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  1. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/33644/psn-pdf
    December 01, 2006 - Establishing a Safety Culture: Thinking Small December 1, 2006 Hoff TJ. Establishing a Safety Culture: Thinking Small. PSNet [internet]. 2006. https://psnet.ahrq.gov/perspective/establishing-safety-culture-thinking-small Perspective Safety cultures are the holy grail in any risky industry. Like all holy grails, th…
  2. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/866697/psn-pdf
    September 11, 2024 - Patient Safety: Emerging Applications of Safety Science. September 11, 2024 Cox C, Hughes H, Nicholls J. Patient Safety: Emerging Applications Of Safety Science. Somerset, UK: Class Publishing; 2024. ISBN 9781801610834. https://psnet.ahrq.gov/issue/patient-safety-emerging-applications-safety-science Patient safety…
  3. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/867394/psn-pdf
    March 10, 2025 - Request for Information: Diagnostic Excellence Measurement. December 18, 2024 Request for Information: Diagnostic Excellence Measurement. Agency for Healthcare Research and Quality. Fed Register. December 12, 2024;89:100497-100498. https://psnet.ahrq.gov/issue/request-information-diagnostic-excellence-measurement …
  4. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/848105/psn-pdf
    April 26, 2023 - GoodDx.org April 26, 2023 GoodDx. https://psnet.ahrq.gov/issue/gooddxorg Effective feedback is an important component of individual, team and organizational learning in order to achieve safe diagnosis. GoodDx.org houses a variety of diagnostic performance feedback resources for use by clinicians, patient safety p…
  5. psnet.ahrq.gov/issue/first-do-no-harm-marshaling-clinician-leadership-counter-opioid-epidemic
    July 19, 2017 - Book/Report First, Do No Harm: Marshaling Clinician Leadership to Counter the Opioid Epidemic. Citation Text: First, Do No Harm: Marshaling Clinician Leadership to Counter the Opioid Epidemic. Adams SM, Blanco C, Chaudhry HJ, et al. Washington, DC: National Academy of Medicine; 2017. ISB…
  6. psnet.ahrq.gov/issue/essential-activities-electronic-health-record-safety-qualitative-study
    April 29, 2018 - Study Essential activities for electronic health record safety: a qualitative study. Citation Text: Ash JS, Singh H, Wright A, et al. Essential activities for electronic health record safety: A qualitative study. Health Informatics J. 2019:1460458219833109. doi:10.1177/1460458219833109. …
  7. psnet.ahrq.gov/issue/current-challenges-health-information-technology-related-patient-safety
    July 16, 2015 - Commentary Current challenges in health information technology–related patient safety. Citation Text: Sittig DF, Wright A, Coiera E, et al. Current challenges in health information technology–related patient safety. Health Inform J. 2020;26(1):181-189. doi:10.1177/1460458218814893. Cop…
  8. psnet.ahrq.gov/issue/preventing-medication-errors-quality-chasm-series
    January 04, 2009 - Book/Report Classic Preventing Medication Errors: Quality Chasm Series. Citation Text: Preventing Medication Errors: Quality Chasm Series. Aspden P, Wolcott J, Bootman JL, et al, eds; Institute of Medicine, Committee on Identifying and Preventing Medication …
  9. psnet.ahrq.gov/issue/optimizing-transitions-care-reduce-rehospitalizations
    November 04, 2015 - Review Optimizing transitions of care to reduce rehospitalizations. Citation Text: Li J, Young R, Williams M. Optimizing transitions of care to reduce rehospitalizations. Cleve Clin J Med. 2014;81(5):312-20. doi:10.3949/ccjm.81a.13106. Copy Citation Format: DOI Google Schol…
  10. psnet.ahrq.gov/issue/limits-safety-organizations-accidents-and-nuclear-weapons
    July 28, 2013 - Book/Report Classic The Limits of Safety: Organizations, Accidents and Nuclear Weapons. Citation Text: The Limits of Safety: Organizations, Accidents and Nuclear Weapons. Sagan SD. Princeton NJ: Princeton University Press; 1993. ISBN: 9780691032214. Copy Cit…
  11. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/866257/psn-pdf
