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  1. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/43444/psn-pdf
    August 27, 2014 - Patient-safety–related hospital deaths in England: thematic analysis of incidents reported to a national database, 2010–2012. August 27, 2014 Donaldson LJ, Panesar S, Darzi A. Patient-safety-related hospital deaths in England: thematic analysis of incidents reported to a national database, 2010-2012. PLoS Med. 201…
  2. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/44501/psn-pdf
    January 22, 2016 - Patient safety perceptions in pediatric out-of-hospital emergency care: Children's Safety Initiative. January 22, 2016 Guise J-M, Meckler G, O'Brien K, et al. Patient Safety Perceptions in Pediatric Out-of-Hospital Emergency Care: Children's Safety Initiative. J Pediatr. 2015;167(5):1143-8.e1. doi:10.1016/j.jpeds.2…
  3. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/46678/psn-pdf
    January 03, 2018 - Measuring patient safety in real time: an essential method for effectively improving the safety of care. January 3, 2018 Classen DC, Griffin FA, Berwick DM. Measuring Patient Safety in Real Time: An Essential Method for Effectively Improving the Safety of Care. Ann Intern Med. 2017;167(12). doi:10.7326/m17-2202. h…
  4. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/45966/psn-pdf
    April 05, 2017 - Fundamental Use of Surgical Energy (FUSE): an essential educational program for operating room safety. April 5, 2017 Jones SB, Munro MG, Feldman LS, et al. Fundamental Use of Surgical Energy (FUSE): An Essential Educational Program for Operating Room Safety. Perm J. 2017;21:16-050. doi:10.7812/TPP/16-050. https://…
  5. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/50935/psn-pdf
    February 26, 2020 - Moving from knowledge to action: improving safety and quality of care for patients with limited English proficiency. February 26, 2020 Fox MT, Godage SK, Kim JM, et al. Moving from knowledge to action: improving safety and quality of care for patients with limited English proficiency. Clin Pediatr (Phila). 2020;59…
  6. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/35434/psn-pdf
    June 14, 2011 - Turning the medical gaze in upon itself: root cause analysis and the investigation of clinical error. June 14, 2011 Iedema RAM, Jorm C, Long D, et al. Turning the medical gaze in upon itself: root cause analysis and the investigation of clinical error. Soc Sci Med. 2006;62(7):1605-15. https://psnet.ahrq.gov/issue/…
  7. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/46532/psn-pdf
    July 30, 2018 - Efficiency and safety of speech recognition for documentation in the electronic health record. July 30, 2018 Hodgson T, Magrabi F, Coiera E. Efficiency and safety of speech recognition for documentation in the electronic health record. J Am Med Inform Assoc. 2017;24(6):1127-1133. doi:10.1093/jamia/ocx073. https://…
  8. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/48163/psn-pdf
    July 31, 2019 - The MedSafer Study: a controlled trial of an electronic decision support tool for deprescribing in acute care. July 31, 2019 McDonald EG, Wu PE, Rashidi B, et al. The MedSafer Study: A Controlled Trial of an Electronic Decision Support Tool for Deprescribing in Acute Care. J Am Geriatr Soc. 2019;67(9):1843-1850. d…
  9. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/45914/psn-pdf
    March 20, 2018 - Understanding the multidimensional effects of resident duty hours restrictions: a thematic analysis of published viewpoints in surgery. March 20, 2018 Devitt KS, Kim MJ, Conn LG, et al. Understanding the Multidimensional Effects of Resident Duty Hours Restrictions: A Thematic Analysis of Published Viewpoints in Su…
  10. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/46981/psn-pdf
    May 04, 2019 - Lessons learned from implementing a principled approach to resolution following patient harm. May 4, 2019 Smith KM, Smith LL, (Jack) Gentry JC, et al. Lessons learned from implementing a principled approach to resolution following patient harm. J Patient Saf Risk Manag. 2018;24(2):83-89. doi:10.1177/25160435188138…
