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4461. Development of a proactive process to harmonize policy, infusion pump library, and electronic health record entries for continuous infusions at an academic medical center. | PSNet
      psnet.ahrq.gov/issue/development-proactive-process-harmonize-policy-infusion-pump-library-and-electronic-health
      October 19, 2022 - Study Development of a proactive process to harmonize policy, infusion pump library, and electronic health record entries for continuous infusions at an academic medical center. Citation Text: Christensen SM, Andrews SR, Fox ER. Development of a proactive process to harmonize policy, inf…

4462. Failure to rescue deteriorating patients: a systematic review of root causes and improvement strategies. | PSNet
      psnet.ahrq.gov/issue/failure-rescue-deteriorating-patients-systematic-review-root-causes-and-improvement
      January 18, 2013 - Review Emerging Classic Failure to rescue deteriorating patients: a systematic review of root causes and improvement strategies. Citation Text: Burke JR, Downey C, Almoudaris AM. Failure to rescue deteriorating patients: a systematic review of root causes and im…

4463. Implementing a 48 h EWTD-compliant rota for junior doctors in the UK does not compromise patients' safety: assessor-blind pilot comparison. | PSNet
      psnet.ahrq.gov/issue/implementing-48-h-ewtd-compliant-rota-junior-doctors-uk-does-not-compromise-patients-safety
      June 26, 2019 - Study Implementing a 48 h EWTD-compliant rota for junior doctors in the UK does not compromise patients' safety: assessor-blind pilot comparison. Citation Text: Cappuccio FP, Bakewell A, Taggart FM, et al. Implementing a 48 h EWTD-compliant rota for junior doctors in the UK does not co…

4464. Drug and opioid-involved overdose deaths- United States, 2013-2017. | PSNet
      psnet.ahrq.gov/issue/drug-and-opioid-involved-overdose-deaths-united-states-2013-2017
      June 28, 2017 - Study Drug and opioid-involved overdose deaths- United States, 2013-2017. Citation Text: Scholl L, Seth P, Kariisa M, et al. Drug and Opioid-Involved Overdose Deaths - United States, 2013-2017. MMWR Morb Mortal Wkly Rep. 2018;67(5152):1419-1427. doi:10.15585/mmwr.mm675152e1. Copy Citat…

4465. Persistent opioid use among pediatric patients after surgery. | PSNet
      psnet.ahrq.gov/issue/persistent-opioid-use-among-pediatric-patients-after-surgery
      January 29, 2020 - Study Classic Persistent opioid use among pediatric patients after surgery. Citation Text: Harbaugh CM, Lee JS, Hu HM, et al. Persistent Opioid Use Among Pediatric Patients After Surgery. Pediatrics. 2018;141(1):e20172439. doi:10.1542/peds.2017-2439. Copy Cita…

4466. Talking with patients about other clinicians' errors. | PSNet
      psnet.ahrq.gov/issue/talking-patients-about-other-clinicians-errors
      October 27, 2021 - Study Classic Talking with patients about other clinicians' errors. Citation Text: Gallagher TH, Mello MM, Levinson W, et al. Talking with patients about other clinicians' errors. N Engl J Med. 2013;369(18):1752-7. doi:10.1056/NEJMsb1303119. Copy Citation …

4467. Ensuring safe practice by late career physicians: institutional policies and implementation experiences. | PSNet
      psnet.ahrq.gov/issue/ensuring-safe-practice-late-career-physicians-institutional-policies-and-implementation
      May 20, 2019 - Study Ensuring safe practice by late career physicians: institutional policies and implementation experiences. Citation Text: White AA, Gallagher TH, Osinska PH, et al. Ensuring safe practice by late career physicians: institutional policies and implementation experiences. Ann Intern Med…

4468. A survey of nurses' beliefs about the medical emergency team system in a Canadian tertiary hospital. | PSNet
      psnet.ahrq.gov/issue/survey-nurses-beliefs-about-medical-emergency-team-system-canadian-tertiary-hospital
      January 04, 2012 - Study A survey of nurses' beliefs about the medical emergency team system in a Canadian tertiary hospital. Citation Text: Bagshaw SM, Mondor EE, Scouten C, et al. A survey of nurses' beliefs about the medical emergency team system in a canadian tertiary hospital. Am J Crit Care. 2010;1…

4469. The urgent need to improve health care quality. Institute of Medicine National Roundtable on Health Care Quality. | PSNet
      psnet.ahrq.gov/issue/urgent-need-improve-health-care-quality-institute-medicine-national-roundtable-health-care
      May 27, 2015 - Commentary Classic The urgent need to improve health care quality. Institute of Medicine National Roundtable on Health Care Quality. Citation Text: Chassin MR, Galvin RW. The urgent need to improve health care quality. Institute of Medicine National Roundtable o…

4470. A framework for engaging physicians in quality and safety. | PSNet
      psnet.ahrq.gov/issue/framework-engaging-physicians-quality-and-safety
      July 10, 2008 - Study Classic A framework for engaging physicians in quality and safety. Citation Text: Taitz JM, Lee TH, Sequist TD. A framework for engaging physicians in quality and safety. BMJ Qual Saf. 2012;21(9):722-728. doi:10.1136/bmjqs-2011-000167. Copy Citation …

