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psnet.ahrq.gov/issue/guidelines-us-hospitals-and-clinicians-assessment-electronic-health-record-safety-using-safer
June 24, 2020 - Commentary
Guidelines for US hospitals and clinicians on assessment of electronic health record safety using SAFER Guides.
Citation Text:
Sittig DF, Sengstack P, Singh H. Guidelines for US hospitals and clinicians on assessment of electronic health record safety using SAFER Guides. JAMA.…
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psnet.ahrq.gov/issue/assessment-use-patient-vital-sign-data-preventing-misidentification-and-medical-errors
February 16, 2022 - Commentary
Assessment of the use of patient vital sign data for preventing misidentification and medical errors.
Citation Text:
Maul J, Straub J. Assessment of the use of patient vital sign data for preventing misidentification and medical errors. Healthcare (Basel). 2022;10(12):2440. do…
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psnet.ahrq.gov/issue/institute-safe-medication-practices-and-poison-control-centers-collaborating-prevent
April 22, 2017 - Commentary
The Institute for Safe Medication Practices and poison control centers: collaborating to prevent medication errors and unintentional poisonings.
Citation Text:
Vaida AJ. The Institute for Safe Medication Practices and Poison Control Centers: Collaborating to Prevent Medication…
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psnet.ahrq.gov/issue/optimal-preoperative-assessment-geriatric-surgical-patient-best-practices-guideline-american
July 13, 2010 - Commentary
Optimal preoperative assessment of the geriatric surgical patient: a best practices guideline from the American College of Surgeons National Surgical Quality Improvement Program and the American Geriatrics Society.
Citation Text:
Chow WB, Rosenthal RA, Merkow RP, et al. Optim…
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psnet.ahrq.gov/issue/sbar-mm-feasible-reliable-and-valid-tool-assess-quality-surgical-morbidity-and-mortality
July 02, 2014 - Study
SBAR M&M: a feasible, reliable, and valid tool to assess the quality of, surgical morbidity and mortality conference presentations.
Citation Text:
Mitchell EL, Lee DY, Arora S, et al. SBAR M&M: a feasible, reliable, and valid tool to assess the quality of, surgical morbidity and …
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psnet.ahrq.gov/node/72582/psn-pdf
December 16, 2020 - Deficiencies in the Veterans Crisis Line Response to a
Veteran Caller Who Died.
December 16, 2020
Washington, DC: Department of Veterans Affairs, Office of Inspector General; November 17, 2020. Report
No 19-08542-11.
https://psnet.ahrq.gov/issue/deficiencies-veterans-crisis-line-response-veteran-caller-who-died
I…
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psnet.ahrq.gov/perspective/conversation-ann-l-hendrich-rn-phd
February 26, 2025 - In Conversation With… Ann L. Hendrich, RN, PhD
December 1, 2011
Citation Text:
In Conversation With… Ann L. Hendrich, RN, PhD. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2011.
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psnet.ahrq.gov/node/865466/psn-pdf
March 27, 2024 - These
disparities may further feed into, and become entrenched in, AI assessments of its own efficacy
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psnet.ahrq.gov/node/865655/psn-pdf
April 24, 2024 - In patients at risk for compartment syndrome, maintain a high index of suspicion and perform serial
assessments
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psnet.ahrq.gov/node/837902/psn-pdf
August 24, 2022 - Development and pilot evaluation of an electronic health
record usability and safety self-assessment tool.
August 24, 2022
Pruitt Z, Howe JL, Krevat S, et al. Development and pilot evaluation of an electronic health record usability
and safety self-assessment tool. JAMIA Open. 2022;5(3):ooac070. doi:10.1093/jamiaop…
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psnet.ahrq.gov/node/851067/psn-pdf
June 28, 2023 - Assessing medication safety in settings not designated
solely for pediatric patients.
June 28, 2023
ISMP Medication Safety Alert! Acute care edition. June 15, 2023;28(12);1-5.
https://psnet.ahrq.gov/issue/assessing-medication-safety-settings-not-designated-solely-pediatric-patients
Pediatric patients are at increa…
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psnet.ahrq.gov/node/49853/psn-pdf
February 01, 2019 - Adverse Event During Intrahospital Transport
February 1, 2019
Bergman L, Chaboyer W. Adverse Event During Intrahospital Transport. PSNet [internet]. 2019.
https://psnet.ahrq.gov/web-mm/adverse-event-during-intrahospital-transport
The Case
A 4-year-old boy underwent surgery under general anesthesia for correction o…
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psnet.ahrq.gov/issue/healthcare-failure-mode-and-effect-analysis
May 24, 2017 - Toolkit
Healthcare Failure Mode and Effect Analysis.
Citation Text:
Healthcare Failure Mode and Effect Analysis. National Center for Patient Safety.
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psnet.ahrq.gov/issue/score-your-safety-culture
March 04, 2015 - Measurement Tool/Indicator
Score Your Safety Culture.
Citation Text:
Score Your Safety Culture. Reason J. Flight Safety Australia. 2001;5(1):40-41.
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psnet.ahrq.gov/node/43870/psn-pdf
January 28, 2015 - Peer review of medical practices: missed opportunities to
learn.
January 28, 2015
Kadar N. Peer review of medical practices: missed opportunities to learn. Am J Obstet Gynecol.
2014;211(6):596-601. doi:10.1016/j.ajog.2014.08.018.
https://psnet.ahrq.gov/issue/peer-review-medical-practices-missed-opportunities-learn…
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psnet.ahrq.gov/node/74236/psn-pdf
January 12, 2022 - Can SBAR be implemented with high fidelity and does it
improve communication between healthcare workers? A
systematic review.
January 12, 2022
Lo L, Rotteau L, Shojania KG. Can SBAR be implemented with high fidelity and does it improve
communication between healthcare workers? A systematic review. BMJ Open. 2021;1…
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psnet.ahrq.gov/issue/effects-team-based-assessment-and-intervention-patient-safety-culture-general-practice-open
August 14, 2013 - Study
Effects of a team-based assessment and intervention on patient safety culture in general practice: an open randomised controlled trial.
Citation Text:
Hoffmann B, Müller V, Rochon J, et al. Effects of a team-based assessment and intervention on patient safety culture in general p…
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psnet.ahrq.gov/issue/qualitative-study-why-general-practitioners-may-participate-significant-event-analysis-and
October 29, 2008 - Study
A qualitative study of why general practitioners may participate in significant event analysis and educational peer assessment.
Citation Text:
Bowie P, McKay J, Dalgetty E, et al. A qualitative study of why general practitioners may participate in significant event analysis and e…
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psnet.ahrq.gov/issue/reliability-verbal-handoff-assessment-and-handoff-quality-and-after-implementation-resident
November 16, 2022 - Study
Reliability of verbal handoff assessment and handoff quality before and after implementation of a resident handoff bundle.
Citation Text:
Feraco AM, Starmer AJ, Sectish TC, et al. Reliability of Verbal Handoff Assessment and Handoff Quality Before and After Implementation of a Resi…
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psnet.ahrq.gov/issue/assessment-patient-preferred-language-achieve-goal-aligned-deprescribing-older-adults
December 19, 2018 - Study
Assessment of patient-preferred language to achieve goal-aligned deprescribing in older adults.
Citation Text:
Green AR, Aschmann H, Boyd CM, et al. Assessment of patient-preferred language to achieve goal-aligned deprescribing in older adults. JAMA Netw Open. 2021;4(4):e212633. do…