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Applying principles from aviation safety investigations to root cause analysis of a critical incident during a simulated emergency. | PSNet

psnet.ahrq.gov/issue/applying-principles-aviation-safety-investigations-root-cause-analysis-critical-incident

July 27, 2016 - Study Applying principles from aviation safety investigations to root cause analysis of a critical incident during a simulated emergency. Citation Text: Imach S, Eppich W, Zech A, et al. Applying principles from aviation safety investigations to root cause analysis of a critical incident…

The good, the bad, and the ugly: operative staff perspectives of surgeon coping with intraoperative errors. | PSNet

psnet.ahrq.gov/issue/good-bad-and-ugly-operative-staff-perspectives-surgeon-coping-intraoperative-errors

September 22, 2021 - Study The good, the bad, and the ugly: operative staff perspectives of surgeon coping with intraoperative errors. Citation Text: D’Angelo A-LD, Kapur N, Kelley SR, et al. The good, the bad, and the ugly: operative staff perspectives of surgeon coping with intraoperative errors. Surgery. …

Using behavioral insights to strengthen strategies for change. Practical applications for quality improvement in healthcare. | PSNet

psnet.ahrq.gov/issue/using-behavioral-insights-strengthen-strategies-change-practical-applications-quality

April 06, 2022 - Commentary Using behavioral insights to strengthen strategies for change. Practical applications for quality improvement in healthcare. Citation Text: Johansen RLR, Tulloch S. Using behavioral insights to strengthen strategies for change. Practical applications for quality improvement in…

The Economic Measurement of Medical Errors. | PSNet

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March 23, 2022 - Book/Report The Economic Measurement of Medical Errors. Citation Text: The Economic Measurement of Medical Errors. Shreve J, van Den Bos J, Gray T, Halford M, Rustagi K, Ziemkiewicz E. Schaumburg, IL: The Society of Actuaries; 2010. Copy Citation Save Save t…

Anesthesiology patient handoff education interventions: a systematic review. | PSNet

psnet.ahrq.gov/issue/anesthesiology-patient-handoff-education-interventions-systematic-review

April 28, 2021 - Review Anesthesiology patient handoff education interventions: a systematic review. Citation Text: Riesenberg LA, Davis R, Heng A, et al. Anesthesiology patient handoff education interventions: a systematic review. Jt Comm J Qual Patient Saf. 2023;49(8):394-404. doi:10.1016/j.jcjq.2022.1…

Provider bias in prescribing opioid analgesics: a study of electronic medical records at a hospital emergency department. | PSNet

psnet.ahrq.gov/issue/provider-bias-prescribing-opioid-analgesics-study-electronic-medical-records-hospital

September 30, 2020 - Study Provider bias in prescribing opioid analgesics: a study of electronic medical records at a hospital emergency department. Citation Text: Keister LA, Stecher C, Aronson B, et al. Provider bias in prescribing opioid analgesics: a study of electronic medical records at a hospital emer…

Influence of socioeconomic bias on emergency medicine resident decision making and patient care. | PSNet

psnet.ahrq.gov/issue/influence-socioeconomic-bias-emergency-medicine-resident-decision-making-and-patient-care

March 02, 2022 - Study Influence of socioeconomic bias on emergency medicine resident decision making and patient care. Citation Text: Fasano HT, McCarter MSJ, Simonis JM, et al. Influence of socioeconomic bias on emergency medicine resident decision making and patient care. Simul Healthc. 2021;6(2):85-9…

A national mixed-methods evaluation of preparedness for general surgery residency and the association with resident burnout. | PSNet

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September 02, 2020 - Study A national mixed-methods evaluation of preparedness for general surgery residency and the association with resident burnout. Citation Text: Engelhardt KE, Bilimoria KY, Johnson JK, et al. A national mixed-methods evaluation of preparedness for general surgery residency and the asso…

Exploring perinatal shift-to-shift handover communication and process: an observational study. | PSNet

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April 04, 2018 - Study Exploring perinatal shift-to-shift handover communication and process: an observational study. Citation Text: Poot EP, de Bruijne M, Wouters MGAJ, et al. Exploring perinatal shift-to-shift handover communication and process: an observational study. J Eval Clin Pract. 2014;20(2):166…

Enabling sustained communication with patients for safe and effective management of oral chemotherapy: a longitudinal ethnography. | PSNet

psnet.ahrq.gov/issue/enabling-sustained-communication-patients-safe-and-effective-management-oral-chemotherapy

October 14, 2020 - Study Enabling sustained communication with patients for safe and effective management of oral chemotherapy: a longitudinal ethnography. Citation Text: Mitchell G, Porter S, Manias E. Enabling sustained communication with patients for safe and effective management of oral chemotherapy: a…

Observational study of conformity in yet another medical learning environment: conformity to preceptors during high-fidelity simulation. | PSNet

psnet.ahrq.gov/issue/observational-study-conformity-yet-another-medical-learning-environment-conformity-preceptors

