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psnet.ahrq.gov/issue/conflict-interest-dr-charles-denham-and-journal-patient-safety
July 07, 2021 - Review
Conflict of interest, Dr Charles Denham and the Journal of Patient Safety.
Citation Text:
Wu AW, Kavanagh KT, Pronovost P, et al. Conflict of interest, Dr Charles Denham and the Journal of Patient Safety. J Patient Saf. 2014;10(4):181-5. doi:10.1097/PTS.0000000000000144.
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psnet.ahrq.gov/issue/learning-litigation-role-claims-analysis-patient-safety
November 21, 2018 - Study
Learning from litigation. The role of claims analysis in patient safety.
Citation Text:
Vincent CA, Davy C, Esmail A, et al. Learning from litigation. The role of claims analysis in patient safety. J Eval Clin Pract. 2006;12(6):665-74.
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psnet.ahrq.gov/issue/compendium-strategies-prevent-hais-acute-care-hospitals-2014
July 02, 2009 - Special or Theme Issue
Compendium of Strategies to Prevent HAIs in Acute Care Hospitals 2014.
Citation Text:
Compendium of Strategies to Prevent HAIs in Acute Care Hospitals 2014. Infect Control Hosp Epidemiol. 2014;35(Suppl 2):s1-s178;35:460-463;797-801.
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psnet.ahrq.gov/issue/identifying-patient-safety-problems-during-team-rounds-ethnographic-study
May 11, 2022 - Study
Identifying patient safety problems during team rounds: an ethnographic study.
Citation Text:
Lamba R, Linn K, Fletcher KE. Identifying patient safety problems during team rounds: an ethnographic study. BMJ Qual Saf. 2014;23(8):667-9. doi:10.1136/bmjqs-2013-002324.
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psnet.ahrq.gov/issue/latent-risk-assessment-tool-health-care-leaders
September 05, 2018 - Commentary
Latent risk assessment tool for health care leaders.
Citation Text:
Paine LA, Holzmueller CG, Elliott R, et al. Latent risk assessment tool for health care leaders. J Healthc Risk Manag. 2018;38(2):36-46. doi:10.1002/jhrm.21316.
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psnet.ahrq.gov/issue/contribution-prescription-chart-design-and-familiarity-prescribing-error-prospective
March 20, 2024 - Study
The contribution of prescription chart design and familiarity to prescribing error: a prospective, randomised, cross-over study.
Citation Text:
Tallentire VR, Hale RL, Dewhurst NG, et al. The contribution of prescription chart design and familiarity to prescribing error: a prospe…
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psnet.ahrq.gov/issue/delayed-medical-emergency-team-calls-and-associated-outcomes
October 13, 2018 - Study
Delayed medical emergency team calls and associated outcomes.
Citation Text:
Boniatti MM, Azzolini N, Viana M, et al. Delayed medical emergency team calls and associated outcomes. Crit Care Med. 2014;42(1):26-30. doi:10.1097/CCM.0b013e31829e53b9.
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www.ahrq.gov/es/programs/index.html?page=0
January 01, 2016 - Digital Healthcare Research Advancing healthcare quality, safety, and effectiveness through the evolving digital healthcare ecosystem. More
PSNet Discover the latest literature, news, and expert commentary on patient safety topics. More
CAHPS The CAHPS program aims to advance our scientific …
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psnet.ahrq.gov/issue/using-system-analysis-build-safety-culture-improving-reliability-epidural-analgesia
January 14, 2009 - Study
Using system analysis to build a safety culture: improving the reliability of epidural analgesia.
Citation Text:
Garnerin P, Huchet-Belouard A, Diby M, et al. Using system analysis to build a safety culture: improving the reliability of epidural analgesia. Acta Anaesthesiol Scand…
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psnet.ahrq.gov/issue/evaluating-implementation-rapid-response-team-considering-alternative-outcome-measures
October 19, 2022 - Study
Evaluating implementation of a rapid response team: considering alternative outcome measures.
