The PSNet Collection: All Content

The AHRQ PSNet Collection comprises an extensive selection of resources relevant to the patient safety community. These resources come in a variety of formats, including literature, research, tools, and Web sites. Resources are identified using the National Library of Medicine’s Medline database, various news and content aggregators, and the expertise of the AHRQ PSNet editorial and technical teams.

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Displaying 1 - 20 of 148 Results

ISMP Medication Safety Intensive.

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Institute for Safe Medication Practices. October 4-5, 2023, 10:45 AM - 7:45 PM (eastern).

This virtual workshop will explore tactics to ensure medication safety, including strategic planning, risk assessment, and Just Culture principles.

‘The Retrievals’ reveals painful experiences of female patients are often ignored.

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Desjardins L. PBS NewsHour. August 29, 2023.

Disregard for women’s pain is a persistent problem in health care. This news segment discusses a podcast highlighting a pattern of dismissal of patient concerns that resulted in harm and allowed fentanyl diversion by a nurse with substance abuse disorder to go undetected.

TeamSTEPPS Refresher Course.

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AHA Training. October 3-24, 2023. Tuesdays 2:00 PM - 3:30 PM (eastern).

Revisiting concept foundations is an important strategy to learn from experience and energize project participants. This virtual series will prepare participants to begin the implementation of the TeamSTEPPS program at their institutions and draw from the knowledge of others to make adjustments as needed to support teamwork training efforts.

Certified Professional in Patient Safety Review Course.

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Institute for Healthcare Improvement. September 28–29, 2023. 12:00 PM - 4:00 PM (eastern)

This online class prepares individuals to apply for the Institute for Healthcare Improvement patient safety certification program. The on-demand or live sessions cover key patient safety concepts to enhance participants' knowledge about safety culture, systems thinking, leadership, risk identification and analysis, information technology, and human factors. The next online session is August 2-3, 2023.

Patient Safety Executive Development Program.

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Institute for Healthcare Improvement. Boston, MA and online. August 30-October 13, 2023.

Organization executives influence the success of patient safety improvement. This hybrid workshop will highlight how leaders can use assessments, planning, and evidence to improve the safety culture at their organizations.

National Action Alliance to Advance Patient Safety Webinar Series.

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US Department of Health and Human Services. September 26, 2023. 2:00-3:00 PM (eastern).

Work toward zero harm in health care is gaining national attention in the United States. This webinar aligns with efforts by the National Action Alliance to Advance Patient Safety. The session will explore the successful application of high reliability concepts at the Veterans Health Administration. This is the fifth in a series of offerings from the Alliance supporting its work to improve safety.

Striving for diagnostic excellence.

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Centor RM, Dhaliwal G. Annals On Call. July 2023.

Diagnostic accuracy requires both cognitive and team-focused skill development. This podcast interview shares problem-solving tactics that support diagnostic excellence and how to measure it. Tracking diagnosis outcomes at a patient level is one strategy discussed.

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

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CAHPS Research Meetings. Agency for Healthcare Research and Quality, Rockville, MD. October 19, 2023; 11:00 AM—4:00 PM (eastern).

Patient narrative is an important resource for understanding care delivery. This webinar will discuss how Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys can provide patient experience insights that could inform safety culture improvement efforts and lower risks stemming from poor patient/team communication.

IHI Fellowship Program.

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Institute for Healthcare Improvement.

This virtual fellowship program focuses on developing competencies for leading patient safety efforts. The deadline for submitting an application for the 2023–2024 class is October 16, 2023.

TeamSTEPPS Master Training Course.

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Armstrong Institute for Patient Safety and Quality. October 3 and 5, 2023.

Team training programs seek to improve communication and coordination among team members to reduce the potential for medical error. This virtual workshop will train participants to design, implement, and evaluate team training programs in their organizations based on the TeamSTEPPS model.

Northwest Patient Safety Conference.

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Washington Patient Safety Coalition. October 17-18, 2023.

The emphasis on improvement solutions rather than counting adverse events is an emerging patient safety strategy. This 20th annual virtual conference will highlight regional and local experiences enhancing patient and family engagement, systems safety, and equitable practice.

Annual Communication, Apology, and Resolution (CARe) Forum.

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Betsy Lehman Center for Patient Safety. September 29, 2023, 10:00 AM - 12:30 PM (eastern).

Communication and resolution programs are a promising strategy for successful management of relationships and actions after medical error occurrence. This annual hybrid session explores elements of effective discussions after an adverse event through case simulation and dialogue. The site also includes an archive of videos and materials from previous forums.

CUSP Implementation Training.

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Armstrong Institute for Patient Safety and Quality.

The comprehensive unit-based safety program (CUSP) approach emphasizes improving safety culture through a continuous process of reporting and learning from errors, improving teamwork, and engaging staff at all levels in safety efforts. Available on demand and live, this session covers how to utilize CUSP, including understanding and addressing challenges to implementation. The next virtual session will be held October 17-18, 2023.

Advancing Diagnostic Excellence in Maternal Health Care.

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Board on Health Care Services, National Academies of Science, Engineering, and Medicine. Arnold and Mabel Beckman Center, Irvine, CA. July 27, 2023.

Misdiagnosis during pregnancy can have tragic results for both the pregnant person and infant. This free workshop will discuss current challenges in maternal diagnostic excellence, identifications of knowledge gaps, and strategies to decrease maternal disparities. The workshop is open to the public can be attended in-person or virtually.

Unequal Treatment Revisited: A Workshop Series.

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Committee on Unequal Treatment, National Academies. 2023.

Health disparities and unequal care contribute to patient and family harm. This 3-component workshop series explored ethnic and racial disparities in health care. A planned September workshop will revisit the findings from the three sessions.

TeamSTEPPS Master Training Virtual Course.

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AHA Team Training. September 7 - November 2, 2023.

The TeamSTEPPS program was developed to support effective communication and teamwork in health care. This online series will prepare participants to guide their organizations through implementation of the TeamSTEPPS program. It is designed for individuals that are new to TeamSTEPPS processes.

Up Next for Patient Safety.

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National Patient Safety Board. 2021-2023.

Patient safety expertise builds on a wide range of subjects to inform progress. This webinar series features discussions on topics spanning concerns that impact effective care delivery such as peer evaluation, systemic failures, human factors, and translating research into practice. A discussion guide accompanies the series to support conversation and reflection.

SOPS Ambulatory Surgery Center Survey: What You Need to Know.

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Agency for Healthcare Policy and Research: April 27, 2023.

Ambulatory surgery centers (ASC) experience a variety of error types that can be exacerbated by poor safety culture. This webcast provided information on AHRQ’s Surveys on Patient Safety Culture™ (SOPS®) Ambulatory Surgery Center (ASC) Survey, including a review of the SOPS ASC program, survey administration, database submission, and available resources.

Redesigning Event Review with RCA2

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Institute for Healthcare Improvement. September 13 - November 7, 2023.

Root cause analysis (RCA) is a widely recognized retrospective strategy for learning from failure that is challenging to implement. This series of webinars will feature an innovative approach to RCA that expands on the concept to facilitate its use in incident investigations. Instructors for the series will include Dr. Terry Fairbanks and Dr. Tejal K. Gandhi.

Just a Cup of Tea – an Introduction to the SEIPS Framework.

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Epsom and St Helier University Hospitals. Epsom, UK: National Health Service; March 21, 2023.

The Systems Engineering Initiative for Patient Safety (SEIPS) framework is an established human factors-based approach to designing care system improvements. This video introduces the concepts behind SEIPS and uses an everyday non-clinical activity to illustrate its use for a broad audience to identify problems.

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