Patient Safety Research Summaries.

Book/Report

Patient Safety Research Summaries.

April 9, 2024

Rockville, MD: Agency for Healthcare Research and Quality; 2023-2024.

The application of evidence in real situations helps to embed innovation across systems and sustain care improvement. This collection of project highlight reports shares descriptions of implementation projects and research funded by AHRQ. The latest report examines the role of teamwork as a component of safety success.

Available at

Engaging Patients and Families (PDF)

Enhancing Health Information Technology and Health Information Exchange (PDF)

Enhancing Healthcare Facility Design (PDF)

Improving Healthcare Safety by Enhancing Teamwork and Leadership (PDF)

Related Resources From the Same Author(s)

Making Healthcare Safer IV: A Continuous Updating of Patient Safety Harms and Practices.

April 22, 2024

National Healthcare Quality and Disparities Report Chartbook on Patient Safety.

March 22, 2024

Diagnostic Safety Issue Briefs.

January 28, 2024

Current State of Diagnostic Safety: Implications for Research, Practice, and Policy.

February 7, 2024

Respectful Maternity Care: Dissemination and Implementation of Perinatal Safety Culture to Improve Equitable Maternal Healthcare Delivery and Outcomes.

January 10, 2024

Surveys on Patient Safety Culture (SOPS) Medical Office Survey: 2024 User Database Report.

February 28, 2024

Patient Experience, Patient Safety, and Provider Well-Being: Associations and Paths for Quality Improvement.

February 6, 2024

Final Report on Prioritization of Patient Safety Practices for a New Rapid Review or Rapid Response. Making Healthcare Safer IV Series.

August 9, 2023

Dissemination and Implementation of Equity-Focused Evidence-Based Interventions in Healthcare Delivery Systems (R18).

March 8, 2023

Understanding and Improving Diagnostic Safety in Ambulatory Care.

September 6, 2023

AHRQ-Funded Patient Safety Project Highlights: Improving Healthcare Safety by Engaging Patients and Families.

February 15, 2023

Network of Patient Safety Databases Chartbook.

November 8, 2023

Surveys on Patient Safety Culture (SOPS) Ambulatory Surgery Center Survey: User Database Report.

January 14, 2024

AHRQ Safety Program for MRSA Prevention.

February 14, 2023

Systems-Based Approaches to Improve Patient Safety by Improving Healthcare Worker Safety and Well-Being (R01 Clinical Trial Optional).

December 20, 2023

NPSD Data Spotlight: Patterns of Fall Interventions.

November 15, 2023

Toolkits To Reduce Hypertension in Pregnancy and Obstetric Hemorrhage.

August 16, 2023

Reimagining Healthcare Teams: Leveraging the Patient-Clinician-AI Triad To Improve Diagnostic Safety.

August 16, 2023

Patient Experience as a Source for Understanding the Origins, Impact, and Remediation of Diagnostic Errors.

August 2, 2023

Diagnostic Safety Across Transitions of Care Throughout the Healthcare System: Current State and a Call to Action.

June 28, 2023

Strategies for Improving Clinician Psychological Safety in Reporting and Discussing Diagnostic Error.

September 27, 2023

Pediatric Diagnostic Safety: State of the Science and Future Directions.

September 13, 2023

Challenge Competition: Impact of Patient Safety Tools.

December 12, 2023

Burnout in Primary Care: Assessing and Addressing It in Your Practice.

May 3, 2023

TeamSTEPPS Core Curriculum.

July 19, 2023

Surveys on Patient Safety Culture Nursing Home Survey: 2023 User Database Report.

February 8, 2023

Medical Office Survey on Patient Safety Culture.

September 1, 2021

Preventable Hospitalizations: A Window Into Primary and Preventive Care, 2000.

March 27, 2005

Notice of Intent to Publish Funding Opportunity Announcements to Understand and Improve Diagnostic Safety in Ambulatory Care.

August 16, 2023

Improving Medication Safety in High Risk Medicare Beneficiaries Toolkit.

August 1, 2012

AHRQ Health Information Technology Research: 2018 Year in Review.

October 23, 2019

AHRQ's Safety Program for Ambulatory Surgery.

May 1, 2017

Reducing and Preventing Adverse Drug Events to Decrease Hospital Costs.

March 6, 2005

Inpatient Computerized Provider Order Entry: Findings from the AHRQ Health IT Portfolio.

March 4, 2009

Using Telehealth to Improve Quality and Safety: Findings from the AHRQ Portfolio.

January 21, 2009

Healthcare Simulation Dictionary, Second Edition.

November 23, 2016

Surveys on Patient Safety Culture(TM) (SOPS®) Hospital Survey 2021 User Database Reports.

March 31, 2021

Telediagnosis for Acute Care: Implications for the Quality and Safety of Diagnosis.

August 19, 2020

Medical Office Survey: 2020 User Database Report.

