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  1. psnet.ahrq.gov/web-mm/fumbled-handoff-inpatient-rehab
    December 21, 2018 - A Fumbled Handoff to Inpatient Rehab Citation Text: Ashcraft LE, Kahn JM. A Fumbled Handoff to Inpatient Rehab. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2015. Copy Citation Format: Google Scholar BibTeX EndNote X3…
  2. psnet.ahrq.gov/web-mm/walking-out-hospital-after-attempted-suicide
    March 29, 2023 - Walking Out of a Hospital After Attempted Suicide Citation Text: Bourgeois JA, Xiong G. Walking Out of a Hospital After Attempted Suicide. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2023. Copy Citation Format: Googl…
  3. psnet.ahrq.gov/web-mm/adverse-event-during-intrahospital-transport
    June 16, 2021 - Adverse Event During Intrahospital Transport Citation Text: Bergman L, Chaboyer W. Adverse Event During Intrahospital Transport. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2019. Copy Citation Format: Google Scholar …
  4. psnet.ahrq.gov/web-mm/fatal-patient-controlled-analgesia-pca-opioid-induced-respiratory-depression
    May 26, 2021 - timing and duration of monitoring can differ among organizations. 30 Societies agree that the timing of assessments
  5. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/849595/psn-pdf
    May 31, 2023 - Effect of an emergency department process improvement package on suicide prevention: the ED-SAFE 2 cluster randomized clinical trial. May 31, 2023 Boudreaux ED, Larkin C, Vallejo Sefair A, et al. Effect of an emergency department process improvement package on suicide prevention: the ED-SAFE 2 cluster randomized c…
  6. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/45101/psn-pdf
    July 01, 2017 - A systematic review of patient safety measures in adult primary care. July 1, 2017 Hatoun J, Chan J, Yaksic E, et al. A Systematic Review of Patient Safety Measures in Adult Primary Care. Am J Med Qual. 2017;32(3):237-245. doi:10.1177/1062860616644328. https://psnet.ahrq.gov/issue/systematic-review-patient-safety-…
  7. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/50814/psn-pdf
    January 22, 2020 - Evaluation of the extended-release/long-acting opioid prescribing Risk Evaluation and Mitigation Strategy Program by the US Food and Drug Administration: a review. January 22, 2020 Heyward J, Olson L, Sharfstein JM, et al. Evaluation of the Extended-Release/Long-Acting Opioid Prescribing Risk Evaluation and Mitig…
  8. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/43697/psn-pdf
    March 26, 2015 - Establishing an international baseline for medication safety in oncology: findings from the 2012 ISMP International Medication Safety Self Assessment for Oncology. March 26, 2015 Greenall J, Shastay A, Vaida AJ, et al. Establishing an international baseline for medication safety in oncology: Findings from the 201…
  9. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/41298/psn-pdf
    November 27, 2012 - Patient safety culture and the association with safe resident care in nursing homes. November 27, 2012 Thomas KS, Hyer K, Castle NG, et al. Patient safety culture and the association with safe resident care in nursing homes. Gerontologist. 2012;52(6):802-811. doi:10.1093/geront/gns007. https://psnet.ahrq.gov/issue…
  10. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/72624/psn-pdf
    January 05, 2021 - The LifePoint National Quality Program Provides Structured Framework for Reducing Inpatient Harm January 5, 2021 https://psnet.ahrq.gov/innovation/lifepoint-national-quality-program-provides-structured-framework- reducing-inpatient-harm Summary Building on the company’s experience as a Hospital Engagement Network…
  11. psnet.ahrq.gov/issue/measurement-and-training-teamstepps-dimensions-using-medical-team-performance-assessment-tool
