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psnet.ahrq.gov/issue/performance-variability-perioperative-sentinel-events-report-nationwide-data-set
November 04, 2020 - Study
Performance variability in perioperative sentinel events: report on a nationwide data set.
Citation Text:
Reijmerink IM, Bos K, Leistikow IP, et al. Performance variability in perioperative sentinel events: report on a nationwide data set. Br J Surg. 2022;109(7):573-575. doi:10.109…
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psnet.ahrq.gov/issue/effect-facility-complexity-perceptions-safety-climate-operating-room-size-matters
December 21, 2014 - Study
The effect of facility complexity on perceptions of safety climate in the operating room: size matters.
Citation Text:
Carney BT, West P, Neily J, et al. The effect of facility complexity on perceptions of safety climate in the operating room: size matters. Am J Med Qual. 2010;25…
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psnet.ahrq.gov/issue/reducing-risk-diagnostic-error-covid-19-era
September 23, 2020 - Commentary
Emerging Classic
Reducing the risk of diagnostic error in the COVID-19 era.
Citation Text:
Gandhi TK, Singh H. Reducing the risk of diagnostic error in the COVID-19 era. J. Hosp Med. 2020;15(6):363-366. doi:10.12788/jhm.3461.
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Forma…
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psnet.ahrq.gov/issue/impact-remote-consultations-antibiotic-prescribing-primary-healthcare-systematic-review
November 30, 2022 - Review
Emerging Classic
Impact of remote consultations on antibiotic prescribing in primary healthcare: systematic review.
Citation Text:
Han SM, Greenfield G, Majeed A, et al. Impact of remote consultations on antibiotic prescribing in primary healthcare: syste…
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psnet.ahrq.gov/issue/national-healthcare-safety-networks-digital-quality-measures-cdcs-automated-measures
September 23, 2020 - Study
The National Healthcare Safety Network's digital quality measures: CDC's automated measures for surveillance of patient safety.
Citation Text:
Shehab N, Alschuler L, McILvenna S, et al. The National Healthcare Safety Network’s digital quality measures: CDC’s automated measures for …
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psnet.ahrq.gov/issue/text-mining-approach-categorize-patient-safety-event-reports-medication-error-type
December 07, 2022 - Study
A text mining approach to categorize patient safety event reports by medication error type.
Citation Text:
Boxley C, Fujimoto M, Ratwani RM, et al. A text mining approach to categorize patient safety event reports by medication error type. Sci Rep. 2023;13(1):18354. doi:10.1038/s41…
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psnet.ahrq.gov/issue/analysis-critical-incident-reports-using-natural-language-processing
June 14, 2023 - Study
Analysis of critical incident reports using natural language processing.
Citation Text:
Denecke K, Paula H. Analysis of critical incident reports using natural language processing. Stud Health Technol Inform. 2024;313:1-6. doi:10.3233/shti240002.
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Format:
…
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www.ahrq.gov/sites/default/files/2025-05/bisantz-report.pdf
January 01, 2025 - participants answered a set of situation awareness (SA) questions
(Situation Awareness Global Assessment Technique
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psnet.ahrq.gov/issue/innovative-tool-experiential-learning-nursing-quality-and-safety-competencies
October 16, 2012 - September 29, 2010
The SBAR communication technique: teaching nursing students professional
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www.ahrq.gov/sites/default/files/publications/files/simulproj11.pdf
June 30, 2014 - Improving Patient Safety Through Simulation Research: Funded Projects
Introduction
Simulation in health care creates a safe
learning environment that allows
researchers and practitioners to test new
clinical processes and enhance
individual and team skills before
encountering patients. Many simulation
applications in…
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psnet.ahrq.gov/web-mm/shake-well
September 01, 2006 - Shake Well
Citation Text:
Flynn EA. Shake Well. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2003.