  11. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/42419/psn-pdf
    July 17, 2013 - Health IT Patient Safety Action and Surveillance Plan. July 17, 2013 Washington, DC: Office of the National Coordinator for Health Information Technology; July 2, 2013. https://psnet.ahrq.gov/issue/health-it-patient-safety-action-and-surveillance-plan This report from the Department of Health and Human Services (HH…
  12. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/45700/psn-pdf
    September 01, 2018 - Resolving malpractice claims after tort reform: experience in a self-insured Texas public academic health system. September 1, 2018 Sage WM, Harding MC, Thomas EJ. Resolving Malpractice Claims after Tort Reform: Experience in a Self- Insured Texas Public Academic Health System. Health Serv Res. 2016;51 Suppl 3:2615…
  13. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/42832/psn-pdf
    September 01, 2016 - Overrides of medication-related clinical decision support alerts in outpatients. September 1, 2016 Nanji KC, Slight SP, Seger DL, et al. Overrides of medication-related clinical decision support alerts in outpatients. J Am Med Inform Assoc. 2014;21(3):487-91. doi:10.1136/amiajnl-2013-001813. https://psnet.ahrq.gov…
  14. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/45175/psn-pdf
    February 22, 2017 - Improving physician's hand over among oncology staff using standardized communication tool. February 22, 2017 Alolayan A, Alkaiyat M, Ali Y, et al. Improving physician's hand over among oncology staff using standardized communication tool. BMJ Qual Improv Rep. 2017;6(1). doi:10.1136/bmjquality.u211844.w6141. http…
  15. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/867041/psn-pdf
    October 30, 2024 - "What else could it be?" A scoping review of questions for patients to ask throughout the diagnostic process. October 30, 2024 Hill MA, Coppinger T, Sedig K, et al. "What else could it be?" A scoping review of questions for patients to ask throughout the diagnostic process. J Patient Saf. 2024;20(8):529-534. doi:1…
  16. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/42149/psn-pdf
    December 23, 2016 - Medical device alarm safety in hospitals. December 23, 2016 Medical device alarm safety in hospitals. Sentinel event alert. 2013;(50):1-3. https://psnet.ahrq.gov/issue/medical-device-alarm-safety-hospitals The cacophony of alarms in hospitals has led many health care providers to become desensitized to them, a con…
  17. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/37849/psn-pdf
    March 23, 2011 - The incidence and nature of in-hospital adverse events: a systematic review. March 23, 2011 de Vries EN, Ramrattan MA, Smorenburg SM, et al. The incidence and nature of in-hospital adverse events: a systematic review. Qual Saf Health Care. 2008;17(3):216-223. doi:10.1136/qshc.2007.023622. https://psnet.ahrq.gov/is…
  18. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/42484/psn-pdf
    August 14, 2013 - Parent willingness to remind health care workers to perform hand hygiene. August 14, 2013 Buser GL, Fisher BT, Shea JA, et al. Parent willingness to remind health care workers to perform hand hygiene. Am J Infect Control. 2013;41(6):492-6. doi:10.1016/j.ajic.2012.08.006. https://psnet.ahrq.gov/issue/parent-willing…
  19. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/45458/psn-pdf
    November 30, 2016 - Request for comments on the proposed measures and 2020 targets for the National Action Plan for Adverse Drug Event Prevention: inpatient and outpatient measures for reduction of adverse drug events from anticoagulants, diabetes agents, and opioid analgesics. November 30, 2016 Office of Disease Prevention and Heal…
  20. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/60540/psn-pdf
    November 01, 2016 - Quality improvement initiatives lead to reduction in nulliparous term singleton vertex cesarean delivery rate. November 1, 2016 Vadnais MA, Hacker MR, Shah NT, et al. Quality improvement initiatives lead to reduction in nulliparous term singleton vertex cesarean delivery rate. Jt Comm J Qual Patient Saf. 2016;43(2)…

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