April 28, 2021

Using Innovative Digital Healthcare Solutions to Improve Quality at the Point of Care (R21/R33 - Clinical Trial Optional).

February 24, 2021

Health Information Technology for Engaging Patients in Diagnostic Decision Making in Emergency Departments.

February 17, 2021

Toolkit to Improve Antibiotic Use in Long-Term Care.

July 14, 2021

Leadership To Improve Diagnosis: A Call to Action.

July 7, 2021

Workplace Safety Supplemental Item Set for Hospital SOPS.

November 17, 2021

AHRQ announces interest in research on digital healthcare safety.

November 10, 2021

Malnutrition in Hospitalized Adults: A Systematic Review.

October 27, 2021

The Contribution of Diagnostic Errors to Maternal Morbidity and Mortality During and Immediately After Childbirth: State of the Science.

October 6, 2021

Making Health Care Safer in Ambulatory Care Settings and Long-term Care Facilities (R18).

September 22, 2021

National Nursing Home COVID Action Network.

October 7, 2020

Evidence on Use of Clinical Reasoning Checklists for Diagnostic Error Reduction.

September 30, 2020

NPSD Data Spotlight, Patient Safety and COVID-19: A Qualitative Analysis of Concerns During the Public Health Emergency, 2021.

December 22, 2021

Input for the TeamSTEPPS Curriculum Updates.

December 15, 2021

Strategies to Improve Patient Safety: Final Report to Congress Required by the Patient Safety and Quality Improvement Act of 2005.

December 15, 2021

New AHRQ SOPS® Workplace Safety Supplemental Items for Hospitals.

December 16, 2021 - December 16, 2021

Toolkit for Engaging Patients to Improve Diagnostic Safety.

September 8, 2021

Diagnostic Centers of Excellence: Partnerships to Improve Diagnostic Safety and Quality (R18).

April 20, 2022

Surveys on Patient Safety Culture (SOPS) Medical Office Survey: 2022 User Database Report.

April 6, 2022

Improving Education—A Key to Better Diagnostic Outcomes.

March 30, 2022

TeamSTEPPS for Diagnosis Improvement.

March 23, 2022

Diagnostic Safety Centers of Excellence.

November 9, 2022

Surveys on Patient Safety Culture (SOPS) Hospital Survey 2.0: 2022 User Database Report.

November 9, 2022

Toolkit To Improve Antibiotic Use in Ambulatory Care.

October 26, 2022

Calibrate Dx: A Resource to Improve Diagnostic Decisions.

October 19, 2022

Reinforcing the Value and Roles of Nurses in Diagnostic Safety: Pragmatic Recommendations for Nurse Leaders and Educators.

October 5, 2022

Improved Diagnostic Accuracy Through Probability-Based Diagnosis.

September 28, 2022

Distributed Cognition and the Role of Nurses in Diagnostic Safety in the Emergency Department.

August 17, 2022

Measure Dx: A Resource to Identify, Analyze, and Learn from Diagnostic Safety Events.

July 27, 2022

2022 Updated Results for the AHRQ Surveys on Patient Safety Culture (SOPS) Diagnostic Safety Supplemental Items.

June 1, 2022

AHRQ Safety Program for Intensive Care Units: Preventing CLABSI and CAUTI: Final Report.

May 18, 2022

AHRQ Challenge on Innovative Solutions To Update or Re-Create TeamSTEPPS Videos.

May 11, 2022

Toolkit for Preventing CLABSI and CAUTI in ICUs.

April 27, 2022

Northeastern University Hospital Surge Capacity Planning Model: Bed, Ventilator, and PPE 1-30 Day Demand.

July 15, 2020

Medication Safety: Advancing the Development of Improvement Strategies and Tools (R18).

October 9, 2022

January 11, 2017

National Scorecard on Rates of Hospital-Acquired Conditions 2010 to 2015: Interim Data From National Efforts to Make Health Care Safer.

December 21, 2016

Nursing Home Antimicrobial Stewardship Guide.

November 9, 2016

October 3, 2018

Efforts To Improve Patient Safety Result in 1.3 Million Fewer Patient Harms: Interim Update on 2013 Annual Hospital-Acquired Condition Rate and Estimates of Cost Savings and Deaths Averted From 2010 to 2013.

December 10, 2014

Explicit and Standardized Prescription Medicine Instructions.

January 21, 2015

TeamSTEPPS for Office-Based Care Version.

November 19, 2014

AHRQ Nursing Home Survey on Patient Safety Culture: 2014 User Comparative Database Report.

November 19, 2014

2013 Annual Hospital-Acquired Condition Rate and Estimates of Cost Savings and Deaths Averted From 2010 to 2013.

November 18, 2015

Environmental Cleaning for the Prevention of Healthcare-Associated Infections (HAIs).

September 16, 2015

Examining the Relationship Between Health IT and Ambulatory Care Workflow Redesign.

September 2, 2015

Health Care Simulation to Advance Safety: Responding to Ebola and Other Threats.

