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psnet.ahrq.gov/issue/disclosing-harmful-pathology-errors-patients
May 18, 2022 - Commentary
Disclosing harmful pathology errors to patients.
Citation Text:
Dintzis SM, Gallagher TH. Disclosing harmful pathology errors to patients. Am J Clin Pathol. 2009;131(4):463-5. doi:10.1309/AJCPIO5SHDOD6URI.
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psnet.ahrq.gov/issue/what-ethically-informed-approach-managing-patient-safety-risk-during-discharge-planning
November 16, 2022 - Commentary
What is an ethically informed approach to managing patient safety risk during discharge planning?
Citation Text:
West JC. What Is an Ethically Informed Approach to Managing Patient Safety Risk During Discharge Planning? AMA J Ethics. 2020;22(!1):e919-e923. doi:10.1001/amajethi…
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psnet.ahrq.gov/issue/plan-achieving-significant-improvement-patient-safety
September 23, 2020 - Commentary
A plan for achieving significant improvement in patient safety.
Citation Text:
Johnson K, Maultsby CC. A plan for achieving significant improvement in patient safety. J Nurs Care Qual. 2007;22(2):164-71.
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psnet.ahrq.gov/issue/improving-care-teams-functioning-recommendations-team-science
June 24, 2020 - Commentary
Improving care teams' functioning: recommendations from team science.
Citation Text:
Fiscella K, Mauksch L, Bodenheimer T, et al. Improving Care Teams' Functioning: Recommendations from Team Science. Jt Comm J Qual Patient Saf. 2017;43(7):361-368. doi:10.1016/j.jcjq.2017.03.00…
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psnet.ahrq.gov/issue/obstetric-medical-emergency-teams-are-step-forward-maternal-safety
November 04, 2020 - Review
Obstetric medical emergency teams are a step forward in maternal safety!
Citation Text:
Al Kadri HMF. Obstetric medical emergency teams are a step forward in maternal safety!. J Emerg Trauma Shock. 2010;3(4):337-341. doi:10.4103/0974-2700.70755.
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psnet.ahrq.gov/issue/patient-raceethnicity-age-gender-and-education-are-not-related-preference-or-response
April 11, 2011 - Study
Patient race/ethnicity, age, gender and education are not related to preference for or response to disclosure.
Citation Text:
Hobgood C, Tamayo-Sarver JH, Weiner B. Patient race/ethnicity, age, gender and education are not related to preference for or response to disclosure. Qual…
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psnet.ahrq.gov/issue/improving-disclosure-and-management-medical-error-opportunity-transform-surgeons-tomorrow
April 11, 2012 - Review
Improving disclosure and management of medical error—an opportunity to transform the surgeons of tomorrow.
Citation Text:
Tevlin R, Doherty E, Traynor O. Improving disclosure and management of medical error - an opportunity to transform the surgeons of tomorrow. Surgeon. 2013;11…
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psnet.ahrq.gov/issue/factors-influencing-perioperative-nurses-error-reporting-preferences
June 23, 2010 - Study
Factors influencing perioperative nurses' error reporting preferences.
Citation Text:
Espin S, Regehr G, Levinson W, et al. Factors influencing perioperative nurses' error reporting preferences. AORN J. 2007;85(3):527-43.
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psnet.ahrq.gov/issue/evaluation-information-transfer-through-continuum-surgical-care-feasibility-study
December 21, 2014 - Study
An evaluation of information transfer through the continuum of surgical care: a feasibility study.
Citation Text:
Nagpal K, Vats A, Ahmed K, et al. An evaluation of information transfer through the continuum of surgical care: a feasibility study. Ann Surg. 2010;252(2):402-7. doi:1…
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psnet.ahrq.gov/issue/taking-ergonomics-bedside-multi-disciplinary-approach-designing-safer-healthcare
June 01, 2012 - Study
Taking ergonomics to the bedside—a multi-disciplinary approach to designing safer healthcare.
Citation Text:
Norris B, West J, Anderson O, et al. Taking ergonomics to the bedside--a multi-disciplinary approach to designing safer healthcare. Appl Ergon. 2014;45(3):629-38. doi:10.1…
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psnet.ahrq.gov/issue/longitudinal-analyses-nurse-staffing-and-patient-outcomes-more-about-failure-rescue
February 24, 2021 - Study
Longitudinal analyses of nurse staffing and patient outcomes: more about failure to rescue.
