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psnet.ahrq.gov/node/43858/psn-pdf
February 18, 2015 - Hospital system barriers to rapid response team
activation: a cognitive work analysis.
February 18, 2015
Braaten JS. CE: Original research: hospital system barriers to rapid response team activation: a cognitive
work analysis. Am J Nurs. 2015;115(2):22-32; test 33; 47. doi:10.1097/01.NAJ.0000460672.74447.4a.
https…
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psnet.ahrq.gov/node/36413/psn-pdf
July 13, 2010 - Implications of the failure to identify high-risk
electrocardiogram findings for the quality of care of
patients with acute myocardial infarction: results of the
Emergency Department Quality in Myocardial Infarction
(EDQMI) study.
July 13, 2010
Masoudi FA, Magid DJ, Vinson DR, et al. Implications of the failure t…
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psnet.ahrq.gov/node/40811/psn-pdf
June 25, 2012 - Utility of clinical examination in the diagnosis of
emergency department patients admitted to the
department of medicine of an academic hospital.
June 25, 2012
Paley L, Zornitzki T, Cohen J, et al. Utility of clinical examination in the diagnosis of emergency department
patients admitted to the department of medic…
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psnet.ahrq.gov/node/44749/psn-pdf
December 27, 2018 - Southern Baptist Hospital of Florida v. Charles.
December 27, 2018
Fla Ct App, 1st Dist. October 28, 2015.
https://psnet.ahrq.gov/issue/southern-baptist-hospital-florida-v-charles
The Patient Safety and Quality Improvement Act (PSQIA) provides federal protection of adverse event
reports voluntarily submitted to pa…
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psnet.ahrq.gov/node/50870/psn-pdf
February 05, 2020 - A survey of outpatient internal medicine clinician
perceptions of diagnostic error.
February 5, 2020
Matulis JC, Kok SN, Dankbar EC, et al. A survey of outpatient Internal Medicine clinician perceptions of
diagnostic error. Diagnosis. 2020;7(2):107-114. doi:10.1515/dx-2019-0070.
https://psnet.ahrq.gov/issue/survey…
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psnet.ahrq.gov/node/46254/psn-pdf
October 09, 2017 - Using risk stratification to reduce medical errors in
cervical cancer prevention.
October 9, 2017
Perkins RB, Cain JM, Feldman S. Using Risk Stratification to Reduce Medical Errors in Cervical Cancer
Prevention. JAMA Intern Med. 2017;177(10):1411-1412. doi:10.1001/jamainternmed.2017.3999.
https://psnet.ahrq.gov/is…
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psnet.ahrq.gov/node/47555/psn-pdf
November 14, 2018 - How one hospital improved patient safety in 10 minutes a
day.
November 14, 2018
van der Heijde R, Deichmann D. Harv Bus Rev. October 30, 2018.
https://psnet.ahrq.gov/issue/how-one-hospital-improved-patient-safety-10-minutes-day
Aviation continues to provide inspiration for patient safety innovation. This commentar…
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psnet.ahrq.gov/node/46392/psn-pdf
October 13, 2018 - The clinical and medicolegal implications of radiology
results communication.
October 13, 2018
Aryal B, Khorsand DA, Dubinsky TJ. The Clinical and Medicolegal Implications of Radiology Results
Communication. Curr Probl Diagn Radiol. 2018;47(5):287-289. doi:10.1067/j.cpradiol.2017.09.009.
https://psnet.ahrq.gov/iss…
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psnet.ahrq.gov/node/866411/psn-pdf
July 31, 2024 - Simulation to Improve Patient Safety: Getting Started.
July 31, 2024
Deutsch ES, Bajaj K. Simulation To Improve Patient Safety: Getting Started. Rockville, MD: Agency for
Healthcare Research and Quality; July 2024. Publication No. 24-0055.
https://psnet.ahrq.gov/issue/simulation-improve-patient-safety-getting-start…
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psnet.ahrq.gov/node/45259/psn-pdf
July 13, 2016 - Communicating Radiation Risks in Paediatric Imaging:
Information to Support Healthcare Discussions About
Benefit and Risk.
