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psnet.ahrq.gov/node/862999/psn-pdf
February 21, 2024 - Health tech hazards: at-home medical devices, AI
governance on ECRI's new list.
February 21, 2024
Miliard M. Healthcare IT News. February 1, 2024.
https://psnet.ahrq.gov/issue/health-tech-hazards-home-medical-devices-ai-governance-ecris-new-list
Technologies provide improvements and introduce unique problems to ca…
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psnet.ahrq.gov/node/43515/psn-pdf
July 03, 2016 - Targeting improvements in patient safety at a large
academic center: an institutional handoff curriculum for
graduate medical education.
July 3, 2016
Allen S, Caton C, Cluver J, et al. Targeting improvements in patient safety at a large academic center: an
institutional handoff curriculum for graduate medical educ…
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psnet.ahrq.gov/node/34750/psn-pdf
May 21, 2019 - The Basics of FMEA. 2nd ed.
May 21, 2019
McDermott RE, Mikulak RJ, Beauregard MR. New York, NY: CRC Press; 2009. ISBN: 9781563273773.
https://psnet.ahrq.gov/issue/basics-fmea-2nd-edition
The authors provide a handbook that serves as the core tool for understanding and implementing the
failure mode and effect analy…
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psnet.ahrq.gov/node/41022/psn-pdf
December 21, 2011 - Key performance outcomes of patient safety curricula:
root cause analysis, failure mode and effects analysis,
and structured communications skills.
December 21, 2011
Fassett WE. Key performance outcomes of patient safety curricula: root cause analysis, failure mode and
effects analysis, and structured communicatio…
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psnet.ahrq.gov/node/73668/psn-pdf
September 01, 2021 - Leadership: an effective human factor during COVID-19.
September 1, 2021
Dhahri AA, Refson J. Leadership: an effective human factor during COVID-19. BMJ Leader. 2021;5:203-
205. doi:10.1136/leader-2020-000384.
https://psnet.ahrq.gov/issue/leadership-effective-human-factor-during-covid-19
Hierarchy and professional…
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psnet.ahrq.gov/node/44389/psn-pdf
August 19, 2015 - A method of addressing proprietary name similarity for
US prescription drugs.
August 19, 2015
Stockbridge MD, Taylor K. A Method of Addressing Proprietary Name Similarity for US Prescription Drugs.
Ther Innov Regul Sci. 2015;49(4). doi:10.1177/2168479015570331.
https://psnet.ahrq.gov/issue/method-addressing-propri…
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psnet.ahrq.gov/node/43537/psn-pdf
October 15, 2014 - Predictors of healthcare professionals' attitudes towards
family involvement in safety-relevant behaviours: a cross-
sectional factorial survey study.
October 15, 2014
Davis R, Savvopoulou M, Shergill R, et al. Predictors of healthcare professionals' attitudes towards family
involvement in safety-relevant behaviou…
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psnet.ahrq.gov/node/47906/psn-pdf
August 21, 2019 - Creating a just culture: the Ottawa Hospital's experience.
August 21, 2019
Forster AJ, Hamilton S, Hayes T, et al. Creating a Just Culture: The Ottawa Hospital's experience. Healthc
Manage Forum. 2019;32(5):266-271. doi:10.1177/0840470419853303.
https://psnet.ahrq.gov/issue/creating-just-culture-ottawa-hospitals-ex…
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psnet.ahrq.gov/node/60815/psn-pdf
August 19, 2020 - Clinical reasoning in the wild: premature closure during
the COVID-19 pandemic.
August 19, 2020
Boyle JG, Walters MR, Jamieson S, et al. Clinical reasoning in the wild: premature closure during the
COVID-19 pandemic. Diagnosis (Berl). 2020;7(3):177-179. doi:10.1515/dx-2020-0061.
https://psnet.ahrq.gov/issue/clinic…
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psnet.ahrq.gov/node/43473/psn-pdf
August 27, 2014 - Rapid response team implementation and in-hospital
mortality.
August 27, 2014
Salvatierra G, Bindler RC, Corbett CF, et al. Rapid response team implementation and in-hospital
mortality*. Crit Care Med. 2014;42(9):2001-6. doi:10.1097/CCM.0000000000000347.
https://psnet.ahrq.gov/issue/rapid-response-team-implementat…
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psnet.ahrq.gov/node/838317/psn-pdf
October 12, 2022 - Prevalence and sources of duplicate information in the
electronic medical record.