June 19, 2019 - Study Observational study of conformity in yet another medical learning environment: conformity to preceptors during high-fidelity simulation. Citation Text: Beran T, Altabbaa G, Oddone Paolucci E. Observational study of conformity in yet another medical learning environment: conformity …

Safety gaps in medical team communication: closing the loop on quality improvement efforts in the cardiac catheterization lab. | PSNet

psnet.ahrq.gov/issue/safety-gaps-medical-team-communication-closing-loop-quality-improvement-efforts-cardiac

June 01, 2022 - Study Safety gaps in medical team communication: closing the loop on quality improvement efforts in the cardiac catheterization lab. Citation Text: Doorey AJ, Turi ZG, Lazzara EH, et al. Safety gaps in medical team communication: closing the loop on quality improvement efforts in the car…

Effect of warning symbols in combination with education on the frequency of erroneously crushing medication in nursing homes: an uncontrolled before and after study. | PSNet

psnet.ahrq.gov/issue/effect-warning-symbols-combination-education-frequency-erroneously-crushing-medication

March 04, 2011 - Study Effect of warning symbols in combination with education on the frequency of erroneously crushing medication in nursing homes: an uncontrolled before and after study. Citation Text: van Welie S, Wijma L, Beerden T, et al. Effect of warning symbols in combination with education on th…

Improving care safety by characterizing task interruptions during interactions between healthcare professionals: an observational study. | PSNet

psnet.ahrq.gov/issue/improving-care-safety-characterizing-task-interruptions-during-interactions-between

March 05, 2025 - Study Improving care safety by characterizing task interruptions during interactions between healthcare professionals: an observational study. Citation Text: Teigné D, Cazet L, Birgand G, et al. Improving care safety by characterizing task interruptions during interactions between health…

Perspectives on perioperative team-based morbidity and mortality conferences: a mixed-methods study. | PSNet

psnet.ahrq.gov/issue/perspectives-perioperative-team-based-morbidity-and-mortality-conferences-mixed-methods-study

October 11, 2023 - Study Perspectives on perioperative team-based morbidity and mortality conferences: a mixed-methods study. Citation Text: Samost-Williams A, Rosen R, Cummins E, et al. Perspectives on Perioperative Team-Based Morbidity and Mortality Conferences: A Mixed Methods Study. Jt Comm J Qual Pati…

Incident and error reporting systems in intensive care: a systematic review of the literature. | PSNet

psnet.ahrq.gov/issue/incident-and-error-reporting-systems-intensive-care-systematic-review-literature

November 10, 2015 - Review Incident and error reporting systems in intensive care: a systematic review of the literature. Citation Text: Brunsveld-Reinders AH, Arbous S, De Vos R, et al. Incident and error reporting systems in intensive care: a systematic review of the literature. Int J Qual Health Care. 20…

Increasing trainee reporting of adverse events with monthly, trainee-directed review of adverse events. | PSNet

psnet.ahrq.gov/issue/increasing-trainee-reporting-adverse-events-monthly-trainee-directed-review-adverse-events

July 01, 2017 - Study Increasing trainee reporting of adverse events with monthly, trainee-directed review of adverse events. Citation Text: Smith A, Hatoun J, Moses J. Increasing Trainee Reporting of Adverse Events With Monthly Trainee-Directed Review of Adverse Events. Acad Pediatr. 2017;17(8):902-906…

Implementing the Comprehensive Unit-Based Safety Program (CUSP) to improve patient safety in an academic primary care practice. | PSNet

psnet.ahrq.gov/issue/implementing-comprehensive-unit-based-safety-program-cusp-improve-patient-safety-academic

April 21, 2016 - Study Implementing the Comprehensive Unit-Based Safety Program (CUSP) to improve patient safety in an academic primary care practice. Citation Text: Pitts SI, Maruthur NM, Luu N-P, et al. Implementing the Comprehensive Unit-Based Safety Program (CUSP) to Improve Patient Safety in an Acad…

Perceptions of nurses who are second victims in a hospital setting. | PSNet

psnet.ahrq.gov/issue/perceptions-nurses-who-are-second-victims-hospital-setting

February 28, 2018 - Study Perceptions of nurses who are second victims in a hospital setting. Citation Text: Draus C, Mianecki TB, Musgrove H, et al. Perceptions of nurses who are second victims in a hospital setting. J Nurs Care Qual. 2022;37(2):110-116. doi:10.1097/ncq.0000000000000603. Copy Citation …

Machine learning to enhance electronic detection of diagnostic errors. | PSNet

psnet.ahrq.gov/issue/machine-learning-enhance-electronic-detection-diagnostic-errors

December 18, 2024 - Commentary Machine learning to enhance electronic detection of diagnostic errors. Citation Text: Zimolzak AJ, Wei L, Mir U, et al. Machine learning to enhance electronic detection of diagnostic errors. JAMA Netw Open. 2024;7(9):e2431982. doi:10.1001/jamanetworkopen.2024.31982. Copy Cit…

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