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psnet.ahrq.gov/issue/changes-prognosis-after-first-postoperative-complication
June 29, 2022 - Study
Changes in prognosis after the first postoperative complication.
Citation Text:
Silber JH, Rosenbaum PR, Trudeau ME, et al. Changes in prognosis after the first postoperative complication. Med Care. 2005;43(2):122-31.
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psnet.ahrq.gov/issue/pediatric-radiology-malpractice-claims-characteristics-and-comparison-adult-radiology-claims
December 01, 2021 - Study
Pediatric radiology malpractice claims—characteristics and comparison to adult radiology claims.
Citation Text:
Breen MA, Dwyer K, Yu-Moe W, et al. Pediatric radiology malpractice claims - characteristics and comparison to adult radiology claims. Pediatr Radiol. 2017;47(7):808-816.…
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psnet.ahrq.gov/issue/tolerance-uncertainty-and-fears-making-mistakes-among-fifth-year-medical-students
December 09, 2020 - Study
Tolerance of uncertainty and fears of making mistakes among fifth-year medical students.
Citation Text:
Nevalainen M, Kuikka L, Sjoberg L, et al. Tolerance of uncertainty and fears of making mistakes among fifth-year medical students. Fam Med. 2012;44(4):240-6.
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psnet.ahrq.gov/issue/high-cost-low-frequency-events-anatomy-and-economics-surgical-mishaps
October 19, 2022 - Study
Classic
The high cost of low-frequency events: the anatomy and economics of surgical mishaps.
Citation Text:
Couch NP, Tilney NL, Rayner AA, et al. The high cost of low-frequency events: the anatomy and economics of surgical mishaps. N Engl J Med. 1981;3…
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psnet.ahrq.gov/issue/adverse-event-screening-tool-based-routinely-collected-hospital-acquired-diagnoses
July 23, 2008 - Study
An adverse event screening tool based on routinely collected hospital-acquired diagnoses.
Citation Text:
Brand CA, Tropea J, Gorelik A, et al. An adverse event screening tool based on routinely collected hospital-acquired diagnoses. Int J Qual Health Care. 2012;24(3):266-78. doi:10…
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psnet.ahrq.gov/issue/introducing-safety-score-audit-staff-member-and-patient-safety
April 16, 2014 - Commentary
Introducing the safety score audit for staff member and patient safety.
Citation Text:
Sinnott M, Eley R, Winch S. Introducing the safety score audit for staff member and patient safety. AORN J. 2014;100(1):91-5. doi:10.1016/j.aorn.2014.05.006.
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psnet.ahrq.gov/issue/relationship-between-safety-climate-and-safety-performance-review
February 03, 2021 - Review
The relationship between safety climate and safety performance: a review.
Citation Text:
Syed-Yahya SNN, Idris MA, Noblet AJ. The relationship between safety climate and safety performance: a review. J Safety Res. 2022;83:105-118. doi:10.1016/j.jsr.2022.08.008.
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psnet.ahrq.gov/issue/persistence-unsafe-practice-everyday-work-exploration-organizational-and-psychological
April 06, 2011 - Study
Persistence of unsafe practice in everyday work: an exploration of organizational and psychological factors constraining safety in the operating room.
Citation Text:
Espin S, Lingard L, Baker GR, et al. Persistence of unsafe practice in everyday work: an exploration of organizati…
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psnet.ahrq.gov/issue/analysis-and-prioritization-near-miss-adverse-events-radiology-department
June 15, 2016 - Study
Analysis and prioritization of near-miss adverse events in a radiology department.
Citation Text:
Thornton RH, Miransky J, Killen A, et al. Analysis and prioritization of near-miss adverse events in a radiology department. AJR Am J Roentgenol. 2011;196(5):1120-4. doi:10.2214/AJR.10…
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psnet.ahrq.gov/issue/improving-inpatient-mental-health-medication-safety-through-process-obtaining-himss-stage-7
July 17, 2019 - Commentary
Improving inpatient mental health medication safety through the process of obtaining HIMSS Stage 7: a case report.
