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psnet.ahrq.gov/issue/intraoperative-handoffs-among-anesthesia-providers-increase-incidence-documentation-errors
April 12, 2019 - Study
Intraoperative handoffs among anesthesia providers increase the incidence of documentation errors for controlled drugs.
Citation Text:
Epstein RH, Dexter F, Gratch DM, et al. Intraoperative Handoffs Among Anesthesia Providers Increase the Incidence of Documentation Errors for Contr…
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psnet.ahrq.gov/issue/impact-miscommunication-medical-dispute-cases-japan
September 25, 2019 - Study
Impact of miscommunication in medical dispute cases in Japan.
Citation Text:
Aoki N, Uda K, Ohta S, et al. Impact of miscommunication in medical dispute cases in Japan. Int J Qual Health Care. 2008;20(5):358-62. doi:10.1093/intqhc/mzn028.
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psnet.ahrq.gov/issue/clinically-missed-cancer-how-effectively-can-radiologists-use-computer-aided-detection
October 04, 2023 - Study
Clinically missed cancer: how effectively can radiologists use computer-aided detection?
Citation Text:
Nishikawa RM, Schmidt RA, Linver MN, et al. Clinically Missed Cancer: How Effectively Can Radiologists Use Computer-Aided Detection? American Journal of Roentgenology. 2012;198(3…
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psnet.ahrq.gov/issue/relationship-between-electronic-health-records-and-malpractice-claims
August 05, 2009 - Study
The relationship between electronic health records and malpractice claims.
Citation Text:
Quinn MA, Kats AM, Kleinman K, et al. The relationship between electronic health records and malpractice claims. Arch Intern Med. 2012;172(15):1187-9. doi:10.1001/archinternmed.2012.2371.
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psnet.ahrq.gov/issue/how-do-physicians-conduct-medication-reviews
September 02, 2010 - Study
How do physicians conduct medication reviews?
Citation Text:
Tarn DM, Paterniti DA, Kravitz RL, et al. How do physicians conduct medication reviews? J Gen Intern Med. 2009;24(12):1296-302. doi:10.1007/s11606-009-1132-4.
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psnet.ahrq.gov/issue/designing-highly-reliable-adverse-event-detection-systems-predict-subsequent-claims
September 01, 2018 - Study
Designing highly reliable adverse-event detection systems to predict subsequent claims.
Citation Text:
Helmchen LA, Burke ME, Wojtusiak J. Designing highly reliable adverse-event detection systems to predict subsequent claims. J Healthc Risk Manag. 2015;34(4):7-17. doi:10.1002/jhrm…
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psnet.ahrq.gov/issue/morphine-sulfate-oral-solution-100-mg-5-ml-20-mgml-medication-use-error-reports-accidental
June 22, 2011 - Press Release/Announcement
Morphine sulfate oral solution 100 mg per 5 mL (20 mg/mL): medication use error—reports of accidental overdose.
Citation Text:
Morphine sulfate oral solution 100 mg per 5 mL (20 mg/mL): medication use error—reports of accidental overdose. MedWatch Safety Al…
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psnet.ahrq.gov/issue/safety-and-efficiency-considerations-introduction-electronic-ordering-blood-bank
March 25, 2015 - Study
Safety and efficiency considerations for the introduction of electronic ordering in a blood bank.
Citation Text:
Georgiou A, Greenfield T, Callen J, et al. Safety and efficiency considerations for the introduction of electronic ordering in a blood bank. Arch Pathol Lab Med. 2009;1…
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psnet.ahrq.gov/issue/electronic-prescribing-improving-efficiency-and-accuracy-prescribing-ambulatory-care-setting
March 16, 2022 - Review
Electronic prescribing: improving the efficiency and accuracy of prescribing in the ambulatory care setting.
Citation Text:
Porterfield A, Engelbert K, Coustasse A. Electronic prescribing: improving the efficiency and accuracy of prescribing in the ambulatory care setting. Perspec…
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psnet.ahrq.gov/issue/little-shop-errors-innovative-simulation-patient-safety-workshop-community-health-care
October 14, 2009 - Commentary
Little shop of errors: an innovative simulation patient safety workshop for community health care professionals.
