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psnet.ahrq.gov/issue/career-impact-chief-resident-quality-and-safety-training-program-alumni-evaluation
June 19, 2019 - suggests that such programs can teach residents to lead and engage other residents in patient safety and ultimately
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psnet.ahrq.gov/issue/medical-bias-pain-pills-covid-19-racial-discrimination-health-care-festers
June 24, 2020 - This story examines how racial bias can affect diagnosis, research, and treatment, ultimately resulting
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psnet.ahrq.gov/issue/quality-improvement-primary-approach-change-healthcare-precarious-self-limiting-choice
June 08, 2022 - harm” goals) over participants’ emotional experience and sociotechnical design elements, which can ultimately
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digital.ahrq.gov/program-overview/research-stories/improving-safety-postoperative-handoff-communication-telemedicine
January 01, 2023 - promote effective and efficient communication, foster interdisciplinary collaborative team workflows, and ultimately
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digital.ahrq.gov/sites/default/files/docs/page/guide-to-evaluating-hie-projects-section-5.pdf
June 16, 2021 - dissemination plan would account for these preferences, address
each stakeholder’s pain points, and ultimately
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digital.ahrq.gov/2020-year-review/research-summary/improving-medication-safety-accurate-e-prescribing-tool
January 01, 2020 - Ultimately, the e-prescribing tool CancelRx helps pharmacists do the job that they want to do, and do
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www.ahrq.gov/teamstepps-program/curriculum/implement/pre-measure.html
May 01, 2023 - Stress the need for TeamSTEPPS to ultimately change results or outcomes within your organization.
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www.ahrq.gov/diagnostic-safety/resources/issue-briefs/healthit-ed-2.html
February 01, 2021 - found that less than 10 percent of all radiology and laboratory test results ordered in the ED were ultimately
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psnet.ahrq.gov/node/39549/psn-pdf
March 22, 2011 - Ultimately, creation of a "closed-loop" system that integrates
technological solutions to prescription
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psnet.ahrq.gov/node/42968/psn-pdf
February 26, 2014 - prescribing physician's note with the order entered into the e-prescribing system and the medication
ultimately
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psnet.ahrq.gov/issue/blaming-others-threatening-events
November 25, 2009 - and personal characteristics, with interpersonal and intrapersonal mediators playing a role, which ultimately
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psnet.ahrq.gov/issue/safety-incidents-family-medicine
December 11, 2013 - reporting system, designed to encourage error reporting in ambulatory family medicine practices, ultimately
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psnet.ahrq.gov/cme
February 26, 2025 - However, she suffered from ischemic stroke and intracranial hemorrhages, ultimately leading to a transition … Ultimately, he developed osteomyelitis, requiring multiple surgeries and a long hospital stay due to
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psnet.ahrq.gov/node/846127/psn-pdf
March 15, 2023 - By the time this patient ultimately
underwent surgical reassessment, his symptoms had worsened and he … The patient in this case ultimately developed septic complications and was admitted to the hospital for … may lead to lower readmission rates,7 better provider
communication and patient satisfaction, and ultimately
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psnet.ahrq.gov/issue/collapse-sensemaking-organizations-mann-gulch-disaster
May 21, 2019 - who improvised a response to a fire by setting a back-fire while the rest of his crew panicked and ultimately
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psnet.ahrq.gov/node/33726/psn-pdf
March 01, 2012 - One of the early
cases we tried was a case that ultimately I could have settled for $40,000 or $50,000 … Instead of seeing people as ultimately
disposable, we're getting our arms around them and we're enrolling … Hold them
accountable but protect them from draconian penalties if we want to protect ultimately our … Ultimately it's not about claims at all, it's about making people
safer. … RB: I bristle at the headlines that say apology saves money because ultimately it's not about claims—it's
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www.ahrq.gov/prevention/chronic-care/decision/research-centers/rce_profile_liss.html
August 01, 2014 - Liss ultimately decided to pursue a postdoctoral Research Associate position at The Center for Advancing
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www.ahrq.gov/news/blog/ahrqviews/delivery-preventive-services.html
October 01, 2024 - quality of care disparities, increase patient safety, improve healthcare access and effectiveness, and ultimately
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www.ahrq.gov/diagnostic-safety/resources/issue-briefs/dxsafety-terminology10.html
April 01, 2025 - originate, and their practical applications will improve communication, enhance collaboration, and ultimately
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psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.368_slideshow.ppt
February 01, 2016 - The urologist persisted in using the robotic technology and ultimately was able to complete the procedure … The patient ultimately required several additional surgeries and a prolonged hospital stay.
6
Background … already complex and risk-fraught arena
24
Take-Home Points (2)
In general, surgical outcomes are ultimately