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psnet.ahrq.gov/issue/situ-simulation-quality-improvement-tool-identify-and-mitigate-latent-safety-threats
February 22, 2023 - Study
In situ simulation as a quality improvement tool to identify and mitigate latent safety threats for emergency department SARS-CoV-2 airway management: a multi-institutional initiative.
Citation Text:
Yang CJ, Saggar V, Seneviratne N, et al. In situ simulation as a quality improveme…
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psnet.ahrq.gov/issue/veterans-affairs-root-cause-analysis-system-action
June 22, 2022 - Study
Classic
The Veterans Affairs root cause analysis system in action.
Citation Text:
Bagian JP, Gosbee JW, Lee CZ, et al. The Veterans Affairs Root Cause Analysis System in Action. Jt Comm J Qual Improv. 2016;28(10):531-545. doi:10.1016/s1070-3241(02)28057-8.…
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digital.ahrq.gov/health-it-tools-and-resources/workflow-assessment-health-it-toolkit/research/schectman-jm-et-al-2005
January 01, 2005 - Schectman JM et al. 2005 "Determinants of physician use of an ambulatory prescription expert system."
Reference
Schectman JM, Schorling JB, Nadkarni MM, et al. Determinants of physician use of an ambulatory prescription expert system. Int J Med Inf 2005;74(9):711-717.
Abstract
"Purpose: To det…
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psnet.ahrq.gov/issue/delayed-time-defibrillation-after-hospital-cardiac-arrest
June 08, 2010 - Study
Classic
Delayed time to defibrillation after in-hospital cardiac arrest.
Citation Text:
Chan PS, Krumholz HM, Nichol G, et al. Delayed time to defibrillation after in-hospital cardiac arrest. N Engl J Med. 2008;358(1):9-17. doi:10.1056/NEJMoa0706467.
C…
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psnet.ahrq.gov/issue/i-pass-handoff-program-use-campaign-effect-transformational-change
April 24, 2018 - Study
I-PASS handoff program: use of a campaign to effect transformational change.
Citation Text:
Rosenbluth G, Destino LA, Starmer AJ, et al. I-PASS Handoff Program: Use of a Campaign to Effect Transformational Change. Ped Qual Saf. 2018;3(4):e088. doi:10.1097/pq9.0000000000000088.
Co…
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psnet.ahrq.gov/issue/rates-medical-errors-and-preventable-adverse-events-among-hospitalized-children-following
November 12, 2014 - Study
Classic
Rates of medical errors and preventable adverse events among hospitalized children following implementation of a resident handoff bundle.
Citation Text:
Starmer AJ, Sectish TC, Simon DW, et al. Rates of medical errors and preventable adverse events…
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psnet.ahrq.gov/issue/impact-introducing-automated-dispensing-cabinets-barcode-medication-administration-and-closed
March 10, 2021 - Review
Emerging Classic
The impact of introducing automated dispensing cabinets, barcode medication administration, and closed-loop electronic medication management systems on work processes and safety of controlled medications in hospitals: a systematic review.
C…
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psnet.ahrq.gov/issue/171-billion-problem-annual-cost-measurable-medical-errors
May 26, 2021 - Study
Classic
The $17.1 billion problem: the annual cost of measurable medical errors.
Citation Text:
Van Den Bos J, Rustagi K, Gray T, et al. The $17.1 Billion Problem: The Annual Cost Of Measurable Medical Errors. Health Aff. 2011;30(4):596-603. doi:10.1377/hl…
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psnet.ahrq.gov/issue/success-resident-led-safety-council-model-satisfying-cler-pathways-excellence-patient-safety
August 01, 2018 - Study
Success of a resident-led safety council: a model for satisfying CLER Pathways to Excellence patient safety goals.
Citation Text:
Cohen SP, Pelletier JH, Ladd JM, et al. Success of a resident-led safety council: a model for satisfying CLER Pathways to Excellence patient safety goal…
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psnet.ahrq.gov/issue/cross-sectional-study-relationship-between-utilization-root-cause-analysis-and-patient-safety
January 11, 2017 - Study
A cross-sectional study on the relationship between utilization of root cause analysis and patient safety at 139 Department of Veterans Affairs medical centers.
