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psnet.ahrq.gov/issue/training-health-care-professionals-root-cause-analysis-cross-sectional-study-post-training
February 29, 2012 - Study
Training health care professionals in root cause analysis: a cross-sectional study of post-training experiences, benefits and attitudes.
Citation Text:
Bowie P, Skinner J, de Wet C. Training health care professionals in root cause analysis: a cross-sectional study of post-training…
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psnet.ahrq.gov/issue/measuring-overall-development-patient-safety-new-hospital-using-trigger-tools
April 12, 2019 - Study
Measuring the overall development of patient safety in a new hospital using trigger tools.
Citation Text:
Adamovic I, Dahlem P, Brachmann J. Measuring the overall development of patient safety in a new hospital using trigger tools. Int J Qual Health Care. 2024;36(3):mzae064. doi:10…
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psnet.ahrq.gov/issue/medical-record-review-deaths-unexpected-intensive-care-unit-admissions-and-clinician
October 12, 2022 - Study
Medical record review of deaths, unexpected intensive care unit admissions and clinician referrals: detection of adverse events and insight into the system.
Citation Text:
Dunn KL, Reddy P, Moulden A, et al. Medical record review of deaths, unexpected intensive care unit admissio…
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psnet.ahrq.gov/issue/new-category-never-events-ending-harmful-hospital-policies
September 07, 2022 - Commentary
A new category of "never events"-ending harmful hospital policies.
Citation Text:
Chokshi DA, Beckman AL. A new category of "never events"-ending harmful hospital policies. JAMA Health Forum. 2022;3(10):e224703. doi:10.1001/jamahealthforum.2022.4703.
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psnet.ahrq.gov/issue/safe-surgery-how-accurate-are-we-predicting-intra-operative-blood-loss
March 21, 2018 - Study
Safe surgery: how accurate are we at predicting intra-operative blood loss?
Citation Text:
Solon JG, Egan C, McNamara DA. Safe surgery: how accurate are we at predicting intra-operative blood loss? J Eval Clin Pract. 2013;19(1):100-5. doi:10.1111/j.1365-2753.2011.01779.x.
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psnet.ahrq.gov/issue/identifying-understanding-and-minimizing-unconscious-cognitive-biases-perioperative-crisis
June 19, 2019 - Review
Identifying, understanding, and minimizing unconscious cognitive biases in perioperative crisis management: a narrative review.
Citation Text:
Yan L, Karamchandani K, Gaiser RR, et al. Identifying, understanding, and minimizing unconscious cognitive biases in perioperative crisis …
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psnet.ahrq.gov/issue/patient-safety-community-dementia-services-what-can-we-learn-experiences-caregivers-and
March 05, 2025 - Study
Patient safety in community dementia services: what can we learn from the experiences of caregivers and healthcare professionals?
Citation Text:
Behrman S, Wilkinson P, Lloyd H, et al. Patient safety in community dementia services: what can we learn from the experiences of caregive…
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psnet.ahrq.gov/issue/quality-indicators-implementation-safety-promotion-towards-valid-and-reliable-global
February 03, 2010 - Study
Quality indicators for implementation of safety promotion: towards valid and reliable global certification of local programmes.
Citation Text:
Timpka T, Nordqvist C, Festin K, et al. Quality indicators for implementation of safety promotion: towards valid and reliable global cert…
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psnet.ahrq.gov/issue/reporting-perioperative-adverse-events-pediatric-anesthesiologists-tertiary-childrens
April 24, 2018 - Study
Reporting of perioperative adverse events by pediatric anesthesiologists at a tertiary children's hospital: targeted interventions to increase the rate of reporting.
Citation Text:
Williams GD, Muffly MK, Mendoza JM, et al. Reporting of Perioperative Adverse Events by Pediatric Ane…
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psnet.ahrq.gov/issue/measuring-and-managing-quality-surgery-statistical-vs-incidental-approaches
August 04, 2021 - Commentary
Classic
Measuring and managing quality of surgery. Statistical vs incidental approaches.
