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  1. How payers can help hospitals become safer through value-based programs. | PSNet

    psnet.ahrq.gov/issue/how-payers-can-help-hospitals-become-safer-through-value-based-programs
    December 21, 2022 - Commentary How payers can help hospitals become safer through value-based programs. Citation Text: Hsu E, Ma S, Winn B, et al. How payers can help hospitals become safer through value-based programs. NEJM Catalyst. 2024;5(7):CAT.24.0049. doi:10.1056/cat.24.0049. Copy Citation Forma…

  2. Controversies in diagnosis: contemporary debates in the diagnostic safety literature. | PSNet

    psnet.ahrq.gov/issue/controversies-diagnosis-contemporary-debates-diagnostic-safety-literature
    December 21, 2018 - Review Controversies in diagnosis: contemporary debates in the diagnostic safety literature. Citation Text: Bergl PA, Wijesekera TP, Nassery N, et al. Controversies in diagnosis: contemporary debates in the diagnostic safety literature. Diagnosis (Berl). 2020;7(1):3-9. doi:10.1515/dx-201…

  3. Patient safety strategies targeted at diagnostic errors: a systematic review. | PSNet

    psnet.ahrq.gov/issue/patient-safety-strategies-targeted-diagnostic-errors-systematic-review
    March 20, 2013 - Review Patient safety strategies targeted at diagnostic errors: a systematic review. Citation Text: McDonald KM, Matesic B, Contopoulos-Ioannidis DG, et al. Patient safety strategies targeted at diagnostic errors: a systematic review. Ann Intern Med. 2013;158(5 Pt 2):381-389. doi:10.7…

  4. A cognitive task analysis of information management strategies in a computerized provider order entry environment. | PSNet

    psnet.ahrq.gov/issue/cognitive-task-analysis-information-management-strategies-computerized-provider-order-entry
    May 27, 2011 - Study A cognitive task analysis of information management strategies in a computerized provider order entry environment. Citation Text: Weir C, Nebeker JJR, Hicken BL, et al. A cognitive task analysis of information management strategies in a computerized provider order entry environme…

  5. Identifying hot spots for harm and blind spots across the care pathway from patient complaints about general practice. | PSNet

    psnet.ahrq.gov/issue/identifying-hot-spots-harm-and-blind-spots-across-care-pathway-patient-complaints-about
    May 04, 2022 - Study Identifying hot spots for harm and blind spots across the care pathway from patient complaints about general practice. Citation Text: O’Dowd E, Lydon S, Lambe KA, et al. Identifying hot spots for harm and blind spots across the care pathway from patient complaints about general pra…

  6. Assessing resident and attending error and adverse events in the emergency department. | PSNet

    psnet.ahrq.gov/issue/assessing-resident-and-attending-error-and-adverse-events-emergency-department
    November 25, 2020 - Study Assessing resident and attending error and adverse events in the emergency department. Citation Text: Adler JL, Gurley K, Rosen CL, et al. Assessing resident and attending error and adverse events in the emergency department. Am J Emerg Med. 2022;54:228-231. doi:10.1016/j.ajem.2022…

  7. Hospital board checklist to improve culture and reduce central line–associated bloodstream infections. | PSNet

    psnet.ahrq.gov/issue/hospital-board-checklist-improve-culture-and-reduce-central-line-associated-bloodstream
    May 24, 2012 - Commentary Hospital board checklist to improve culture and reduce central line–associated bloodstream infections. Citation Text: Goeschel CA, Holzmueller CG, Pronovost P. Hospital Board Checklist to improve culture and reduce central line-associated bloodstream infections. Jt Comm J Qual…

  8. Providers' and patients' perspectives on diagnostic errors in the acute care setting. | PSNet

    psnet.ahrq.gov/issue/providers-and-patients-perspectives-diagnostic-errors-acute-care-setting
    October 20, 2021 - Study Providers' and patients' perspectives on diagnostic errors in the acute care setting. Citation Text: Schnock KO, Garber A, Fraser H, et al. Providers' and patients' perspectives on diagnostic errors in the acute care setting. Jt Comm J Qual Patient Saf. 2023;49(2):89-97. doi:10.101…

  9. The impact of internal service quality on preventable adverse events in hospitals. | PSNet

    psnet.ahrq.gov/issue/impact-internal-service-quality-preventable-adverse-events-hospitals
    September 24, 2016 - Study The impact of internal service quality on preventable adverse events in hospitals. Citation Text: Zheng S, Tucker AL, Ren ZJ, et al. The Impact of Internal Service Quality on Preventable Adverse Events in Hospitals. Production Operations Manag. 2017;27(12):2201-2212. doi:10.1111/po…

  10. Computer-assisted process modeling to enhance intraoperative safety in cardiac surgery. | PSNet

    psnet.ahrq.gov/issue/computer-assisted-process-modeling-enhance-intraoperative-safety-cardiac-surgery
    July 19, 2023 - Study Computer-assisted process modeling to enhance intraoperative safety in cardiac surgery. Citation Text: Tarola CL, Quin JA, Haime ME, et al. Computer-Assisted Process Modeling to Enhance Intraoperative Safety in Cardiac Surgery. JAMA Surg. 2016;151(12):1183-1186. doi:10.1001/jamasur…

