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  1. Misdiagnosis of thoracic aortic emergencies occurs frequently among transfers to aortic referral centers: an analysis of over 3700 patients. | PSNet

    psnet.ahrq.gov/issue/misdiagnosis-thoracic-aortic-emergencies-occurs-frequently-among-transfers-aortic-referral
    October 28, 2020 - Study Misdiagnosis of thoracic aortic emergencies occurs frequently among transfers to aortic referral centers: an analysis of over 3700 patients. Citation Text: Arnaoutakis GJ, Ogami T, Aranda‐Michel E, et al. Misdiagnosis of thoracic aortic emergencies occurs frequently among transfers…

  2. Development, testing, and findings of a pediatric-focused trigger tool to identify medication-related harm in US children's hospitals. | PSNet

    psnet.ahrq.gov/issue/development-testing-and-findings-pediatric-focused-trigger-tool-identify-medication-related
    April 11, 2011 - Study Development, testing, and findings of a pediatric-focused trigger tool to identify medication-related harm in US children's hospitals. Citation Text: Takata GS, Mason W, Taketomo C, et al. Development, testing, and findings of a pediatric-focused trigger tool to identify medicati…

  3. Strengths and weaknesses in the diagnostic process of endometriosis from the patients' perspective: a focus group study. | PSNet

    psnet.ahrq.gov/issue/strengths-and-weaknesses-diagnostic-process-endometriosis-patients-perspective-focus-group
    March 06, 2019 - Study Strengths and weaknesses in the diagnostic process of endometriosis from the patients' perspective: a focus group study. Citation Text: van der Zanden M, de Kok L, Nelen WLDM, et al. Strengths and weaknesses in the diagnostic process of endometriosis from the patients’ perspective:…

  4. What can we learn from in-depth analysis of human errors resulting in diagnostic errors in the emergency department: an analysis of serious adverse event reports. | PSNet

    psnet.ahrq.gov/issue/what-can-we-learn-depth-analysis-human-errors-resulting-diagnostic-errors-emergency
    June 08, 2022 - Study What can we learn from in-depth analysis of human errors resulting in diagnostic errors in the emergency department: an analysis of serious adverse event reports. Citation Text: Baartmans MC, Hooftman J, Zwaan L, et al. What can we learn from in-depth analysis of human errors resul…

  5. Effectiveness of a barcode medication administration system in reducing preventable adverse drug events in a neonatal intensive care unit: a prospective cohort study. | PSNet

    psnet.ahrq.gov/issue/effectiveness-barcode-medication-administration-system-reducing-preventable-adverse-drug
    December 14, 2022 - Study Effectiveness of a barcode medication administration system in reducing preventable adverse drug events in a neonatal intensive care unit: a prospective cohort study. Citation Text: Morriss FH, Abramowitz PW, Nelson S, et al. Effectiveness of a barcode medication administration s…

  6. Deriving a framework for a systems approach to agitated patient care in the emergency department. | PSNet

    psnet.ahrq.gov/issue/deriving-framework-systems-approach-agitated-patient-care-emergency-department
    June 13, 2018 - Study Deriving a framework for a systems approach to agitated patient care in the emergency department. Citation Text: Wong AH, Ruppel H, Crispino LJ, et al. Deriving a Framework for a Systems Approach to Agitated Patient Care in the Emergency Department. Jt Comm J Qual Patient Saf. 2018…

  7. Implicit racial bias, health care provider attitudes, and perceptions of health care quality among African American college students in Georgia, USA. | PSNet

    psnet.ahrq.gov/issue/implicit-racial-bias-health-care-provider-attitudes-and-perceptions-health-care-quality-among
    March 31, 2021 - Study Implicit racial bias, health care provider attitudes, and perceptions of health care quality among African American college students in Georgia, USA. Citation Text: Armstrong-Mensah E, Rasheed N, Williams D, et al. Implicit racial bias, health care provider attitudes, and perceptio…

  8. Association of adverse events in opioid addiction treatment with quality measure for continuity of pharmacotherapy. | PSNet

    psnet.ahrq.gov/issue/association-adverse-events-opioid-addiction-treatment-quality-measure-continuity
    March 09, 2022 - Study Association of adverse events in opioid addiction treatment with quality measure for continuity of pharmacotherapy. Citation Text: Liu Y, Becker A, Mattke S. Association of adverse events in opioid addiction treatment with quality measure for continuity of pharmacotherapy. J Health…

  9. Accuracy of emergency department clinical findings for diagnosis of coronavirus disease 2019. | PSNet

    psnet.ahrq.gov/issue/accuracy-emergency-department-clinical-findings-diagnosis-coronavirus-disease-2019
    September 09, 2020 - Study Accuracy of emergency department clinical findings for diagnosis of coronavirus disease 2019. Citation Text: Peyrony O, Marbeuf-Gueye C, Truong V, et al. Accuracy of emergency department clinical findings for diagnosis of coronavirus disease 2019. Ann Emerg Med. 2020;76(4):405-412.…

  10. Effect of a real-time pediatric ICU safety bundle dashboard on quality improvement measures. | PSNet

    psnet.ahrq.gov/issue/effect-real-time-pediatric-icu-safety-bundle-dashboard-quality-improvement-measures
    June 21, 2015 - Study Effect of a real-time pediatric ICU safety bundle dashboard on quality improvement measures. Citation Text: Shaw SJ, Jacobs B, Stockwell DC, et al. Effect of a Real-Time Pediatric ICU Safety Bundle Dashboard on Quality Improvement Measures. Jt Comm J Qual Patient Saf. 2015;41(9):41…