Citation Text:
McGuire HH, Horsley JS, Salter DR, et al. Measuring and managing quality of surgery. Statistical vs incidental approaches. Arch Surg. 1992;127(6):7…
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psnet.ahrq.gov/issue/how-health-systems-decide-use-artificial-intelligence-clinical-decision-support
March 30, 2022 - Study
How health systems decide to use artificial intelligence for clinical decision support.
Citation Text:
Gonzalez-Smith J, Shen H, Singletary E, et al. How health systems decide to use artificial intelligence for clinical decision support. NEJM Catal Innov Care Deliv. 2022;3(4). doi:…
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psnet.ahrq.gov/issue/adverse-event-reporting-practices-us-hospitals-results-national-survey
December 30, 2014 - Study
Adverse-event-reporting practices by US hospitals: results of a national survey.
Citation Text:
Farley DO, Haviland A, Champagne S, et al. Adverse-event-reporting practices by US hospitals: results of a national survey. Qual Saf Health Care. 2008;17(6):416-23. doi:10.1136/qshc.20…
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psnet.ahrq.gov/issue/effectiveness-and-efficiency-root-cause-analysis-medicine
July 11, 2012 - Commentary
Classic
Effectiveness and efficiency of root cause analysis in medicine.
Citation Text:
Wu AW. Effectiveness and Efficiency of Root Cause Analysis in Medicine. JAMA. 2008;299(6):685-687. doi:10.1001/jama.299.6.685.
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psnet.ahrq.gov/issue/incidence-adverse-events-and-negligence-hospitalized-patients-results-harvard-medical
February 18, 2011 - Study
Classic
Incidence of adverse events and negligence in hospitalized patients. Results of the Harvard Medical Practice Study I.
Citation Text:
Brennan TA, Leape LL, Laird NM, et al. Incidence of Adverse Events and Negligence in Hospitalized Patients. N Eng…
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psnet.ahrq.gov/issue/strengths-and-weaknesses-working-global-trigger-tool-method-retrospective-record-review-focus
March 24, 2012 - Study
Strengths and weaknesses of working with the Global Trigger Tool method for retrospective record review: focus group interviews with team members.
Citation Text:
Schildmeijer K, Nilsson L, Perk J, et al. Strengths and weaknesses of working with the Global Trigger Tool method for r…
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psnet.ahrq.gov/issue/trigger-tool-detect-harm-pediatric-inpatient-settings
December 07, 2016 - Study
Classic
A trigger tool to detect harm in pediatric inpatient settings.
Citation Text:
Stockwell DC, Bisarya H, Classen D, et al. A trigger tool to detect harm in pediatric inpatient settings. Pediatrics. 2015;135(6):1036-42. doi:10.1542/peds.2014-2152.
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psnet.ahrq.gov/issue/emotional-safety-patient-safety
October 21, 2020 - Commentary
Emotional safety is patient safety.
Citation Text:
Lyndon A, Davis D-A, Sharma AE, et al. Emotional safety is patient safety. BMJ Qual Saf. 2023;32(7):369-372. doi:10.1136/bmjqs-2022-015573.
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psnet.ahrq.gov/issue/manifestations-high-reliability-principles-hospital-units-varying-safety-profiles-qualitative
December 16, 2015 - Study
Manifestations of high-reliability principles on hospital units with varying safety profiles: a qualitative analysis.
Citation Text:
Mossburg SE, Weaver SJ, Pillari MS, et al. Manifestations of High-Reliability Principles on Hospital Units With Varying Safety Profiles: A Qualitativ…
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psnet.ahrq.gov/issue/understanding-principles-high-reliability-organizations-through-eyes-vione-clinical-program
November 15, 2023 - Study
Understanding principles of high reliability organizations through the eyes of VIONE: a clinical program to improve patient safety by deprescribing potentially inappropriate medications and reducing polypharmacy.
Citation Text:
Battar S, Dickerson KRW, Sedgwick C, et al. Understand…
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psnet.ahrq.gov/issue/role-theory-research-develop-and-evaluate-implementation-patient-safety-practices
September 20, 2011 - Commentary
The role of theory in research to develop and evaluate the implementation of patient safety practices.
Citation Text:
Foy R, Ovretveit J, Shekelle PG, et al. The role of theory in research to develop and evaluate the implementation of patient safety practices. BMJ Qual Saf. …