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101. Opioid stewardship program and postoperative adverse events: a difference-in-differences cohort study. | PSNet
     psnet.ahrq.gov/issue/opioid-stewardship-program-and-postoperative-adverse-events-difference-differences-cohort
     June 30, 2021 - following two policies in North Carolina, 2012-2018 - controlled and single-series interrupted time series analyses … following two policies in North Carolina, 2012-2018 - controlled and single-series interrupted time series analyses

102. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/43040/psn-pdf
     March 05, 2014 - Framework for analysing risk and safety in clinical medicine. March 5, 2014 Vincent C, Taylor-Adams S, Stanhope N. Framework for analysing risk and safety in clinical medicine. BMJ. 1998;316(7138):1154-1157. https://psnet.ahrq.gov/issue/framework-analysing-risk-and-safety-clinical-medicine-0 This commentary outli…

103. Maximize Patient Safety with Advanced Root Cause Analysis. | PSNet
     psnet.ahrq.gov/issue/maximize-patient-safety-advanced-root-cause-analysis
     November 18, 2011 - May 21, 2019 RCA2: Improving Root Cause Analyses and Actions to Prevent Harm. … March 23, 2016 VA Health Care: Actions Needed to Assess Decrease in Root Cause Analyses

104. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/43790/psn-pdf
     October 23, 2023 - complaints-about-acute-trusts-2016-2017 The National Health Service broadly reports the results of system-level analyses

105. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/842435/psn-pdf
     January 26, 2023 - psnet.ahrq.gov/perspective/rethinking-root-cause-analysis https://psnet.ahrq.gov/issue/rca2-improving-root-cause-analyses-and-actions-prevent-harm

106. Evaluation of policies limiting opioid exposure on opioid prescribing and patient pain in opioid-naive patients undergoing elective surgery in a large American health system. | PSNet
     psnet.ahrq.gov/issue/evaluation-policies-limiting-opioid-exposure-opioid-prescribing-and-patient-pain-opioid-naive
     May 18, 2022 - following two policies in North Carolina, 2012-2018 - controlled and single-series interrupted time series analyses … following two policies in North Carolina, 2012-2018 - controlled and single-series interrupted time series analyses

107. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/867179/psn-pdf
     January 01, 2025 - implementation-standardized-tool-root-cause-analysis-selection https://psnet.ahrq.gov/issue/rca2-improving-root-cause-analyses-and-actions-prevent-harm

108. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/60820/psn-pdf
     August 19, 2020 - Thematic analyses revealed that organizational learning was more effective when closely aligned with

109. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/74735/psn-pdf
     February 02, 2022 - addressing-intimate-partner-violence-and-helping-protect-patients https://psnet.ahrq.gov/issue/root-cause-analyses-suicides-mental-health-clients

110. A qualitative study of why general practitioners may participate in significant event analysis and educational peer assessment. | PSNet
     psnet.ahrq.gov/issue/qualitative-study-why-general-practitioners-may-participate-significant-event-analysis-and
     October 29, 2008 - April 9, 2013 Bayesian cohort and cross-sectional analyses of the PINCER trial: a pharmacist-led

111. Systemic vulnerabilities to suicide among veterans from the Iraq and Afghanistan conflicts: review of case reports from a national Veterans Affairs database. | PSNet
     psnet.ahrq.gov/issue/systemic-vulnerabilities-suicide-among-veterans-iraq-and-afghanistan-conflicts-review-case
     January 22, 2017 - February 10, 2021 Root cause analyses of reported adverse events occurring during gastrointestinal … September 19, 2016 Root cause analyses of suicides of mental health clients.

112. The economic burden of patient safety targets in acute care: a systematic review. | PSNet
     psnet.ahrq.gov/issue/economic-burden-patient-safety-targets-acute-care-systematic-review
     April 05, 2013 - Citation Related Resources From the Same Author(s) Comparative economic analyses … September 9, 2013 Comparative economic analyses of patient safety improvement strategies

113. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/842775/psn-pdf
     January 18, 2023 - national-steering-committee-patient-safety https://psnet.ahrq.gov/issue/prioritising-recommendations-following-analyses-adverse-events-healthcare-systematic-review

114. Swiss Cheese Model | PSNet
     psnet.ahrq.gov/taxonomy/term/3460
     July 10, 2025 - Swiss Cheese Model Reason developed the "Swiss cheese model" to illustrate how analyses of major accidents

115. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/836812/psn-pdf
     March 30, 2022 - glossary-heading-term-73785 https://psnet.ahrq.gov/issue/recasting-rca-improved-model-performing-root-cause-analyses … Root Cause Analysis Root cause analyses (RCAs) are problem-solving tools and techniques used to retrospectively … psnet.ahrq.gov/perspective/rethinking-root-cause-analysis https://psnet.ahrq.gov/issue/rca2-improving-root-cause-analyses-and-actions-prevent-harm

116. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/73495/psn-pdf
     July 14, 2021 - Thematic analyses suggest that the most commonly used implementation strategies included restructuring

117. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/852452/psn-pdf
     August 16, 2023 - This article outlines several recommendations for improved cost-effectiveness analyses of deprescribing

118. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/46287/psn-pdf
     April 12, 2019 - anesthesia-adverse-events-voluntarily-reported-veterans-health- administration-and-lessons This study examined root cause analyses

119. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/60983/psn-pdf
     October 07, 2020 - Thematic analyses identified five key factors that are influenced by the presence of a parent during

120. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/60980/psn-pdf
     January 01, 2022 - Multivariable analyses showed several potential risk factors for safety events – including length of