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psnet.ahrq.gov/node/74269/psn-pdf
January 19, 2022 - Safety culture, safety climate, and safety performance in
healthcare facilities: a systematic review.
January 19, 2022
Noor Arzahan IS, Ismail Z, Yasin SM. Safety culture, safety climate, and safety performance in healthcare
facilities: A systematic review. Safety Sci. 2022;147:105624. doi:10.1016/j.ssci.2021.10562…
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psnet.ahrq.gov/node/837330/psn-pdf
June 08, 2022 - A call to action: next steps to advance diagnosis
education in the health professions.
June 8, 2022
Graber ML, Holmboe ES, Stanley J, et al. A call to action: next steps to advance diagnosis education in the
health professions. Diagnosis (Berl). 2022;9(2):166-175. doi:10.1515/dx-2021-0103.
https://psnet.ahrq.gov/i…
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psnet.ahrq.gov/node/44867/psn-pdf
March 23, 2016 - Understanding why quality initiatives succeed or fail: a
sociotechnical systems perspective.
March 23, 2016
Wiegmann DA. Understanding Why Quality Initiatives Succeed or Fail: A Sociotechnical Systems
Perspective. Ann Surg. 2016;263(1):9-11. doi:10.1097/SLA.0000000000001333.
https://psnet.ahrq.gov/issue/understand…
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psnet.ahrq.gov/node/838080/psn-pdf
September 14, 2022 - Effect on diagnostic accuracy of cognitive reasoning
tools for the workplace setting: systematic review and
meta-analysis.
September 14, 2022
Staal J, Hooftman J, Gunput STG, et al. Effect on diagnostic accuracy of cognitive reasoning tools for the
workplace setting: systematic review and meta-analysis. BMJ Qual S…
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psnet.ahrq.gov/node/43200/psn-pdf
May 21, 2014 - How Does Hospital Quality Management Drive Quality?
Results From the "Deepening Our Understanding of
Quality Improvement (DUQuE)" Project.
May 21, 2014
Schneider EC, ed. Int J Qual Healthc. 2014;26(suppl 1):1-115.
https://psnet.ahrq.gov/issue/how-does-hospital-quality-management-drive-quality-results-deepening-our…
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psnet.ahrq.gov/node/36964/psn-pdf
March 24, 2011 - Patients use an internet technology to report when things
go wrong.
March 24, 2011
Wasson JH, MacKenzie TA, Hall M. Patients use an internet technology to report when things go wrong.
Qual Saf Health Care. 2007;16(3):213-5.
https://psnet.ahrq.gov/issue/patients-use-internet-technology-report-when-things-go-wrong
…
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psnet.ahrq.gov/node/39975/psn-pdf
March 03, 2011 - Communication failure in the operating room.
March 3, 2011
Halverson AL, Casey JT, Andersson J, et al. Communication failure in the operating room. Surgery.
2011;149(3):305-310. doi:10.1016/j.surg.2010.07.051.
https://psnet.ahrq.gov/issue/communication-failure-operating-room
Communication failures are a well-chara…
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psnet.ahrq.gov/node/44798/psn-pdf
November 02, 2016 - From the closest observers of patient care: a thematic
analysis of online narrative reviews of hospitals.
November 2, 2016
Bardach N, Lyndon A, Asteria-Peñaloza R, et al. From the closest observers of patient care: a thematic
analysis of online narrative reviews of hospitals. BMJ Qual Saf. 2016;25(11):889-897. doi:…
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psnet.ahrq.gov/node/866251/psn-pdf
July 10, 2024 - A systematic review and meta-analysis of artificial
intelligence versus clinicians for skin cancer diagnosis.
July 10, 2024
Salinas MP, Sepúlveda J, Hidalgo L, et al. A systematic review and meta-analysis of artificial intelligence
versus clinicians for skin cancer diagnosis. NPJ Digit Med. 2024;7(1):125. doi:10.10…
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psnet.ahrq.gov/node/46777/psn-pdf
January 24, 2018 - Safety analysis over time: seven major changes to
adverse event investigation.
January 24, 2018
Vincent CA, Carthey J, Macrae C, et al. Safety analysis over time: seven major changes to adverse event
investigation. Implementation Science. 2017;12(1). doi:10.1186/s13012-017-0695-4.
https://psnet.ahrq.gov/issue/safe…
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psnet.ahrq.gov/node/836825/psn-pdf
March 30, 2022 - Antibiotic prescribing errors in patients discharged from
the pediatric emergency department.
