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psnet.ahrq.gov/node/42663/psn-pdf
October 16, 2023 - Patient Safety: A Case-based Innovative Playbook for
Safer Care. Second Edition.
October 16, 2023
Agrawal A, Bhatt J, eds. Cham, Switzerland, Springer Nature; 2023. ISBN: 9783031359330.
https://psnet.ahrq.gov/issue/patient-safety-case-based-innovative-playbook-safer-care-second-edition
This publication describes a…
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psnet.ahrq.gov/node/60768/psn-pdf
August 05, 2020 - Missed and delayed diagnoses of non-COVID conditions--
collateral harm from a pandemic.
August 5, 2020
Carr S. Missed and delayed diagnoses of non-COVID conditions- collateral harm from a pandemic.
ImproveDx. 2020;7(4):1-5.
https://psnet.ahrq.gov/issue/missed-and-delayed-diagnoses-non-covid-conditions-collateral-h…
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psnet.ahrq.gov/node/73672/psn-pdf
September 01, 2021 - ‘He thought what he was doing was good for people.’ Why
is it so difficult to prevent unnecessary medical
procedures in the U.S. health-care system?
September 1, 2021
Outcalt C. The Atlantic. August 2021.
https://psnet.ahrq.gov/issue/he-thought-what-he-was-doing-was-good-people-why-it-so-difficult-prevent-
unnece…
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psnet.ahrq.gov/node/45903/psn-pdf
June 21, 2017 - Association between state medical malpractice
environment and postoperative outcomes in the United
States.
June 21, 2017
Minami CA, Sheils CR, Pavey E, et al. Association Between State Medical Malpractice Environment and
Postoperative Outcomes in the United States. J Am Coll Surg. 2017;224(3):310-318.e2.
doi:10.1…
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psnet.ahrq.gov/node/764406/psn-pdf
March 02, 2022 - Patient safety assurance in the age of defensive
medicine: a review.
March 2, 2022
Shenoy A, Shenoy GN, Shenoy GG. Patient safety assurance in the age of defensive medicine: a review.
Patient Saf Surg. 2022;16(1):10. doi:10.1186/s13037-022-00319-8.
https://psnet.ahrq.gov/issue/patient-safety-assurance-age-defensiv…
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psnet.ahrq.gov/node/47499/psn-pdf
November 07, 2018 - Defensive medicine: it is time to finally slow down an
epidemic.
November 7, 2018
Vento S, Cainelli F, Vallone A. Defensive medicine: It is time to finally slow down an epidemic. World J Clin
Cases. 2018;6(11):406-409. doi:10.12998/wjcc.v6.i11.406.
https://psnet.ahrq.gov/issue/defensive-medicine-it-time-finally-sl…
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psnet.ahrq.gov/node/48005/psn-pdf
May 08, 2019 - Why your doctor's white coat can be a threat to your
health.
May 8, 2019
Haun N, Hooper-Lane C, Safdar N. Healthcare Personnel Attire and Devices as Fomites: A Systematic
Review. Infect Control Hosp Epidemiol. 2016;37(11):1367-1373.
https://psnet.ahrq.gov/issue/why-your-doctors-white-coat-can-be-threat-your-health…
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psnet.ahrq.gov/node/47055/psn-pdf
May 23, 2018 - Surgical checklists save lives—but once in a while, they
don't. Why?
May 23, 2018
Mukherjee S. New York Times Magazine. May 9, 2018.
https://psnet.ahrq.gov/issue/surgical-checklists-save-lives-once-while-they-dont-why
Checklists can coordinate action and communication to augment safety, but human and system factor…
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psnet.ahrq.gov/node/74044/psn-pdf
November 03, 2021 - Challenges with requiring five characters during ADC
drug searches via override.
November 3, 2021
ISMP Medication Safety Alert! Acute care edition. October 21, 2021;26(21):1-3.
https://psnet.ahrq.gov/issue/challenges-requiring-five-characters-during-adc-drug-searches-override
Shortcuts in automated data entry beha…
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psnet.ahrq.gov/node/38571/psn-pdf
April 22, 2009 - The Oxford NOTECHS System: reliability and validity of a
tool for measuring teamwork behaviour in the operating
theatre.
