U.S. Department of Health and Human Services
Agency for Healthcare Research and Quality: Advancing Excellence in Health Care
Sign up for a Free Account
Wolpaw J, Schwengel D, Hensley N, et al. J Cardiothorac Vasc Anesth. 2018;32:522-533.
Wolpaw J ; Schwengel D ; Hensley N; et al. Engaging the front line: tapping into hospital-wide quality and safety initiatives. J Cardiothorac Vasc Anesth. 2018; 32: 522-533
Engaging clinicians and hospital staff is important for sustainable quality and safety improvement. This commentary describes a program to enhance staff involvement by providing education in risk identification, process assessment, project management, and patient engagement.
Improving America's Hospitals: A Report on Quality and Safety.
Oakbrook Terrace, IL: The Joint Commission; March 2007.
Quality and Safety Between Ward and Board: a Biography of Artefacts Study.
Keen J, Nicklin E, Long A, et al. Health Services and Delivery Research. Southampton, UK: NIHR Journals Library; 2018.
How DeKalb Medical fixed drug safety problems after fatal error.
Porter S. HealthLeaders Media. April 26, 2018.
Hospitals, medical groups start to worry about skills of older doctors.
Cavanaugh M, Clark C, Bazzo D. KPBS Midday Edition. August 18, 2015.
Individual Clinician Performance Issues
Diagnostic errors and the bedside clinical examination.
Clark BW, Derakhshan A, Desai SV. Med Clin North Am. 2018;102:453-464.
The effectiveness of assertiveness communication training programs for healthcare professionals and students: a systematic review.
Omura M, Maguire J, Levett-Jones T, Stone TE. Int J Nurs Stud. 2017;76:120-128.
Health Literacy Tools for Providers of Medication Therapy Management.
Rockville, MD: Agency for Healthcare Research and Quality.
Measures to improve diagnostic safety in clinical practice.
Singh H, Graber ML, Hofer TP. J Patient Saf. 2016 Oct 20; [Epub ahead of print].
Confidential Physician Feedback Reports: Designing for Optimal Impact on Performance.
McNamara P, Shaller D, De La Mare J, Ivers N. Rockville, MD: Agency for Healthcare Research and Quality; March 2016. AHRQ Publication No. 16-0017-EF.
Healthcare Safety for Nursing Personnel: An Organizational Guide to Achieving Results.
Tweedy JT. Boca Raton, FL: CRC Press; 2014. ISBN: 9781482230277.
Facilitating Patient Understanding of Discharge Instructions: Workshop Summary.
Alper J, Hernandez LM; Roundtable on Health Literacy, Board on Population Health and Public Health Practice, Institute of Medicine. Washington, DC: National Academies Press; December 2014. ISBN: 9780309307383.
Clinical faculty: taking the lead in teaching quality improvement and patient safety.
Davis NL, Davis DA, Rayburn WF. Am J Obstet Gynecol. 2014;211:215-215.e1.
Medication errors: an overview for clinicians.
Wittich CM, Burkle CM, Lanier WL. Mayo Clin Proc. 2014;89:1116-1125.
Demonstrating high reliability on accountability measures at The Johns Hopkins Hospital.
Pronovost PJ, Demski R, Callender T, et al. Jt Comm J Qual Patient Saf. 2013;39:531-544.
Teaching about how doctors think: a longitudinal curriculum in cognitive bias and diagnostic error for residents.
Reilly JB, Ogdie AR, Von Feldt JM, Myers JS. BMJ Qual Saf. 2013;22:1044-1050.
The effect of an organizational network for patient safety on safety event reporting.
Jeffs L, Hayes C, Smith O, et al. Eval Health Prof. 2014;37:366-378.
Transformative learning in a professional development course aimed at addressing disruptive physician behavior: a composite case study.
Samenow CP, Worley LLM, Neufeld R, Fishel T, Swiggart W. Acad Med. 2013;88:117-123.
The value of library and information services in patient care: results of a multisite study.
Marshall JG, Sollenberger J, Easterby-Gannett S, et al. J Med Libr Assoc. 2013;101:38-46.
Spreading a medication administration intervention organizationwide in six hospitals.
Kliger J, Singer S, Hoffman F, O'Neil E. Jt Comm J Qual Patient Saf. 2012;38:51-60.
Improving America's Hospitals: The Joint Commission's Annual Report on Quality and Safety 2009.
Oakbrook Terrace, IL: The Joint Commission; January 2010.
Improving America's Hospitals: The Joint Commission's Annual Report on Quality and Safety 2007.
Oakbrook Terrace, IL: The Joint Commission; November 2007.
Smart pumps: advanced capabilities and continuous quality improvement.
Vanderveen T. Patient Saf Quality Healthc. January/February 2007.
Intravenous medication safety and smart infusion systems: lessons learned and future opportunities.
Keohane CA, Hayes J, Saniuk C, Rothschild JM, Bates DW. J Infus Nurs. 2005;28:321-328.
How to reduce maternal mortality rates in the United States.
Livingston E, Howell EA. JAMA Clinical Reviews. April 2, 2019.
PSNET: Patient Safety Network
PSNet is produced for the Agency for Healthcare Research and Quality by a team of editors at the University of California, San Francisco with guidance from a prominent Technical Expert/Advisory Panel. The AHRQ PSNet site was designed and implemented by Silverchair.
Agency for Healthcare Research and Quality
5600 Fishers Lane
Rockville, MD 20857
Telephone: (301) 427-1364