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Format:
Google Scholar BibTeX EndNote X3 XML EndNote 7 XML Endnote tagged PubMedId RIS
Downloa…
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psnet.ahrq.gov/node/33808/psn-pdf
May 01, 2016 - Reducing the Safety Hazards of Monitor Alert and Alarm
Fatigue
May 1, 2016
Jacques S, Williams E. Reducing the Safety Hazards of Monitor Alert and Alarm Fatigue. PSNet [internet].
2016.
https://psnet.ahrq.gov/perspective/reducing-safety-hazards-monitor-alert-and-alarm-fatigue
Perspective
Alarm fatigue occurs whe…
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www.ahrq.gov/sites/default/files/wysiwyg/evidencenow/tools-and-materials/evidence-now-webinar-learning-health-care-systems.pdf
August 02, 2017 - Creating a Learning Health Care System: The Role of Practice Facilitators in Primary Care
Creating a
Learning Health Care System:
The Role of Practice Facilitators in Primary Care
Speakers: Bob McNellis, Lyndee Knox, Ann Lefebvre, Stephanie Kirchner
Moderator: Gabrielle Weber
August 2, 2017
Welcome an…
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www.ahrq.gov/sites/default/files/wysiwyg/takeheart/training/module-8-slides.pdf
November 18, 2021 - Implementing Effective Care
Coordination
Module 8
Diann Gaalema, PhD
Hicham Skali, MD, MSc
TAKEheart Training and Technical Assistance Components
2
PURPOSE
Training sessions guided by the Million
Hearts®/AACVPR Cardiac Rehabilitation
Change Package (CRCP), located in the
Resource Center TAKEheart Website
M…
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/ambulatory-surgery/sections/sustainability/management/overview/component-kit.docx
May 01, 2017 - Module 1- Component Kit
AHRQ Safety Program for Ambulatory Surgery
Management Practices for Sustainability
Module 1: Overview
A Frontline Management System To Sustain Improvement in Safety Practices
Contents
1. Why a Frontline Management System? 2
2. Components of the Frontline Management System 3
3. Interactions of …
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digital.ahrq.gov/sites/default/files/docs/page/reduction-in-hospital-acquired-complications-and-infections-quick-reference-guide.pdf
January 01, 2010 - Reduction in Hospital-Acquired Complications and Infections
Advancing Excellence in Health Care www.ahrq.gov
Agency for Healthcare Research and Quality
Health IT
Reduction in Hospital-
Acquired Complications
and Infections
embolism, can be prevented by following
recommendations of the American College of Chest
Ph…
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digital.ahrq.gov/ahrq-funded-projects/computer-automated-developmental-surveillance-and-screening
January 01, 2023 - Computer Automated Developmental Surveillance and Screening
Project Final Report ( PDF , 57.42 KB) Disclaimer
Disclaimer
The findings and conclusions in this document are those of the author(s), who are responsible for its content, and do not necessarily represent the views of …
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psnet.ahrq.gov/node/41683/psn-pdf
September 19, 2012 - Techniques to improve patient safety in hospitals: what
nurse administrators need to know.
September 19, 2012
Fagan MJ. Techniques to improve patient safety in hospitals: what nurse administrators need to know. J
Nurs Adm. 2012;42(9):426-430. doi:10.1097/NNA.0b013e3182664df5.
https://psnet.ahrq.gov/issue/technique…
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psnet.ahrq.gov/node/38698/psn-pdf
June 10, 2009 - Towards a framework to select techniques for error
prediction: supporting novice users in the healthcare
sector.
June 10, 2009
Lyons M. Towards a framework to select techniques for error prediction: supporting novice users in the
healthcare sector. Appl Ergon. 2009;40(3):379-95. doi:10.1016/j.apergo.2008.11.004.
…
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psnet.ahrq.gov/node/46304/psn-pdf
November 01, 2017 - Comparative performance of pediatric weight estimation
techniques: a human factor errors analysis.
November 1, 2017
Abdel-Rahman SM, Jacobsen R, Watts JL, et al. Comparative performance of pediatric weight estimation
techniques: a human factor errors analysis. Pediatr Emerg Care. 2015;33(8):548-552.
doi:10.1097/pe…