4471. Effect of computer order entry on prevention of serious medication errors in hospitalized children. | PSNet
      psnet.ahrq.gov/issue/effect-computer-order-entry-prevention-serious-medication-errors-hospitalized-children
      May 27, 2011 - Study Classic Effect of computer order entry on prevention of serious medication errors in hospitalized children. Citation Text: Walsh KE, Landrigan CP, Adams WG, et al. Effect of computer order entry on prevention of serious medication errors in hospitalized …

4472. HCBS CAHPS Survey Database: What You Need to Know - BROWN (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/cahps/news-and-events/events/webinars/hcbs-webcast-051623-brown.pdf
      June 02, 2025 - HCBS CAHPS Survey Database: What You Need to Know - BROWN Looking Forward: HCBS Quality Measures Alignment and HCBS CAHPS® Survey Melanie Brown, PhD, Technical Director Division of Community Systems Transformation, Disabled and Elderly Health Programs Group, Center for Medicaid and CHIP Services, Centers for Medic…

4473. Medical misadventures as errors and mistakes and motor vehicular accidents in the disproportionate burden of childhood mortality among Blacks/African Americans in the United States: CDC Dataset, 1968-2015. | PSNet
      psnet.ahrq.gov/issue/medical-misadventures-errors-and-mistakes-and-motor-vehicular-accidents-disproportionate
      March 05, 2025 - Study Medical misadventures as errors and mistakes and motor vehicular accidents in the disproportionate burden of childhood mortality among Blacks/African Americans in the United States: CDC Dataset, 1968-2015. Citation Text: Holmes L, Enwere M, Mason R, et al. Medical misadventures as …

4474. Distractions in the cardiac catheterisation laboratory: impact for cardiologists and patient safety. | PSNet
      psnet.ahrq.gov/issue/distractions-cardiac-catheterisation-laboratory-impact-cardiologists-and-patient-safety
      June 07, 2023 - Study Distractions in the cardiac catheterisation laboratory: impact for cardiologists and patient safety. Citation Text: Mahadevan K, Cowan E, Kalsi N, et al. Distractions in the cardiac catheterisation laboratory: impact for cardiologists and patient safety. Open Heart. 2020;7(2). doi:…

4475. Adverse drug event nonrecognition in emergency departments: an exploratory study on factors related to patients and drugs. | PSNet
      psnet.ahrq.gov/issue/adverse-drug-event-nonrecognition-emergency-departments-exploratory-study-factors-related
      April 12, 2011 - Study Adverse drug event nonrecognition in emergency departments: an exploratory study on factors related to patients and drugs. Citation Text: Roulet L, Ballereau F, Hardouin J-B, et al. Adverse drug event nonrecognition in emergency departments: an exploratory study on factors related …

4476. Strategies for Improving CAHPS Clinician & Group (CG-CAHPS) Survey Scores (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/cahps/news-and-events/events/20160315/debra-rosen-slides.pdf
      March 15, 2016 - Strategies for Improving CAHPS Clinician & Group (CG-CAHPS) Survey Scores Improving CG-CAHPS Scores in a Federally Qualified Health Center Presented By Debra Rosen, RN, MPH Director, Quality & Health Education “Strategies for Improving CAHPS Clinician & Group (CG-CAHPS) Survey Scores” A Webcast Pres…

4477. Barriers to the implementation of checklists in the office-based procedural setting. | PSNet
      psnet.ahrq.gov/issue/barriers-implementation-checklists-office-based-procedural-setting
      February 18, 2019 - Study Barriers to the implementation of checklists in the office-based procedural setting. Citation Text: Shapiro FE, Fernando RJ, Urman RD. Barriers to the implementation of checklists in the office-based procedural setting. J Healthc Risk Manag. 2014;33(4):35-43. doi:10.1002/jhrm.21141…

4478. Gap Analysis Facilitator's Guide: Appendix B | Agency for Healthcare Research and Quality
      www.ahrq.gov/patient-safety/settings/hospital/candor/modules/facguide3/apb.html
      August 01, 2022 - Gap Analysis Facilitator's Guide: Appendix B Gap Analysis Structured Interview Questions The Gap Analysis Structured Interview Questions allow the facilitator to lead participants through a set of questions designed to elicit participant views on a variety of key policies and practices. Leadership and Cul…

4479. CPOE in Iran—a viable prospect? Physicians' opinions on using CPOE in an Iranian teaching hospital. | PSNet
      psnet.ahrq.gov/issue/cpoe-iran-viable-prospect-physicians-opinions-using-cpoe-iranian-teaching-hospital
      June 30, 2011 - Study CPOE in Iran—a viable prospect? Physicians' opinions on using CPOE in an Iranian teaching hospital. Citation Text: Kazemi A, Ellenius J, Tofighi S, et al. CPOE in Iran--a viable prospect? Physicians' opinions on using CPOE in an Iranian teaching hospital. Int J Med Inform. 2009;7…

4480. Quality indicators for implementation of safety promotion: towards valid and reliable global certification of local programmes. | PSNet
      psnet.ahrq.gov/issue/quality-indicators-implementation-safety-promotion-towards-valid-and-reliable-global
      February 03, 2010 - Study Quality indicators for implementation of safety promotion: towards valid and reliable global certification of local programmes. Citation Text: Timpka T, Nordqvist C, Festin K, et al. Quality indicators for implementation of safety promotion: towards valid and reliable global cert…