Citation Text:
Percarpio KB, Watts V. A cross-sectional study on the relationship between utilization of root cause ana…
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psnet.ahrq.gov/issue/coping-medical-error-systematic-review-papers-assess-effects-involvement-medical-errors
March 04, 2015 - Review
Coping with medical error: a systematic review of papers to assess the effects of involvement in medical errors on healthcare professionals' psychological well-being.
Citation Text:
Sirriyeh R, Lawton R, Gardner P, et al. Coping with medical error: a systematic review of papers …
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psnet.ahrq.gov/issue/caring-our-own-deploying-systemwide-second-victim-rapid-response-team
September 19, 2016 - Study
Classic
Caring for our own: deploying a systemwide second victim rapid response team.
Citation Text:
Scott SD, Hirschinger LE, Cox KR, et al. Caring for our own: deploying a systemwide second victim rapid response team. Jt Comm J Qual Saf. 2010;36(5):233-2…
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psnet.ahrq.gov/issue/interventions-reliability-seeking-health-care-organizations-systematic-review-their-goals-and
October 19, 2022 - Review
Interventions into reliability-seeking health care organizations: a systematic review of their goals and measuring methods.
Citation Text:
Auschra C, Asaad E, Sydow J, et al. Interventions into reliability-seeking health care organizations: a systematic review of their goals and m…
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psnet.ahrq.gov/issue/burnout-and-medical-errors-among-american-surgeons
December 21, 2014 - Study
Burnout and medical errors among American surgeons.
Citation Text:
Shanafelt TD, Balch CM, Bechamps G, et al. Burnout and medical errors among American surgeons. Ann Surg. 2010;251(6):995-1000. doi:10.1097/SLA.0b013e3181bfdab3.
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psnet.ahrq.gov/issue/complications-daytime-elective-laparoscopic-cholecystectomies-performed-surgeons-who-operated
April 12, 2019 - Study
Complications of daytime elective laparoscopic cholecystectomies performed by surgeons who operated the night before.
Citation Text:
Vinden C, Nash DM, Rangrej J, et al. Complications of daytime elective laparoscopic cholecystectomies performed by surgeons who operated the night be…
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www.ahrq.gov/funding/training-grants/k-awards.html
September 01, 2023 - Career Development (K) Awards
AHRQ sponsors several career development awards intended to foster the career development of promising new investigators in the field of health services research. These programs provide salary and research support for a sustained period of time for early career clinicians and resea…
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psnet.ahrq.gov/issue/association-unexpected-newborn-deaths-changes-obstetric-and-neonatal-process-care
June 01, 2022 - Study
Association of unexpected newborn deaths with changes in obstetric and neonatal process of care.
Citation Text:
Han D, Khadka A, McConnell M, et al. Association of Unexpected Newborn Deaths With Changes in Obstetric and Neonatal Process of Care. JAMA Netw Open. 2020;3(12):e2024589…
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psnet.ahrq.gov/issue/does-suggested-diagnosis-general-practitioners-referral-question-impact-diagnostic-reasoning
September 14, 2022 - Study
Does a suggested diagnosis in a general practitioners' referral question impact diagnostic reasoning: an experimental study.
Citation Text:
Staal J, Speelman M, Brand R, et al. Does a suggested diagnosis in a general practitioners’ referral question impact diagnostic reasoning: an …
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psnet.ahrq.gov/issue/computer-based-simulation-reduce-ehr-related-chemotherapy-ordering-errors
October 27, 2021 - Study
Computer-based simulation to reduce EHR-related chemotherapy ordering errors.
Citation Text:
Wyatt KD, Freedman EB, Arteaga GM, et al. Computer‐based simulation to reduce EHR‐related chemotherapy ordering errors. Cancer Med. 2020;9(23):8844-8851. doi:10.1002/cam4.3496.
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psnet.ahrq.gov/issue/missing-diagnoses-during-covid-19-pandemic-year-review
December 23, 2020 - Commentary
Missing diagnoses during the COVID-19 pandemic: a year in review.
Citation Text:
Pifarré i Arolas H, Vidal-Alaball J, Gil J, et al. Missing diagnoses during the COVID-19 pandemic: a year in review. Int J Environ Res Public Health. 2021;18(10):5335. doi:10.3390/ijerph18105335. …