    July 25, 2024 - Enhancing Surgical Team Communication: SOPS and TeamSTEPPS in Action. July 10, 2024 Agency for Healthcare Research and Quality. July 25, 2024. https://psnet.ahrq.gov/issue/enhancing-surgical-team-communication-sops-and-teamstepps-action Teamwork in the surgical suite is core to safe care but can be challenging to …
  12. psnet.ahrq.gov/issue/utilising-improvement-science-methods-optimise-medication-reconciliation
    July 24, 2017 - Study Utilising improvement science methods to optimise medication reconciliation. Citation Text: White CM, Schoettker PJ, Conway PH, et al. Utilising improvement science methods to optimise medication reconciliation. BMJ Qual Saf. 2011;20(4):372-80. doi:10.1136/bmjqs.2010.047845. Co…
  13. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/74069/psn-pdf
    September 20, 2022 - Diagnostic Excellence. September 20, 2022 JAMA. Nov 2021-Sep 2022.  https://psnet.ahrq.gov/issue/diagnostic-excellence-0 Diagnostic excellence achievement is becoming a primary focus in health care. This 20-article series covers diagnosis as it relates to the Institute of Medicine quality domains, clinical ch…
  14. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/841489/psn-pdf
    December 14, 2022 - Rise to Health Coalition. December 14, 2022 Boston, MA; Institute for Healthcare Improvement: December 2022. https://psnet.ahrq.gov/issue/rise-health-coalition Systemic efforts to improve health equity support patient safety. This announcement highlights an initiative for collective work to address four areas of e…
  15. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/864865/psn-pdf
    March 20, 2024 - The Top Five: A Review of Post-Pandemic Patient Safety Priorities. March 20, 2024 Sacramento, CA: Hospital Quality Institute; 2024. https://psnet.ahrq.gov/issue/top-five-review-post-pandemic-patient-safety-priorities The COVID pandemic posed wide-ranging challenges to both society at large as well as to the health…
  16. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/865347/psn-pdf
    March 27, 2024 - Safety and Human Performance in the Operating Room and Other Extreme Environments. March 27, 2024 Ruskin KJ, ed. Int Anesthesiol Clin. 2024;62(2):1-65. https://psnet.ahrq.gov/issue/safety-and-human-performance-operating-room-and-other-extreme- environments Anesthesia is a vital component of surgical care that can…
  17. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/60008/psn-pdf
    July 09, 2024 - IHI Patient Safety Congress. July 9, 2024 Institute for Healthcare Improvement. San Diego, CA, March 10-11, 2025. https://psnet.ahrq.gov/issue/ihi-patient-safety-congress This annual conference will host pre-session workshops, panels, and presentations covering a variety of patient safety topics that ali…
  18. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/866072/psn-pdf
    June 05, 2024 - WHO Global Report on Patient Safety. June 5, 2024 Geneva, Switzerland: World Health Organization; 2024. ISBN 9789240095458. https://psnet.ahrq.gov/issue/who-global-report-patient-safety Comparative data can help to inform and motivate patient safety improvement efforts. This report uses the seven objectives of the…
  19. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/854639/psn-pdf
    October 18, 2023 - Right Kind of Wrong: Why Learning to Fail can Teach us to Thrive. October 18, 2023 Edmondson A. Atria Books, New York, 2023. ISBN: 9781982195069. https://psnet.ahrq.gov/issue/right-kind-wrong-why-learning-fail-can-teach-us-thrive Despite the harm that failure can cause, its value as a learning opportunity, if exam…
  20. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/42080/psn-pdf
    February 27, 2013 - Transitions of Care (TOC) Portal. February 27, 2013 https://psnet.ahrq.gov/issue/transitions-care-toc-portal This Web site provides resources for clinicians and patients to help achieve safe care transitions. https://psnet.ahrq.gov/issue/transitions-care-toc-portal https://psnet.ahrq.gov/issue/improving-transitions…

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