March 30, 2022
LaScala EC, Monroe AK, Hall GA, et al. Antibiotic prescribing errors in patients discharged from the
pediatric emergency department. Pediatr Emerg Care. 2022;38(1):e387-e392.
doi:10.1097/pec.000000000000229…
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psnet.ahrq.gov/node/838146/psn-pdf
September 21, 2022 - HSIB Maternity Investigation Programme Year in Review
2021/22. Summary of Highlights, Themes and Future
Work.
September 21, 2022
Farnborough, UK: Healthcare Safety Investigation Branch; 2022.
https://psnet.ahrq.gov/issue/hsib-maternity-investigation-programme-year-review-202122-summary-
highlights-themes-and
Thi…
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psnet.ahrq.gov/node/837501/psn-pdf
June 22, 2022 - Development and validation of a brief culture-of-safety
survey.
June 22, 2022
Barnard C, Chung JW, Flaherty V, et al. Development and validation of a brief culture-of-safety survey. Jt
Comm J Qual Patient Saf. 2022;48(9):430-438. doi:10.1016/j.jcjq.2022.04.006.
https://psnet.ahrq.gov/issue/development-and-validati…
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psnet.ahrq.gov/node/46480/psn-pdf
October 29, 2017 - Coaching the debriefer: peer coaching to improve
debriefing quality in simulation programs.
October 29, 2017
Cheng A, Grant V, Huffman J, et al. Coaching the Debriefer: Peer Coaching to Improve Debriefing Quality
in Simulation Programs. Simul Healthc. 2017;12(5):319-325. doi:10.1097/SIH.0000000000000232.
https://p…
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psnet.ahrq.gov/node/40823/psn-pdf
October 05, 2011 - Lessons learnt from incidents reported by postgraduate
trainees in Dutch general practice. A prospective cohort
study.
October 5, 2011
Zwart DLM, Heddema WS, Vermeulen MI, et al. Lessons learnt from incidents reported by postgraduate
trainees in Dutch general practice. A prospective cohort study. BMJ Qual Saf. 201…
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psnet.ahrq.gov/node/44947/psn-pdf
November 18, 2016 - Impact of the 2011 ACGME resident duty hour reform on
hospital patient experience and processes-of-care.
November 18, 2016
Rajaram R, Saadat L, Chung JW, et al. Impact of the 2011 ACGME resident duty hour reform on hospital
patient experience and processes-of-care. BMJ Qual Saf. 2016;25(12):962-970. doi:10.1136/bmj…
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psnet.ahrq.gov/node/41606/psn-pdf
February 01, 2019 - Safe use of opioids in hospitals.
December 23, 2016
Sentinel Event Alert. 2012;49:1-5.
https://psnet.ahrq.gov/issue/safe-use-opioids-hospitals
Opioid pain medications are considered high-risk medications due to the potential for respiratory
depression and other adverse effects. Because these medications are freque…
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psnet.ahrq.gov/node/45449/psn-pdf
October 29, 2017 - Situational awareness—what it means for clinicians, its
recognition and importance in patient safety.
October 29, 2017
Green B, Parry D, Oeppen RS, et al. Situational awareness - what it means for clinicians, its recognition
and importance in patient safety. Oral Dis. 2017;23(6):721-725. doi:10.1111/odi.12547.
htt…
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psnet.ahrq.gov/node/48018/psn-pdf
July 31, 2019 - PEARLS for systems integration: a modified PEARLS
framework for debriefing systems-focused simulations.
July 31, 2019
Dubé MM, Reid J, Kaba A, et al. PEARLS for Systems Integration: A Modified PEARLS Framework for
Debriefing Systems-Focused Simulations. Simul Healthc. 2019;14(5):333-342.
doi:10.1097/SIH.0000000000…
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psnet.ahrq.gov/node/47636/psn-pdf
December 12, 2018 - Learning from tragedy: the Julia Berg story.
December 12, 2018
Graber ML, Berg D, Jerde W, et al. Learning from tragedy: the Julia Berg story. Diagnosis (Berl).
2018;5(4):257-266. doi:10.1515/dx-2018-0067.
https://psnet.ahrq.gov/issue/learning-tragedy-julia-berg-story
This commentary provides a clinical review of …