Citation Text:
Moriarty JP, Schiebel NE, Johnson MG, et al. Evaluating implementation of a rapid response team: considering alternative outcome measures. Int J Qual Health Care. 2014;26(1)…
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psnet.ahrq.gov/issue/association-between-frequency-self-reported-medical-errors-and-anesthesia-trainee-supervision
July 19, 2017 - Study
The association between frequency of self-reported medical errors and anesthesia trainee supervision: a survey of United States anesthesiology residents-in-training.
Citation Text:
De Oliveira GS, Rahmani R, Fitzgerald PC, et al. The association between frequency of self-reported m…
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psnet.ahrq.gov/issue/surgical-skill-predicted-ability-detect-errors
September 02, 2020 - Study
Surgical skill is predicted by the ability to detect errors.
Citation Text:
Bann S, Khan M, Datta V, et al. Surgical skill is predicted by the ability to detect errors. Am J Surg. 2005;189(4):412-5.
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psnet.ahrq.gov/issue/flow-disruptions-trauma-care-handoffs
August 02, 2015 - Study
Flow disruptions in trauma care handoffs.
Citation Text:
Catchpole K, Gangi A, Blocker RC, et al. Flow disruptions in trauma care handoffs. J Surg Res. 2013;184(1):586-91. doi:10.1016/j.jss.2013.02.038.
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psnet.ahrq.gov/issue/exploring-and-evaluating-patient-safety-culture-community-based-primary-care-setting
March 19, 2018 - Study
Exploring and evaluating patient safety culture in a community-based primary care setting.
Citation Text:
Desmedt M, Bergs J, Willaert B, et al. Exploring and Evaluating Patient Safety Culture in a Community-Based Primary Care Setting. J Patient Saf. 2021;17(8):e1216-e1222. doi:10.…
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psnet.ahrq.gov/issue/public-health-approach-patient-safety-reporting-systems-urgently-needed
January 14, 2014 - Review
A public health approach to patient safety reporting systems is urgently needed.
Citation Text:
Noble DJ, Panesar S, Pronovost P. A public health approach to patient safety reporting systems is urgently needed. J Patient Saf. 2011;7(2):109-12. doi:10.1097/PTS.0b013e31821b8a6c.
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psnet.ahrq.gov/issue/hospital-readmission-after-noncardiac-surgery-role-major-complications
July 20, 2016 - Study
Hospital readmission after noncardiac surgery: the role of major complications.
Citation Text:
Glance LG, Kellermann AL, Osler T, et al. Hospital readmission after noncardiac surgery: the role of major complications. JAMA Surg. 2014;149(5):439-45.
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psnet.ahrq.gov/issue/nurses-experiences-drug-administration-errors
October 14, 2020 - Study
Nurses' experiences of drug administration errors.
Citation Text:
Schelbred A-B, Nord R. Nurses' experiences of drug administration errors. J Adv Nurs. 2007;60(3):317-24.
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www.ahrq.gov/news/newsroom/case-studies/201709.html
June 01, 2017 - St. Jude Children's Research Hospital Uses AHRQ Survey to Promote Patient Safety
Search All Impact Case Studies
June 2017
St. Jude Children's Research Hospital uses AHRQ's Hospital Survey on Patient Safety Culture to obtain employee feedback on ways to improve medical care and safety for the approximately…
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www.ahrq.gov/hai/cusp/toolkit/daily-goals.html
December 01, 2012 - Daily Goals Checklist
CUSP Toolkit
Effective communication is particularly important in the unit if complicated care plans are to be effectively managed by the care team
Problem statement: Clear communication among health care providers is paramount. Communication failures lead to patient harm, increased l…
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psnet.ahrq.gov/issue/nonhospital-health-care-associated-hepatitis-b-and-c-virus-transmission-united-states-1998
October 19, 2012 - Review
Nonhospital health care–associated hepatitis B and C virus transmission: United States, 1998-2008.
Citation Text:
Thompson ND, Perz JF, Moorman AC, et al. Nonhospital health care-associated hepatitis B and C virus transmission: United States, 1998-2008. Ann Intern Med. 2009;150(1)…