October 12, 2022
Steinkamp J, Kantrowitz JJ, Airan-Javia S. Prevalence and sources of duplicate information in the
electronic medical record. JAMA Netw Open. 2022;5(9):e2233348.
doi:10.1001/jamanetworkopen.2022.33348.
https://psnet.…
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psnet.ahrq.gov/node/50867/psn-pdf
February 05, 2020 - Cognitive testing of older clinicians prior to
recredentialing.
February 5, 2020
Cooney L, Balcezak T. Cognitive Testing of Older Clinicians Prior to Recredentialing. JAMA.
2020;323(2):179-180. doi:10.1001/jama.2019.18665.
https://psnet.ahrq.gov/issue/cognitive-testing-older-clinicians-prior-recredentialing
In an…
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psnet.ahrq.gov/node/45921/psn-pdf
March 08, 2017 - Do hospital boards matter for better, safer, patient care?
March 8, 2017
Mannion R, Davies HTO, Jacobs R, et al. Do Hospital Boards matter for better, safer, patient care? Soc Sci
Med. 2017;177:278-287. doi:10.1016/j.socscimed.2017.01.045.
https://psnet.ahrq.gov/issue/do-hospital-boards-matter-better-safer-patient-…
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psnet.ahrq.gov/node/40511/psn-pdf
June 08, 2011 - A patient safety curriculum for medical residents based
on the perspectives of residents and supervisors.
June 8, 2011
Jansma JD, Wagner C, Bijnen AB. A patient safety curriculum for medical residents based on the
perspectives of residents and supervisors. J Patient Saf. 2011;7(2):99-105.
doi:10.1097/PTS.0b013e318…
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psnet.ahrq.gov/node/46854/psn-pdf
June 20, 2018 - FDA Safety Communication: recommendations to reduce
surgical fires and related patient injury.
June 20, 2018
MedWatch Safety Alert. Silver Spring, MD: US Food and Drug Administration. May 29, 2018.
https://psnet.ahrq.gov/issue/fda-safety-communication-recommendations-reduce-surgical-fires-and-related-
patient-inju…
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psnet.ahrq.gov/node/41873/psn-pdf
November 28, 2012 - A new tool to give hospitalists feedback to improve
interprofessional teamwork and advance patient care.
November 28, 2012
Chesluk BJ, Bernabeo E, Hess B, et al. A new tool to give hospitalists feedback to improve
interprofessional teamwork and advance patient care. Health Aff (Millwood). 2012;31(11):2485-2492.
do…
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psnet.ahrq.gov/node/41440/psn-pdf
August 17, 2016 - The Toolkit for Using the AHRQ Quality Indicators: How
To Improve Hospital Quality and Safety.
August 17, 2016
Rockville, MD: Agency for Healthcare Research and Quality; July 2016.
https://psnet.ahrq.gov/issue/toolkit-using-ahrq-quality-indicators-how-improve-hospital-quality-and-safety
This toolkit provides resou…
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psnet.ahrq.gov/node/47081/psn-pdf
September 02, 2018 - Beyond Dr. Google: the evidence on consumer-facing
digital tools for diagnosis.
September 2, 2018
Millenson ML, Baldwin JL, Zipperer L, et al. Beyond Dr. Google: the evidence on consumer-facing digital
tools for diagnosis. Diagnosis (Berl). 2018;5(3):95-105. doi:10.1515/dx-2018-0009.
https://psnet.ahrq.gov/issue/b…
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psnet.ahrq.gov/node/837192/psn-pdf
May 25, 2022 - Declaration to Advance Patient Safety.
May 25, 2022
National Steering Committee for Patient Safety. Boston, MA: Institute for Healthcare Improvement; May
2022.
https://psnet.ahrq.gov/issue/declaration-advance-patient-safety
Leadership commitment is crucial to attaining sustainable improvement in patient safety. Th…
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psnet.ahrq.gov/node/45496/psn-pdf
May 09, 2017 - The application of the Global Trigger Tool: a systematic
review.
May 9, 2017
Hibbert PD, Molloy CJ, Hooper TD, et al. The application of the Global Trigger Tool: a systematic review.
Int J Qual Health Care. 2016;28(6):640-649. doi:10.1093/intqhc/mzw115.
https://psnet.ahrq.gov/issue/application-global-trigger-tool-…