    March 09, 2009 - Commentary Measurement and training of TeamSTEPPS dimensions using the Medical Team Performance Assessment Tool. Citation Text: Lineberry M, Bryan E, Brush T, et al. Measurement and training of TeamSTEPPS dimensions using the Medical Team Performance Assessment Tool. Jt Comm J Qual Pat…
  12. psnet.ahrq.gov/issue/emotional-fallout-culture-blame-and-shame
    October 28, 2020 - Commentary The emotional fallout from the culture of blame and shame. Citation Text: Ferguson CC. The emotional fallout from the culture of blame and shame. JAMA Pediatr. 2017;171(12):1141. doi:10.1001/jamapediatrics.2017.2691. Copy Citation Format: DOI Google Scholar PubMe…
  13. psnet.ahrq.gov/issue/assessing-residents-communication-skills-disclosure-adverse-event-standardized-patient
    December 21, 2016 - Study Assessing residents' communication skills: disclosure of an adverse event to a standardized patient. Citation Text: Posner G, Nakajima A. Assessing residents' communication skills: disclosure of an adverse event to a standardized patient. J Obstet Gynaecol Can. 2011;33(3):262-26…
  14. psnet.ahrq.gov/issue/contributions-agency-healthcare-research-and-quality-and-grantees
    July 29, 2010 - Special or Theme Issue Contributions by the Agency for Healthcare Research and Quality and Grantees. Citation Text: Contributions by the Agency for Healthcare Research and Quality and Grantees. Health Serv Res. 2009 Apr;44(2 Pt 2):623-776. Copy Citation Save S…
  15. psnet.ahrq.gov/issue/assessment-patient-safety-research-organizational-ergonomics-and-structural-perspective
    September 09, 2011 - Review Assessment of patient safety research from an organizational ergonomics and structural perspective. Citation Text: Schutz AL, Counte MA, Meurer S. Assessment of patient safety research from an organizational ergonomics and structural perspective. Ergonomics. 2007;50(9):1451-84. …
  16. psnet.ahrq.gov/issue/2024-national-impact-assessment-centers-medicare-medicaid-services-cms-quality-measures
    November 23, 2015 - Book/Report 2024 National Impact Assessment of the Centers for Medicare & Medicaid Services (CMS) Quality Measures Report. Citation Text: 2024 National Impact Assessment of the Centers for Medicare & Medicaid Services (CMS) Quality Measures Report. Baltimore, MD: US Department of Health …
  17. psnet.ahrq.gov/issue/pridx-framework-engage-payers-reducing-diagnostic-errors-healthcare
    January 22, 2025 - Commentary The PRIDx framework to engage payers in reducing diagnostic errors in healthcare. Citation Text: Ali KJ, Goeschel CA, DeLia DM, et al. The PRIDx framework to engage payers in reducing diagnostic errors in healthcare. Diagnosis (Berl). 2024;11(1):17-24. doi:10.1515/dx-2023-0042…
  18. psnet.ahrq.gov/issue/assessing-evidence-context-sensitive-effectiveness-and-safety-patient-safety-practices
    July 27, 2018 - Book/Report Assessing the Evidence for Context-Sensitive Effectiveness and Safety of Patient Safety Practices: Developing Criteria. Citation Text: Assessing the Evidence for Context-Sensitive Effectiveness and Safety of Patient Safety Practices: Developing Criteria. Shekelle PG, Pron…
  19. psnet.ahrq.gov/issue/health-literacy-americas-adults-results-2003-national-assessment-adult-literacy
    January 16, 2019 - Government Resource The Health Literacy of America's Adults: Results from the 2003 National Assessment of Adult Literacy.  Citation Text: The Health Literacy of America's Adults: Results from the 2003 National Assessment of Adult Literacy.  Kutner M, Greenberg E, Jin Y, et al. Washin…
  20. psnet.ahrq.gov/issue/assessment-potential-impact-reminder-system-reduction-diagnostic-errors-quasi-experimental
    April 19, 2011 - Study Assessment of the potential impact of a reminder system on the reduction of diagnostic errors: a quasi-experimental study. Citation Text: Ramnarayan P, Roberts GC, Coren M, et al. Assessment of the potential impact of a reminder system on the reduction of diagnostic errors: a qua…

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