Citation Text:
Improving inpatient mental health medication safety through the process of obtaining HIMSS Stage 7: a case report. Sulkers H, Tajirian T, Paterson …
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/education/curriculum-tools/cusptoolkit/toolkit/Culture-Check-UpTool.docx
June 02, 2025 - Culture Check-Up Tool
Problem statement: Improving safety culture in a patient care area takes time.
What is culture? Attitudes reflect the norms, values, and beliefs in the unit and, in turn, create the culture. No matter what instrument you use to assess patient safety culture, your results provide a snapshot of th…
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www.ahrq.gov/hai/cusp/toolkit/culture-checkup.html
December 01, 2012 - Culture Check-Up Tool
CUSP Toolkit
Health care provider roles
Problem statement: Improving safety culture in a patient care area takes time.
What is culture? Attitudes reflect the norms, values, and beliefs in the unit and, in turn, create the culture. No matter what instrument you use to assess patient…
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psnet.ahrq.gov/issue/team-communication-during-patient-handover-operating-room-more-facts-and-figures
December 16, 2009 - Study
Team communication during patient handover from the operating room: more than facts and figures.
Citation Text:
Manser T, Foster S, Flin R, et al. Team communication during patient handover from the operating room: more than facts and figures. Hum Factors. 2013;55(1):138-56.
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psnet.ahrq.gov/issue/beyond-medical-record-other-modes-error-acknowledgment
August 03, 2009 - Study
Beyond the medical record: other modes of error acknowledgment.
Citation Text:
Rosenthal M, Cornett PL, Sutcliffe K, et al. Beyond the medical record: other modes of error acknowledgment. J Gen Intern Med. 2005;20(5):404-9.
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psnet.ahrq.gov/issue/detection-classification-and-correction-defective-chemotherapy-orders-through-nursing-and
May 27, 2011 - Study
Detection, classification, and correction of defective chemotherapy orders through nursing and pharmacy oversight.
Citation Text:
Mertens WC, Brown DE, Parisi R, et al. Detection, Classification, and Correction of Defective Chemotherapy Orders Through Nursing and Pharmacy Oversig…
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psnet.ahrq.gov/issue/scoping-review-hidden-curriculum-pharmacy-education
November 16, 2022 - Review
A scoping review of the hidden curriculum in pharmacy education.
Citation Text:
Park SK, Chen AMH, Daugherty KK, et al. A scoping review of the hidden curriculum in pharmacy education. Am J Pharm Educ. 2023;87(3):ajpe8999. doi:10.5688/ajpe8999.
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psnet.ahrq.gov/issue/frequency-prescribing-errors-medical-residents-various-training-programs
November 05, 2014 - Study
Frequency of prescribing errors by medical residents in various training programs.
Citation Text:
Honey BL, Bray WM, Gomez MR, et al. Frequency of prescribing errors by medical residents in various training programs. J Patient Saf. 2015;11(2):100-4. doi:10.1097/PTS.0000000000000048…
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psnet.ahrq.gov/issue/importance-leadership-preventing-healthcare-associated-infection-results-multisite
April 13, 2011 - Study
The importance of leadership in preventing healthcare–associated infection: results of a multisite qualitative study.
Citation Text:
Saint S, Kowalski CP, Banaszak-Holl J, et al. The importance of leadership in preventing healthcare-associated infection: results of a multisite qu…
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psnet.ahrq.gov/issue/review-verbal-order-policies-acute-care-hospitals
January 03, 2017 - Study
A review of verbal order policies in acute care hospitals.
Citation Text:
Wakefield DS, Wakefield BJ, Despins L, et al. A review of verbal order policies in acute care hospitals. Jt Comm J Qual Patient Saf. 2012;38(1):24-33.
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psnet.ahrq.gov/issue/s-teams-truly-multiprofessional-course-focusing-nontechnical-skills-improve-patient-safety
November 30, 2022 - Commentary
S-TEAMS: a truly multiprofessional course focusing on nontechnical skills to improve patient safety in the operating theater.
Citation Text:
Stewart-Parker E, Galloway R, Vig S. S-TEAMS: A Truly Multiprofessional Course Focusing on Nontechnical Skills to Improve Patient Safety…