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psnet.ahrq.gov/web-mm/cvc-removal-procedure-any-other
October 01, 2018 - CVC Removal: A Procedure Like Any Other
Citation Text:
Feil M. CVC Removal: A Procedure Like Any Other. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2014.
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March 29, 2023 - Procedure Complications – Who is Responsible for
Follow up?
March 29, 2023
Chalupsky M, Wei H, Marquet E. Procedure Complications – Who is Responsible for Follow up? PSNet
[internet]. 2023.
https://psnet.ahrq.gov/web-mm/procedure-complications-who-responsible-follow
The Case
A 74-year-old man with newly diagnose…
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psnet.ahrq.gov/node/33693/psn-pdf
February 01, 2010 - The Role of Graduate Medical Education (GME) in
Improving Patient Safety
February 1, 2010
Baron RB, Vidyarthi A. The Role of Graduate Medical Education (GME) in Improving Patient Safety. PSNet
[internet]. 2010.
https://psnet.ahrq.gov/perspective/role-graduate-medical-education-gme-improving-patient-safety
Perspec…
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psnet.ahrq.gov/web-mm/preventing-picc-complications-whose-line-it
October 01, 2017 - Preventing PICC Complications: Whose Line Is It?
Citation Text:
Moureau N. Preventing PICC Complications: Whose Line Is It?. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2012.
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psnet.ahrq.gov/node/866869/psn-pdf
October 02, 2024 - Core Elements of Hospital Diagnostic Excellence (DxEx).
October 2, 2024
Core Elements of Hospital Diagnostic Excellence (DxEx). Centers for Disease Control and Prevention.
https://psnet.ahrq.gov/issue/core-elements-hospital-diagnostic-excellence-dxex
Diagnostic excellence is an expansion of the diagnostic error red…
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psnet.ahrq.gov/node/867531/psn-pdf
January 15, 2025 - Psychological Safety in Healthcare Settings.
January 15, 2025
Psychological Safety in Healthcare Settings. Int J Public Health. 2024;69.
https://psnet.ahrq.gov/issue/psychological-safety-healthcare-settings
The importance of creating healthcare environments that enable concerns to be voiced and support
individuals…
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psnet.ahrq.gov/node/36637/psn-pdf
January 14, 2011 - The effect of the fit between organizational culture and
structure on medication errors in medical group
practices.
January 14, 2011
Kaissi A, Kralewski J, Dowd B, et al. The effect of the fit between organizational culture and structure on
medication errors in medical group practices. Health Care Manage Rev. 2007…
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psnet.ahrq.gov/node/33916/psn-pdf
December 22, 2014 - Training of Hospital Staff To Respond to a Mass Casualty
Incident. Summary, Evidence Report/Technology
Assessment.
December 22, 2014
Hsu EB, Jenckes MW, Catlett CL, et al. In: AHRQ Evidence Report Summaries. Rockville, MD: Agency for
Healthcare Research and Quality; 1998-2005. 95. AHRQ Publication No. 04-E015-1
h…
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psnet.ahrq.gov/node/60727/psn-pdf
July 29, 2020 - A randomized trial of a multifactorial strategy to prevent
serious fall injuries.
July 29, 2020
Bhasin S, Gill TM, Reuben DB, et al. A randomized trial of a multifactorial strategy to prevent serious fall
injuries. N Engl J Med. 2020;383(2):129-140. doi:10.1056/nejmoa2002183.
https://psnet.ahrq.gov/issue/randomize…
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psnet.ahrq.gov/node/60671/psn-pdf
July 08, 2020 - Hidden in plain sight — reconsidering the use of race
correction in clinical algorithms.
July 8, 2020
Vyas DA, Eisenstein LG, Jones DS. Hidden in plain sight — reconsidering the use of race correction in
clinical algorithms. N Engl J Med. 2020;383(9):874-882. doi:10.1056/nejmms2004740.
https://psnet.ahrq.gov/issue…
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psnet.ahrq.gov/node/42057/psn-pdf
February 20, 2013 - Improving patient safety in the operating theatre and
perioperative care: obstacles, interventions, and priorities
for accelerating progress.