April 22, 2009
Mishra A, Catchpole K, McCulloch P. The Oxford NOTECHS System: reliability and validity of a tool for
measuring teamwork behaviour in the operating theatre. Qual Saf Health Care. …
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psnet.ahrq.gov/node/46159/psn-pdf
May 31, 2017 - Despite technology, verbal orders persist, read back is
not widespread, and errors continue.
May 31, 2017
ISMP Medication Safety Alert! Acute Care Edition. May 18, 2017;22:1-4.
https://psnet.ahrq.gov/issue/despite-technology-verbal-orders-persist-read-back-not-widespread-and-
errors-continue
Verbal orders are kno…
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psnet.ahrq.gov/node/41573/psn-pdf
October 30, 2013 - The medical student as a patient: attitudes towards
involvement in the quality and safety of health care.
October 30, 2013
Davis R, Joshi D, Patel K, et al. The medical student as a patient: attitudes towards involvement in the
quality and safety of health care. J Eval Clin Pract. 2013;19(5):812-8. doi:10.1111/j.13…
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psnet.ahrq.gov/node/45143/psn-pdf
October 20, 2016 - Medical improv: a novel approach to teaching
communication and professionalism skills.
October 20, 2016
Watson K, Fu B. Medical Improv: A Novel Approach to Teaching Communication and Professionalism
Skills. Ann Intern Med. 2016;165(8):591-592. doi:10.7326/M15-2239.
https://psnet.ahrq.gov/issue/medical-improv-novel…
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psnet.ahrq.gov/node/44309/psn-pdf
June 14, 2019 - Provider and patient perceptions of an external
medication history function.
June 14, 2019
Wolver SE, Stultz JS, Aggarwal A, et al. Provider and Patient Perceptions of an External Medication History
Function. J Patient Saf. 2018;14(4):234-240. doi:10.1097/PTS.0000000000000197.
https://psnet.ahrq.gov/issue/provider…
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psnet.ahrq.gov/node/48133/psn-pdf
November 01, 2024 - The NHS Patient Safety Strategy.
November 1, 2024
NHS England
https://psnet.ahrq.gov/issue/nhs-patient-safety-strategy
The United Kingdom National Health Service (NHS) has been at the forefront of patient safety innovation.
This strategy seeks to further implement approaches that explore and optimize the intersect…
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psnet.ahrq.gov/node/38564/psn-pdf
April 15, 2009 - The effects of aviation-style non-technical skills training
on technical performance and outcome in the operating
theatre.
April 15, 2009
McCulloch P, Mishra A, Handa A, et al. The effects of aviation-style non-technical skills training on
technical performance and outcome in the operating theatre. Qual Saf Healt…
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psnet.ahrq.gov/node/45826/psn-pdf
January 18, 2017 - Ensuring staff safety when treating potentially violent
patients.
January 18, 2017
Roca RP, Charen B, Boronow J. Ensuring Staff Safety When Treating Potentially Violent Patients. JAMA.
2016;316(24):2669-2670. doi:10.1001/jama.2016.18260.
https://psnet.ahrq.gov/issue/ensuring-staff-safety-when-treating-potentially-…
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psnet.ahrq.gov/node/47165/psn-pdf
June 13, 2018 - Changing how we think about healthcare improvement.
June 13, 2018
Braithwaite J. Changing how we think about healthcare improvement. BMJ. 2018;361:k2014.
doi:10.1136/bmj.k2014.
https://psnet.ahrq.gov/issue/changing-how-we-think-about-healthcare-improvement
In learning organizations, leadership behavior creates a s…
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psnet.ahrq.gov/node/866594/psn-pdf
August 28, 2024 - 11 medicine mistakes to avoid.
August 28, 2024
Crouch M. 11 medicine mistakes to avoid. AARP. August 06, 2024;
https://psnet.ahrq.gov/issue/11-medicine-mistakes-avoid
Medication self-management can become increasingly complicated as patients age and take more
medications. This article highlights key behaviors that…
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psnet.ahrq.gov/node/46248/psn-pdf
October 23, 2018 - Medical errors, malpractice, and defensive medicine: an
ill-fated triad.
October 23, 2018
Berlin L. Medical errors, malpractice, and defensive medicine: an ill-fated triad. Diagnosis (Berl).
2017;4(3):133-139. doi:10.1515/dx-2017-0007.
https://psnet.ahrq.gov/issue/medical-errors-malpractice-and-defensive-medicine-…