonatal intensive care: a mixed-methods … November 23, 2016
The effect of an electronic SBAR communication tool on documentation … 2014
The morbidity and mortality conference in PICUs in the United States: a national survey … More About The Topic
Intensive Care Units
Children's Hospitals
Health Care Providers
Patients
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www.ahrq.gov/news/events/nac/2020-07-nac/nacmtg071420-minutes.html
November 01, 2020 - The Medical Expenditure Panel Survey (MEPS) was used to analyze spending on prescription opioids by source … AHRQ’s Surveys on Patient Safety Culture program is developing survey items on workforce safety for the … hospital and possibly other settings and supplemental survey items on diagnostic safety (for the Medical … Office Survey). … It will develop and disseminate a model hospital command center that integrates real-time data on patients
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psnet.ahrq.gov/issue/how-can-interventions-more-directly-address-drivers-unprofessional-behaviour-between
October 09, 2024 - Rapid response systems, antibiotic stewardship and medication reconciliation: a scoping review on … June 26, 2024
What can safety cases offer for patient safety? … July 12, 2023
Identifying safety practices perceived as low value: an exploratory survey … March 8, 2023
National patient safety goal to improve health care equity. … July 7, 2021
Improving America's Hospitals: The Joint Commission's Annual Report on Quality
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psnet.ahrq.gov/issue/systematic-review-prevalence-medication-errors-resulting-hospitalization-and-death-nursing
July 23, 2008 - revealed that a significant number of errors were related to handoffs and that 75% of these older patients … Related Resources From the Same Author(s)
Measurement for improvement: a survey … August 12, 2009
Optimizing Pediatric Patient Safety in the Emergency Care Setting. … , and management of the psychological effects of emerging virus outbreaks on healthcare workers: rapid … November 2, 2018
Effects of interdisciplinary collaboration in hospitals on medication
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psnet.ahrq.gov/issue/clinical-impact-and-economic-burden-hospital-acquired-conditions-following-common-surgical
October 21, 2020 - the prevalence and association of polypharmacy and drug administration errors in hospitalized adult patients … May 18, 2022
Hospital ward adaptation during the COVID-19 pandemic: a national survey … diagnostic stewardship for blood cultures in critically ill children with culture rates, antibiotic use, and patient … February 5, 2020
View More
Related Resources
How satisfied are patients … January 23, 2019
Healthy life-years lost and excess bed-days due to 6 patient safety
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psnet.ahrq.gov/issue/large-language-models-preventing-medication-direction-errors-online-pharmacies
February 27, 2019 - March 15, 2023
Optimizing Pediatric Patient Safety in the Emergency Care Setting. … October 19, 2022
ASHP Guidelines on the Safe Use of Automated Compounding Devices for … telephone-based self-management support program to identify adverse events among ambulatory diabetes patients … February 22, 2011
Development of a high-value care culture survey: a modified Delphi … A multi-method exploratory evaluation of a service designed to improve medication safety for patients
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psnet.ahrq.gov/issue/fall-prevention-implementation-strategies-use-60-united-states-hospitals-descriptive-study
November 11, 2020 - Fall prevention remains a patient safety priority . … May 19, 2021
Impact of structured interdisciplinary bedside rounding on patient outcomes … Safety and Quality
April 26, 2023
Distractions in the operating room: a survey … October 19, 2022
Keeping patients at risk for self-harm safe in the emergency department … December 2, 2020
Clinical deterioration and hospital‐acquired complications in adult patients
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psnet.ahrq.gov/issue/situation-background-assessment-and-recommendation-guided-huddles-improve-communication-and
September 23, 2020 - July 29, 2020
Medical harm: patient perceptions and follow-up actions. … November 21, 2017
Evaluation of clinical practice guidelines on fall prevention and management … patient simulation for agitation management in the emergency department. … : effects on behaviour and attitude. … management course for emergency medicine, phase 1: results from an interdisciplinary needs assessment survey
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psnet.ahrq.gov/issue/empowerment-failure-how-shortcomings-physician-communication-unwittingly-undermine-patient
January 17, 2019 - The authors argue that well-intentioned physicians fail to empower patients and recommend communication … are patients aware of when they do not understand? … Health Organization Trauma Care Checklist Program in 11 centers across multiple economic strata: effect on … symptoms and work-related behavior among healthcare workers and other professionals: results of a global survey … and patient experience.
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psnet.ahrq.gov/issue/safe-day-call-reducing-silos-health-care-through-frontline-risk-assessment
May 25, 2016 - January 15, 2025
Preventing harm in the ICU—building a culture of safety and engaging patients … March 2, 2011
Preventing patient harm via adverse event review: An APSA survey regarding … July 5, 2016
The influence of organizational factors on patient safety: examining successful … January 20, 2016
What do patients think about year-end resident continuity clinic handoffs … Healthcare professional views on hospital to home care transitions.
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digital.ahrq.gov/sites/default/files/docs/behavior-change-slides-07172025.pdf
July 17, 2025 - Empowering Patients To Change Behavior Using Digital Healthcare Tools
Empowering Patients … .
55
Project Game On! … • System Usability Scale (SUS)1 & Usefulness, Satisfaction,
and Ease of Use (USE)2 questionnaire … Measuring usability with the USE
questionnaire.
13
14 … Patient followup messaging features
3. Patient motivation through feedback
4.
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psnet.ahrq.gov/issue/cognitive-balanced-model-conceptual-scheme-diagnostic-decision-making
July 10, 2013 - July 10, 2013
A new perspective on blame culture: an experimental study. … attitudes and barriers to a medical emergency team among nurses and medical doctors: a multi-centre survey … February 25, 2015
Impact of intensive care unit discharge time on patient outcome. … April 8, 2020
Building a safer foundation: the Lessons Learnt patient safety training … physicians, nurses, and patients.
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psnet.ahrq.gov/issue/checklist-based-intervention-improve-surgical-outcomes-michigan-evaluation-keystone-surgery
May 01, 2015 - which combined an evidence-based checklist and the comprehensive unit-based safety program to enhance safety … culture. … the Same Author(s)
Evaluation of the effectiveness of a surgical checklist in Medicare patients … Association of hospital participation in a regional trauma quality improvement collaborative with patient … Intraoperative sentinel events in the era of surgical safety checklists: results of a national survey