Citation Text:
Tupper JB, Pearson KB, Meinersmann KM, et al. Little shop of errors: an innovative simulation patient safety workshop for community health care pro…
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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/preventing-central-line-associated-bloodstream-infections-intensive-care-unit-application
March 10, 2010 - Commentary
Preventing central line–associated bloodstream infections in the intensive care unit: application of high-reliability principles.
Citation Text:
McCraw B, Crutcher T, Polancich S, et al. Preventing Central Line-Associated Bloodstream Infections in the Intensive Care Unit: Appl…
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psnet.ahrq.gov/issue/causes-near-misses-critical-care-neonates-and-children
July 19, 2023 - Study
Causes of near misses in critical care of neonates and children.
Citation Text:
Tourgeman-Bashkin O, Shinar D, Zmora E. Causes of near misses in critical care of neonates and children. Acta Paediatr. 2008;97(3):299-303. doi:10.1111/j.1651-2227.2007.00616.x.
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psnet.ahrq.gov/issue/complexity-diversity-and-science-primary-care-teams
November 18, 2016 - Review
Emerging Classic
The complexity, diversity, and science of primary care teams.
Citation Text:
Fiscella K, McDaniel SH. The complexity, diversity, and science of primary care teams. Amer Psychol. 2018;73(4):451-467. doi:10.1037/amp0000244.
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psnet.ahrq.gov/issue/patient-care-square-rigger-sailing-and-safety
November 16, 2022 - Commentary
Patient care, square-rigger sailing, and safety.
Citation Text:
Henkind SJ, Sinnett C. Patient care, square-rigger sailing, and safety. JAMA. 2008;300(14):1691-3. doi:10.1001/jama.300.14.1691.
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psnet.ahrq.gov/issue/conceptual-framework-reduce-inpatient-preventable-deaths
April 24, 2018 - Study
A conceptual framework to reduce inpatient preventable deaths.
Citation Text:
Davis DP, Aguilar SA, Lawrence B, et al. A Conceptual Framework to Reduce Inpatient Preventable Deaths. Jt Comm J Qual Patient Saf. 2018;44(7):413-420. doi:10.1016/j.jcjq.2018.01.003.
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psnet.ahrq.gov/issue/its-difference-between-life-and-death-views-professional-medical-interpreters-their-role
August 10, 2010 - Study
"It's the difference between life and death": the views of professional medical interpreters on their role in the delivery of safe care to patients with limited English proficiency.
Citation Text:
Wu MS, Rawal S. "It's the difference between life and death": The views of profession…
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psnet.ahrq.gov/issue/impact-obstetrical-hospitalist-program-safety-events-mid-sized-obstetrical-unit
April 03, 2019 - Study
Impact of an obstetrical hospitalist program on the safety events in a mid-sized obstetrical unit.
Citation Text:
Decesare JZ, Bush SY, Morton AN. Impact of an obstetrical hospitalist program on the safety events in a mid-sized obstetrical unit. J Patient Saf. 2020;16(3):e179-e181.…
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psnet.ahrq.gov/issue/successful-remediation-patient-safety-incidents-tale-two-medication-errors
January 26, 2022 - Commentary
Successful remediation of patient safety incidents: a tale of two medication errors.
Citation Text:
Helmchen LA, Richards MR, McDonald TB. Successful remediation of patient safety incidents: a tale of two medication errors. Health Care Manage Rev. 2011;36(2):114-123. doi:10.10…
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psnet.ahrq.gov/issue/consensus-bundle-prevention-surgical-site-infections-after-major-gynecologic-surgery
January 15, 2014 - Commentary
Consensus bundle on prevention of surgical site infections after major gynecologic surgery.
Citation Text:
Pellegrini JE, Toledo P, Soper DE, et al. Consensus Bundle on Prevention of Surgical Site Infections After Major Gynecologic Surgery. Obstet Gynecol. 2017;129(1):50-61. d…