February 20, 2013
Sevdalis N, Hull L, Birnbach DJ. Improving patient safety in the operating theatre and perioperative care:
obstacles, interventions, and priorities for acc…
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psnet.ahrq.gov/node/40599/psn-pdf
November 23, 2011 - Organizational climate determinants of resident safety
culture in nursing homes.
November 23, 2011
Arnetz JE, Zhdanova LS, Elsouhag D, et al. Organizational climate determinants of resident safety culture
in nursing homes. Gerontologist. 2011;51(6):739-49. doi:10.1093/geront/gnr053.
https://psnet.ahrq.gov/issue/or…
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psnet.ahrq.gov/node/42387/psn-pdf
December 30, 2014 - 'Bad apples': time to redefine as a type of systems
problem?
December 30, 2014
Shojania KG, Dixon-Woods M. 'Bad apples': time to redefine as a type of systems problem? BMJ Qual Saf.
2013;22(7):528-531. doi:10.1136/bmjqs-2013-002138.
https://psnet.ahrq.gov/issue/bad-apples-time-redefine-type-systems-problem
While …
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psnet.ahrq.gov/node/45931/psn-pdf
July 05, 2017 - The CARE approach to reducing diagnostic errors.
July 5, 2017
Rush JL, Helms SE, Mostow EN. The CARE approach to reducing diagnostic errors. Int J Dermatol.
2017;56(6):669-673. doi:10.1111/ijd.13532.
https://psnet.ahrq.gov/issue/care-approach-reducing-diagnostic-errors
Cognitive aids such as checklists and mnemoni…
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psnet.ahrq.gov/node/37312/psn-pdf
January 05, 2012 - Delineation of risk through the exploration of a culture of
safety in community home health.
January 5, 2012
Stevenson L, McRae C, Mughal WA. Delineation of Risk Through the Exploration of a Culture of Safety in
Community Home Health. Home Health Care Manag Pract. 2007;19(6). doi:10.1177/1084822307304256.
https://…
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psnet.ahrq.gov/node/37746/psn-pdf
May 14, 2008 - Reducing preventable medication safety events by
recognizing renal risk.
May 14, 2008
Fields W, Tedeschi C, Foltz J, et al. Reducing preventable medication safety events by recognizing renal
risk. Clin Nurse Spec. 2008;22(2):73-8; quiz 79-80. doi:10.1097/01.NUR.0000311795.69476.2f.
https://psnet.ahrq.gov/issue/red…
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psnet.ahrq.gov/node/35053/psn-pdf
November 18, 2015 - Measured response to identified suicide risk and
violence: what you need to know about psychiatric
patient safety.
November 18, 2015
Yeager KR, Saveanu R, Roberts AR, et al. Brief Treat Crisis Intervent. 2005;5(2):121-141
https://psnet.ahrq.gov/issue/measured-response-identified-suicide-risk-and-violence-what-you-…
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psnet.ahrq.gov/node/836870/psn-pdf
April 26, 2022 - A Conversation Among Stakeholders on Medical
Malpractice.
April 6, 2022
Collaborative for Accountability and Improvement. April 26, 2022.
https://psnet.ahrq.gov/issue/conversation-among-stakeholders-medical-malpractice
Communication and resolution programs (CRP) can improve response to patients and families a…
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psnet.ahrq.gov/node/42943/psn-pdf
April 12, 2014 - Doing right by our patients when things go wrong in the
ambulatory setting.
April 12, 2014
Schiff G, Griswold P, Ellis BR, et al. Doing right by our patients when things go wrong in the ambulatory
setting. Jt Comm J Qual Patient Saf. 2014;40(2):91-96.
https://psnet.ahrq.gov/issue/doing-right-our-patients-when-thin…
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psnet.ahrq.gov/node/60538/psn-pdf
May 27, 2020 - Diagnostic Safety Toolkit.
May 27, 2020
Child Health Patient Safety Organization. Diagnostic Safety Toolkit. Washington DC: Children's Hospital
Association. May 2020.
https://psnet.ahrq.gov/issue/diagnostic-safety-toolkit
Effective communication is an important component of diagnostic accuracy. Shaped with data co…