  11. Accountability for medical error: moving beyond blame to advocacy. | PSNet

    psnet.ahrq.gov/issue/accountability-medical-error-moving-beyond-blame-advocacy
    December 19, 2018 - Review Accountability for medical error: moving beyond blame to advocacy. Citation Text: Bell SK, Delbanco T, Anderson-Shaw L, et al. Accountability for medical error: moving beyond blame to advocacy. Chest. 2011;140(2):519-526. doi:10.1378/chest.10-2533. Copy Citation Format: …

  12. Ambulatory care adverse events and preventable adverse events leading to a hospital admission. | PSNet

    psnet.ahrq.gov/issue/ambulatory-care-adverse-events-and-preventable-adverse-events-leading-hospital-admission
    April 11, 2011 - Study Ambulatory care adverse events and preventable adverse events leading to a hospital admission. Citation Text: Woods D, Thomas EJ, Holl JL, et al. Ambulatory care adverse events and preventable adverse events leading to a hospital admission. Qual Saf Health Care. 2007;16(2):127-13…

  13. Error or "act of God"? A study of patients' and operating room team members' perceptions of error definition, reporting, and disclosure. | PSNet

    psnet.ahrq.gov/issue/error-or-act-god-study-patients-and-operating-room-team-members-perceptions-error-definition
    August 10, 2011 - Study Error or "act of God"? A study of patients' and operating room team members' perceptions of error definition, reporting, and disclosure. Citation Text: Espin S, Levinson W, Regehr G, et al. Error or "act of God"? A study of patients' and operating room team members' perceptions o…

  14. The next step in learning from sentinel events in healthcare. | PSNet

    psnet.ahrq.gov/issue/next-step-learning-sentinel-events-healthcare
    June 12, 2024 - Commentary The next step in learning from sentinel events in healthcare. Citation Text: Bos K, Dongelmans DA, Greuters S, et al. The next step in learning from sentinel events in healthcare. BMJ Open Qual. 2020;9(1):e000739. doi:10.1136/bmjoq-2019-000739. Copy Citation Format: …

  15. Adoption of National Quality Forum safe practices by magnet hospitals. | PSNet

    psnet.ahrq.gov/issue/adoption-national-quality-forum-safe-practices-magnet-hospitals
    May 15, 2019 - Study Adoption of National Quality Forum safe practices by magnet hospitals. Citation Text: Jayawardhana J, Welton JM, Lindrooth R. Adoption of National Quality Forum Safe Practices by Magnet® Hospitals. JONA: The Journal of Nursing Administration. 2011;41(9). doi:10.1097/nna.0b013e318…

  16. Evaluating patient identification practices during intrahospital transfers: a human factors approach. | PSNet

    psnet.ahrq.gov/issue/evaluating-patient-identification-practices-during-intrahospital-transfers-human-factors
    August 18, 2021 - Study Evaluating patient identification practices during intrahospital transfers: a human factors approach. Citation Text: Suclupe S, Kitchin J, Sivalingam R, et al. Evaluating patient identification practices during intrahospital transfers: a human factors approach. J Patient Saf. 2023;…

  17. Pediatric patient safety events during hospitalization: approaches to accounting for institution-level effects. | PSNet

    psnet.ahrq.gov/issue/pediatric-patient-safety-events-during-hospitalization-approaches-accounting-institution
    December 23, 2012 - Study Pediatric patient safety events during hospitalization: approaches to accounting for institution-level effects. Citation Text: Slonim A, Marcin JP, Turenne W, et al. Pediatric patient safety events during hospitalization: approaches to accounting for institution-level effects. He…

  18. Surgical leadership in a culture of safety: an inter-professional study of metrics and tools for improving clinical practice. | PSNet

    psnet.ahrq.gov/issue/surgical-leadership-culture-safety-inter-professional-study-metrics-and-tools-improving
    September 14, 2022 - Study Surgical leadership in a culture of safety: an inter-professional study of metrics and tools for improving clinical practice. Citation Text: Gogalniceanu P, Kunduzi B, Ruckley C, et al. Surgical leadership in a culture of safety: an inter-professional study of metrics and tools for…

  19. Diffusion of surgical innovations, patient safety, and minimally invasive radical prostatectomy. | PSNet

    psnet.ahrq.gov/issue/diffusion-surgical-innovations-patient-safety-and-minimally-invasive-radical-prostatectomy
    June 06, 2008 - Study Diffusion of surgical innovations, patient safety, and minimally invasive radical prostatectomy. Citation Text: Parsons K, Messer K, Palazzi K, et al. Diffusion of surgical innovations, patient safety, and minimally invasive radical prostatectomy. JAMA Surg. 2014;149(8):845-51. doi…

  20. Drug manufacturers' delayed disclosure of serious and unexpected adverse events to the US Food and Drug Administration. | PSNet

    psnet.ahrq.gov/issue/drug-manufacturers-delayed-disclosure-serious-and-unexpected-adverse-events-us-food-and-drug
    July 10, 2017 - Study Drug manufacturers' delayed disclosure of serious and unexpected adverse events to the US Food and Drug Administration. Citation Text: Ma P, Marinovic I, Karaca-Mandic P. Drug Manufacturers' Delayed Disclosure of Serious and Unexpected Adverse Events to the US Food and Drug Adminis…
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