  11. Outcomes of emergency department patients presenting with adverse drug events. | PSNet

    psnet.ahrq.gov/issue/outcomes-emergency-department-patients-presenting-adverse-drug-events
    April 22, 2011 - Study Outcomes of emergency department patients presenting with adverse drug events. Citation Text: Hohl CM, Nosyk B, Kuramoto L, et al. Outcomes of emergency department patients presenting with adverse drug events. Ann Emerg Med. 2011;58(3):270-279.e4. doi:10.1016/j.annemergmed.2011.0…

  12. Henry Ford Hospital's Hematology-Oncology Unit Uses AHRQ Safety Program to Lower Bloodstream Infections | Agency for Healthcare Research and Quality

    www.ahrq.gov/news/newsroom/case-studies/202202.html
    February 01, 2022 - Henry Ford Hospital's Hematology-Oncology Unit Uses AHRQ Safety Program to Lower Bloodstream Infections Search All Impact Case Studies February 2022 Using AHRQ's Comprehensive Unit-based Safety Program ( CUSP ), Henry Ford Hospital in Detroit has reduced the incidence of central line-associated bloodstream …

  13. Impact of performance and information feedback on medical interns' confidence-accuracy calibration. | PSNet

    psnet.ahrq.gov/issue/impact-performance-and-information-feedback-medical-interns-confidence-accuracy-calibration
    September 14, 2022 - Study Impact of performance and information feedback on medical interns' confidence-accuracy calibration. Citation Text: Staal J, Katarya K, Speelman M, et al. Impact of performance and information feedback on medical interns' confidence–accuracy calibration. Adv Health Sci Educ Theory P…

  14. Improving formal incivility reporting in ambulatory oncology: implementing the CIVIC Duty program. | PSNet

    psnet.ahrq.gov/innovation/improving-formal-incivility-reporting-ambulatory-oncology-implementing-civic-duty
    March 14, 2022 - EMERGING INNOVATIONS Improving formal incivility reporting in ambulatory oncology: implementing the CIVIC Duty program. Citation Text: Gordon JN. Improving formal incivility reporting in ambulatory oncology: implementing the CIVIC Duty program. Clin J Oncol Nurs. 2023;27(6):602-606. doi:10.1188/23…

  15. Patient Safety Recommendations for COVID-19 Epidemic Outbreak: 3.0 | PSNet

    psnet.ahrq.gov/issue/patient-safety-recommendations-covid-19-epidemic-outbreak-lessons-italian-experience
    February 15, 2023 - Book/Report Patient Safety Recommendations for COVID-19 Epidemic Outbreak: 3.0 Citation Text: Patient Safety Recommendations for COVID-19 Epidemic Outbreak: 3.0 La Regina M, Tanzini M, Venneri F, et al for the Italian Network for Health Safety. Dublin, Ireland: International Society for …

  16. Understanding CAHPS® Surveys: A Primer for New Users - Shaller (pdf file)

    www.ahrq.gov/sites/default/files/wysiwyg/cahps/news-and-events/events/webinars/webinar-012220-shaller.pdf
    June 02, 2025 - Understanding CAHPS® Surveys: A Primer for New Users - Shaller HOW ARE SURVEY RESULTS USED? Dale Shaller, M.P.A. Principal Shaller Consulting Group How Are Survey Results Used? • Quality improvement • Public reporting • Value-based payment • Recognition and certification • Research 30 Using CAHPS Surve…

  17. One-Pager-Aspiration-Pneumonia (doc file)

    www.ahrq.gov/sites/default/files/wysiwyg/antibiotic-use/long-term-care/one-pager-aspiration-pneumonia.docx
    June 01, 2021 - DiagnosisAspiration Pneumonitis and Aspiration Pneumonia · Aspiration pneumonitis is an abrupt chemical injury caused by inhalation of sterile gastric contents. It generally causes fever, increased oxygen requirements, and an elevated white blood cell count, and this typically resolves…

  18. Section 2: Explanation of Mutual Support Key Concepts and Tools | Agency for Healthcare Research and Quality

    www.ahrq.gov/teamstepps-program/curriculum/mutual/tools/index.html
    June 01, 2023 - Section 2: Explanation of Mutual Support Key Concepts and Tools This section contains explanations and illustrations to help you better understand and appreciate the importance of TeamSTEPPS mutual support concepts and tools. If you teach this content or want additional insights into how the material can be mor…

  19. PowerPoint Presentation (ppt file)

    www.ahrq.gov/sites/default/files/wysiwyg/nhguide/5_TK3_P3T5-Training_Slides_for_Nursing_Home_Nurses_Phase_3.ppt
    May 01, 2014 - PowerPoint Presentation Toolkit 3. How To Develop and Implement an Antibiogram Program Phase 3. Implementation Training Slides for Nursing Home Nurses Nursing Home Antimicrobial Stewardship Guide Help Clinicians Choose the Right Antibiotic www.ahrq.gov/NH-ASPGuide ● May 2014 AHRQ Pub. No. 14-0023-6-EF Today we wi…

  20. Developing Invitation Messages that Increase Survey Response Rates - Fowler (pdf file)

    www.ahrq.gov/sites/default/files/wysiwyg/cahps/news-and-events/events/webinars/invitation-messages-fowler.pdf
    June 02, 2025 - Developing Invitation Messages that Increase Survey Response Rates - Fowler EMAIL MESSAGING TO INCREASE WEB SURVEY RESPONSE RATES JACK FOWLER, Ph.D. First, want to thank • Carol Cosenza • Philip Brenner • Lauren Cripps • For their work on this project 13 Goals Two essentials steps to a successful web sur…
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