Citation Text:
Seago JA, Williamson A, Atwood C. Longitudinal Analyses of Nurse Staffing and Patient Outcomes. J Nurs Admin. 2006;36(1):13-21. doi:10.1097/00005110-200601000-00005.
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psnet.ahrq.gov/issue/whats-difference-between-hospital-and-bottling-factory
October 08, 2008 - Commentary
What's the difference between a hospital and a bottling factory?
Citation Text:
Morton A, Cornwell J. What's the difference between a hospital and a bottling factory? BMJ. 2009;339(jul20 1). doi:10.1136/bmj.b2727.
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psnet.ahrq.gov/issue/student-observed-surgical-safety-practices-across-urban-regional-health-authority
August 12, 2020 - Study
Student-observed surgical safety practices across an urban regional health authority.
Citation Text:
Spence J, Goodwin B, Enns C, et al. Student-observed surgical safety practices across an urban regional health authority. BMJ Qual Saf. 2011;20(7):580-6. doi:10.1136/bmjqs.2010.04…
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psnet.ahrq.gov/web-mm/ultrasound-looked-fine-point-care-ultrasound-and-patient-safety
December 01, 2012 - SPOTLIGHT CASE
"The Ultrasound Looked Fine": Point-of-Care Ultrasound and Patient Safety
Citation Text:
Lewiss RE. "The Ultrasound Looked Fine": Point-of-Care Ultrasound and Patient Safety. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and H…
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/perinatal-care/modules/situ/simulation_facguide.pdf
May 01, 2017 - AHRQ Safety Program for Perinatal Care: Establishing a Program of In Situ Simulations
AHRQ Safety Program for Perinatal Care
Establishing a Program of In Situ Simulations
AHRQ Publication No. 17-0003-22-EF
May 2017
SAY:
Establishing a Program of In Situ Simulations
is a pillar of the AHRQ Safety Program for…
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/qitoolkit/pdi/d4j_pdi12-crbsi-bestpractices.pdf
May 17, 2016 - Selected Best Practices and Suggestions for Improvement
Pediatric Toolkit for Using the AHRQ Quality Indicators
How To Improve Hospital Quality and Safety
1 Tool D.4j
Selected Best Practices and Suggestions for Improvement
PDI 12: Central Venous Catheter (CVC)-Related Bloodstream Infection Rate (BSIs)
Why …
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www.ahrq.gov/sites/default/files/2024-07/wears-report.pdf
January 01, 2024 - Final Progress Report: Reducing Risks by Engineering Resilience Into HIT for EDs
Reducing Risks by Engineering Resilience into HIT for EDs
Principal Investigator: Robert L. Wears, MD, MS, PhD
Team Members:
John Wreathall
Rollin (Terry) Fairbanks, MD, MS
Ann M. Bisantz, PhD
Shawna J Perry, MD
Chris Johnson,…
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/qitoolkit/combined/d4x_combo_pdi12-crbsi-bestpractices.pdf
May 17, 2016 - Selected Best Practices and Suggestions for Improvement
Toolkit for Using the AHRQ Quality Indicators
How To Improve Hospital Quality and Safety
1 Tool D.4x
Selected Best Practices and Suggestions for Improvement
PDI 12: Central Venous Catheter (CVC)-Related Bloodstream Infection Rate (BSIs)
Why focus on c…
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www.ahrq.gov/patient-safety/reports/liability/waever.html
August 01, 2017 - Advances in Patient Safety and Medical Liability
Patient Safety Culture and Medical Liability—Recommendations for Measurement, Analysis, and Interpretation: A Commentary
Previous Page Next Page
Table of Contents
Advances in Patient Safety and Medical Liability
Preface
Acknowledgments
Prologue …
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psnet.ahrq.gov/node/33692/psn-pdf
February 01, 2010 - In Conversation with…Thomas J. Nasca, MD
February 1, 2010
In Conversation with…Thomas J. Nasca, MD. PSNet [internet]. 2010.
https://psnet.ahrq.gov/perspective/conversation-withthomas-j-nasca-md
Editor's note: Thomas J. Nasca, MD, is the executive director and chief executive officer of the
Accreditation Council fo…