April 15, 2015

AHRQ Announces Interest in Research About the Epidemiology of Patient Safety Risks and Harms in Ambulatory Health Care Settings.

February 25, 2015

AHRQ announces interest in research on health IT safety.

February 11, 2015

AHRQ Safety Program for End-Stage Renal Disease Facilities—Toolkit.

February 4, 2015

Action Planning Tool for the AHRQ Surveys on Patient Safety Culture.

December 5, 2022

Patient Safety in Ambulatory Settings: Technical Brief.

December 16, 2015

Saving Lives and Saving Money: Hospital-Acquired Conditions Update.

December 9, 2015

Resident Safety Practices in Nursing Home Settings.

November 11, 2015

Toolkit for Reducing CAUTI in Hospitals.

December 9, 2015

Improving Patient Safety in Ambulatory Surgery Centers: A Resource List for Users of the AHRQ Ambulatory Surgery Center Survey on Patient Safety Culture.

May 11, 2016

Hospital Survey on Patient Safety Culture: 2016 User Comparative Database Report.

May 11, 2016

Developing and Testing the Health Care Safety Hotline: A Prototype Consumer Reporting System for Patient Safety Events. Final Report.

May 25, 2016

Trends in Potentially Preventable Inpatient Hospital Admissions and Emergency Department Visits.

May 11, 2016

Choosing a Patient Safety Organization

March 1, 2020

Confidential Physician Feedback Reports: Designing for Optimal Impact on Performance.

March 16, 2016

Designing and Delivering Whole-Person Transitional Care: Hospital Guide to Reducing Medicaid Readmissions.

September 3, 2016

Related Resources

Making Healthcare Safer IV: A Continuous Updating of Patient Safety Harms and Practices.

April 22, 2024

National Healthcare Quality and Disparities Report Chartbook on Patient Safety.

March 22, 2024

Diagnostic Safety Supplemental Item Set for Medical Office SOPS.

March 4, 2024

Prioritizing Patient Safety Through Quality Measurement.

February 28, 2024

Current State of Diagnostic Safety: Implications for Research, Practice, and Policy.

February 7, 2024

Patient Experience, Patient Safety, and Provider Well-Being: Associations and Paths for Quality Improvement.

February 6, 2024

Grand rounds in methodology: key considerations for implementing machine learning solutions in quality improvement initiatives.

January 31, 2024

Surveys on Patient Safety Culture (SOPS) Ambulatory Surgery Center Survey: User Database Report.

January 14, 2024

Respectful Maternity Care: Dissemination and Implementation of Perinatal Safety Culture to Improve Equitable Maternal Healthcare Delivery and Outcomes.

January 10, 2024

Systems-Based Approaches to Improve Patient Safety by Improving Healthcare Worker Safety and Well-Being (R01 Clinical Trial Optional).

December 20, 2023

Challenge Competition: Impact of Patient Safety Tools.

December 12, 2023

NPSD Data Spotlight: Patterns of Fall Interventions.

November 15, 2023

Network of Patient Safety Databases Chartbook.

November 8, 2023

Rethinking Patient Safety: A Discussion Guide for Patients, Healthcare Providers and Leaders.

November 1, 2023

Learning from latent safety threats identified during simulation to improve patient safety.

October 11, 2023

Patient Engagement for Patient Safety: The Why, What, and How of Patient Engagement for Improving Patient Safety.

October 11, 2023

Pediatric Diagnostic Safety: State of the Science and Future Directions.

September 13, 2023

A Transformational Effort on Patient Safety.

September 13, 2023

Understanding and Improving Diagnostic Safety in Ambulatory Care.

September 6, 2023

Interview

In Conversation with... Kathleen Sanford and Sue Schuelke about Virtual Nursing

August 30, 2023

Perspectives on Safety

Virtual Nursing: Improving Patient Care and Meeting Workforce Challenges

August 30, 2023

Reimagining Healthcare Teams: Leveraging the Patient-Clinician-AI Triad To Improve Diagnostic Safety.

August 16, 2023

Toolkits To Reduce Hypertension in Pregnancy and Obstetric Hemorrhage.

August 16, 2023

Final Report on Prioritization of Patient Safety Practices for a New Rapid Review or Rapid Response. Making Healthcare Safer IV Series.

August 9, 2023

Patient Experience as a Source for Understanding the Origins, Impact, and Remediation of Diagnostic Errors.

August 2, 2023

Adverse Events Toolkit: Medical Record Review Methodology.

July 26, 2023

Maternal Health of Women and Girls of African Descent in the Americas.

July 26, 2023

Issues and complexities in safety culture assessment in healthcare.

July 19, 2023

Deficient Care of a Patient Who Died by Suicide and Facility Leaders' Response at the Charlie Norwood VA Medical Center in Augusta, Georgia.

July 5, 2023

Diagnostic Safety Across Transitions of Care Throughout the Healthcare System: Current State and a Call to Action.

June 28, 2023

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