July 13, 2016
Geneva, Switzerland: World Health Organization; 2016. ISBN: 9789241510349.
https://psnet.ahrq.gov/issue/communicating-radiation-risks-paediatric-imaging-information-support-
hea…
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psnet.ahrq.gov/node/42658/psn-pdf
March 17, 2014 - Systematic review of the application of the plan-do-study-
act method to improve quality in healthcare.
March 17, 2014
Taylor MJ, McNicholas C, Nicolay C, et al. Systematic review of the application of the plan-do-study-act
method to improve quality in healthcare. BMJ Qual Saf. 2014;23(4):290-8. doi:10.1136/bmjqs-2…
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psnet.ahrq.gov/node/38587/psn-pdf
May 06, 2009 - Creating a better discharge summary: improvement in
quality and timeliness using an electronic discharge
summary.
May 6, 2009
O'Leary KJ, Liebovitz DM, Feinglass J, et al. Creating a better discharge summary: improvement in quality
and timeliness using an electronic discharge summary. J Hosp Med. 2009;4(4):219-225…
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psnet.ahrq.gov/node/33936/psn-pdf
May 27, 2011 - Computer physician order entry: benefits, costs, and
issues.
May 27, 2011
Kuperman GJ, Gibson RF. Computer physician order entry: benefits, costs, and issues. Ann Intern Med.
2003;139(1):31-9.
https://psnet.ahrq.gov/issue/computer-physician-order-entry-benefits-costs-and-issues
Using existing research, this revie…
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www.ahrq.gov/sites/default/files/wysiwyg/sops/action-planning-tool-infographic-sops.pdf
March 01, 2024 - Surveys on Patient Safety Culture Action Planning Steps
ACTION PLANNING FOR
THE SOPS SURVEYS
The AHRQ Surveys on Patient Safety
Culture® (SOPS®) Action Planning Tool
consists of a three-step process to
guide teams as they work to improve
patient safety culture.
1
Identify Areas
To Improve
• What areas do you…
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psnet.ahrq.gov/node/45267/psn-pdf
December 04, 2016 - Use of medical abbreviations and acronyms: knowledge
among medical students and postgraduates.
December 4, 2016
Awan S, Abid S, Tariq M, et al. Use of medical abbreviations and acronyms: knowledge among medical
students and postgraduates. Postgrad Med J. 2016;92(1094):721-725. doi:10.1136/postgradmedj-2016-
134086…
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psnet.ahrq.gov/node/46386/psn-pdf
April 03, 2018 - The impact of electronic health records on diagnosis.
April 3, 2018
Graber ML, Byrne C, Johnston D. The impact of electronic health records on diagnosis. Diagnosis (Berl).
2017;4(4):211-223. doi:10.1515/dx-2017-0012.
https://psnet.ahrq.gov/issue/impact-electronic-health-records-diagnosis
Health information technol…
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psnet.ahrq.gov/node/842434/psn-pdf
June 01, 2024 - AHRQ Safety Program for Telemedicine.
January 22, 2024
Agency for Healthcare Research and Quality.
https://psnet.ahrq.gov/issue/ahrq-safety-program-telemedicine
Telemedicine efforts harbor both risk and reward to patients and clinicians. The AHRQ Safety Program for
Telemedicine is a national effort to develop and …
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digital.ahrq.gov/principal-investigator/thompson-hale-m
January 01, 2023 - Thompson, Hale M.
A Machine Learning Health System to Integrate Care for Substance Misuse and HIV Treatment and Prevention Among Hospitalized Patients - Final Report
Citation
Held M., Thompson H. A Machine Learning Health System to Integrate Care for Substance Misuse and HIV T…
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digital.ahrq.gov/principal-investigator/held-philip
January 01, 2023 - Held, Philip
A Machine Learning Health System to Integrate Care for Substance Misuse and HIV Treatment and Prevention Among Hospitalized Patients - Final Report
Citation
Held M., Thompson H. A Machine Learning Health System to Integrate Care for Substance Misuse and HIV Treatm…
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www.ahrq.gov/cahps/surveys-guidance/hp/about/survey-measures.html
September 01, 2020 - CAHPS Health Plan Survey 5.0 Measures
For more information: Patient Experience Measures from the CAHPS Health Plan Survey (PDF, 308 KB)
Getting Needed Care
Q9 Easy for respondent to get necessary care, tests, or treatment
Q18 Respondent got appointment with specialists as soon as needed
…