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psnet.ahrq.gov/issue/when-doctor-too-old-job
March 04, 2020 - Newspaper/Magazine Article
When is a doctor too old for the job?
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September 18, 2019
Potential deterioration of an aging surgeon's…
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psnet.ahrq.gov/node/860381/psn-pdf
January 10, 2024 - Measuring the impact of AI in the diagnosis of
hospitalized patients: a randomized clinical vignette
survey study.
January 10, 2024
Jabbour S, Fouhey D, Shepard S, et al. Measuring the impact of AI in the diagnosis of hospitalized
patients: a randomized clinical vignette survey study. JAMA. 2023;330(23):2275.
doi…
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psnet.ahrq.gov/node/60185/psn-pdf
April 01, 2020 - Associations between stopping prescriptions for opioids,
length of opioid treatment, and overdose or suicide
deaths in US veterans: observational evaluation.
April 1, 2020
Oliva EM, Bowe T, Manhapra A, et al. Associations between stopping prescriptions for opioids, length of
opioid treatment, and overdose or suici…
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psnet.ahrq.gov/node/38696/psn-pdf
April 11, 2012 - Hospital Survey on Patient Safety Culture: 2009
Comparative Database Report.
April 11, 2012
Sorra J, Famloaro T, Dyer N, Nelson D, Khanna K. Rockville, MD: Agency for Healthcare Research and
Quality; 2009. AHRQ Publication No. 09-0030.
https://psnet.ahrq.gov/issue/hospital-survey-patient-safety-culture-2009-compar…
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psnet.ahrq.gov/node/42692/psn-pdf
April 21, 2015 - Surgical skill and complication rates after bariatric
surgery.
April 21, 2015
Birkmeyer JD, Finks JF, O'Reilly A, et al. Surgical skill and complication rates after bariatric surgery. N Engl
J Med. 2013;369(15):1434-1442. doi:10.1056/NEJMsa1300625.
https://psnet.ahrq.gov/issue/surgical-skill-and-complication-rates…
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psnet.ahrq.gov/node/35572/psn-pdf
February 03, 2011 - The long road to patient safety: a status report on patient
safety systems.
February 3, 2011
Longo DR, Hewett JE, Ge B, et al. The long road to patient safety: a status report on patient safety
systems. JAMA. 2005;294(22):2858-65.
https://psnet.ahrq.gov/issue/long-road-patient-safety-status-report-patient-safety-s…
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psnet.ahrq.gov/node/47207/psn-pdf
July 19, 2018 - National quality program achieves improvements in
safety culture and reduction in preventable harms in
community hospitals.
July 19, 2018
Frush K, Chamness C, Olson B, et al. National Quality Program Achieves Improvements in Safety Culture
and Reduction in Preventable Harms in Community Hospitals. Jt Comm J Qual P…
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psnet.ahrq.gov/node/74030/psn-pdf
November 03, 2021 - Evaluation of a second victim peer support program on
perceptions of second victim experiences and supportive
resources in pediatric clinical specialties using the
second victim experience and support tool (SVEST).
November 3, 2021
Finney RE, Czinski S, Fjerstad K, et al. Evaluation of a second victim peer support…
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psnet.ahrq.gov/node/38949/psn-pdf
January 28, 2010 - Implementing a pre-operative checklist to increase patient
safety: a 1-year follow-up of personnel attitudes.
January 28, 2010
Nilsson L, Lindberget O, Gupta A, et al. Implementing a pre-operative checklist to increase patient safety: a
1-year follow-up of personnel attitudes. Acta Anaesthesiol Scand. 2010;54(2):17…
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psnet.ahrq.gov/node/43193/psn-pdf
June 17, 2014 - Risks in the implementation and use of smart pumps in a
pediatric intensive care unit: application of the failure
mode and effects analysis.
June 17, 2014
Manrique-Rodríguez S, Sánchez-Galindo AC, López-Herce J, et al. Risks in the implementation and use of
smart pumps in a pediatric intensive care unit: applicati…
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psnet.ahrq.gov/node/46434/psn-pdf
December 21, 2018 - Reducing medication errors in critical care patients:
pharmacist key resources and relationship with
medicines optimisation.
December 21, 2018
Bourne RS, Shulman R, Jennings JK. Reducing medication errors in critical care patients: pharmacist key
resources and relationship with medicines optimisation. In J Pharm P…
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psnet.ahrq.gov/node/39570/psn-pdf
September 20, 2011 - Effect of a 19-item surgical safety checklist during urgent
operations in a global patient population.
September 20, 2011
Weiser TG, Haynes AB, Dziekan G, et al. Effect of A 19-Item Surgical Safety Checklist During Urgent
Operations in A Global Patient Population. Ann Surg. 2010;251(5). doi:10.1097/sla.0b013e3181d9…
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psnet.ahrq.gov/node/846126/psn-pdf
March 09, 2023 - Medication Handling and Compounding Errors in the
Operating Room.
March 15, 2023
Chaudhry J, Manning C, Dakwa D, et al. Medication Handling and Compounding Errors in the Operating
Room. PSNet [internet]. 2023.
https://psnet.ahrq.gov/web-mm/medication-handling-and-compounding-errors-operating-room
The Case
A 62-y…
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psnet.ahrq.gov/web-mm/wrong-patients-blood-evaluating-near-miss-wrong-transfusion-event
July 01, 2017 - SPOTLIGHT CASE
“This is the wrong patient's blood!”: Evaluating a Near-Miss Wrong Transfusion Event
Citation Text:
Barnhard S. “This is the wrong patient's blood!”: Evaluating a Near-Miss Wrong Transfusion Event. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Dep…
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psnet.ahrq.gov/node/72911/psn-pdf
March 15, 2021 - The Impact of Communication on Medication Errors
March 15, 2021
Branch J, Hiner D, Jackson V. The Impact of Communication on Medication Errors. PSNet [internet]. 2021.
https://psnet.ahrq.gov/web-mm/impact-communication-medication-errors
The Case
A 93-year-old man with a history of chronic systolic heart failure…
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psnet.ahrq.gov/web-mm/medication-handling-and-compounding-errors-operating-room
May 16, 2022 - Medication Handling and Compounding Errors in the Operating Room.
Citation Text:
Chaudhry J, Manning C, Dakwa D, et al. Medication Handling and Compounding Errors in the Operating Room.. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services.…
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psnet.ahrq.gov/innovation/abcdef-bundle-data-literacy-training-performance-measurement-tracking-and-performance
September 23, 2024 - ABCDEF Bundle + Data Literacy Training, Performance Measurement Tracking, and Performance Feedback
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February 28, 2024
Innovation
Conta…
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psnet.ahrq.gov/web-mm/reflexive-diagnosis-primary-care
April 01, 2008 - SPOTLIGHT CASE
A "Reflexive" Diagnosis in Primary Care
Citation Text:
Betjemann J, Josephson AS. A "Reflexive" Diagnosis in Primary Care. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2014.
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…
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psnet.ahrq.gov/perspective/conversation-amy-j-starmer-md-mph
May 31, 2023 - In Conversation With… Amy J. Starmer, MD, MPH
April 1, 2016
Citation Text:
In Conversation With… Amy J. Starmer, MD, MPH. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2016.
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psnet.ahrq.gov/node/865610/psn-pdf
April 24, 2024 - Suicide Prevention in an Emergency Department
Population: ED-SAFE
April 24, 2024
https://psnet.ahrq.gov/innovation/suicide-prevention-emergency-department-population-ed-safe
Summary
Suicide is the 12th leading cause of death in the United States, and the 3rd leading cause of death for
people ages 15-24.1 More tha…