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Psn-Pdf (pdf file)
psnet.ahrq.gov/node/73340/psn-pdfJune 02, 2021 - Can patients contribute to enhancing the safety and effectiveness of test-result follow-up? Qualitative outcomes from a health consumer workshop. June 2, 2021 Thomas J, Dahm MR, Li J, et al. Can patients contribute to enhancing the safety and effectiveness of test? result follow?up? Qualitative outcomes from a hea… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/73633/psn-pdfAugust 25, 2021 - Learning from patient safety incidents involving acutely sick adults in hospital assessment units in England and Wales: a mixed methods analysis for quality improvement. August 25, 2021 Urquhart A, Yardley S, Thomas E, et al. Learning from patient safety incidents involving acutely sick adults in hospital assessm… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/47838/psn-pdfJune 02, 2019 - Exploring leadership within a systems approach to reduce health care–associated infections: a scoping review of one work system model. June 2, 2019 Knobloch MJ, Thomas K, Musuuza J, et al. Exploring leadership within a systems approach to reduce health care-associated infections: A scoping review of one work syste… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/60713/psn-pdfJuly 22, 2020 - Assessment of health information technology-related outpatient diagnostic delays in the US Veterans Affairs health care system: a qualitative study of aggregated root cause analysis data. July 22, 2020 Powell L, Sittig DF, Chrouser K, et al. Assessment of health information technology-related outpatient diagnosti… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/60645/psn-pdfJuly 01, 2020 - How health care systems let our patients down: a systematic review into suicide deaths. July 1, 2020 Wyder M, Ray MK, Roennfeldt H, et al. How health care systems let our patients down: a systematic review into suicide deaths. Int J Qual Health Care. 2020;32(5):285-291. doi:10.1093/intqhc/mzaa011. https://psnet.ah… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/867017/psn-pdfOctober 23, 2024 - Clinicians' use of health information exchange technologies for medication reconciliation in the U.S. Department of Veterans Affairs: a qualitative analysis. October 23, 2024 Snyder ME, Nguyen KA, Patel H, et al. Clinicians' use of health information exchange technologies for medication reconciliation in the U.S. … -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/47059/psn-pdfMay 16, 2018 - Participating in a multisite study exploring operational failures encountered by frontline nurses: lessons learned. May 16, 2018 Melnyk H, Rosenfeld P, Glassman KS. Participating in a Multisite Study Exploring Operational Failures Encountered by Frontline Nurses: Lessons Learned. J Nurs Adm. 2018;48(4):203-208. do… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/74832/psn-pdfFebruary 16, 2022 - Preventable adverse events in obstetrics: systemic assessment of their incidence and linked risk factors. February 16, 2022 Hüner B, Derksen C, Schmiedhofer M, et al. Preventable adverse events in obstetrics: systemic assessment of their incidence and linked risk factors. Healthcare (Basel). 2022;10(1):97. doi:10.… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/48014/psn-pdfJuly 10, 2019 - Patient safety morning report: innovation in teaching core patient safety principles to third-year medical students. July 10, 2019 Beekman M, Emani VK, Wolford R, et al. Patient Safety Morning Report: Innovation in Teaching Core Patient Safety Principles to Third-Year Medical Students. J Med Educ Curric Dev. 2019;… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/34043/psn-pdfMarch 11, 2011 - Some unintended consequences of information technology in health care: the nature of patient care information system-related errors. March 11, 2011 Ash JS, Berg M, Coiera E. Some unintended consequences of information technology in health care: the nature of patient care information system-related errors. J Am Med… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/41703/psn-pdfNovember 08, 2012 - Anatomy of an incident disclosure: the importance of dialogue. November 8, 2012 Iedema R, Allen S. Anatomy of an incident disclosure: the importance of dialogue. Jt Comm J Qual Patient Saf. 2012;38(10):435-42. https://psnet.ahrq.gov/issue/anatomy-incident-disclosure-importance-dialogue Physician organizations who… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/866403/psn-pdfJuly 31, 2024 - Patient outcomes compared between admissions coordinated by the transfer center and emergency department at a U.S. tertiary care hospital. July 31, 2024 Pagali SR, Ryu AJ, Fischer KM, et al. Patient outcomes compared between admissions coordinated by the transfer center and emergency department at a U.S. tertiary … -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/47141/psn-pdfAugust 17, 2018 - Association of postoperative readmissions with surgical quality using a Delphi consensus process to identify relevant diagnosis codes. August 17, 2018 Mull HJ, Graham LA, Morris MS, et al. Association of Postoperative Readmissions With Surgical Quality Using a Delphi Consensus Process to Identify Relevant Diagnosi… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/846440/psn-pdfMarch 22, 2023 - "Are we there yet?" Ten persistent hazards and inefficiencies with the use of medication administration technology from the perspective of practicing nurses. March 22, 2023 Taft T, Rudd EA, Thraen I, et al. “Are we there yet?” Ten persistent hazards and inefficiencies with the use of medication administration tech… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/35434/psn-pdfJune 14, 2011 - Turning the medical gaze in upon itself: root cause analysis and the investigation of clinical error. June 14, 2011 Iedema RAM, Jorm C, Long D, et al. Turning the medical gaze in upon itself: root cause analysis and the investigation of clinical error. Soc Sci Med. 2006;62(7):1605-15. https://psnet.ahrq.gov/issue/… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/838126/psn-pdfSeptember 21, 2022 - Sustained improvement in quality of patient handoffs after orthopaedic surgery I-PASS intervention. September 21, 2022 Stenquist DS, Yeung CM, Szapary HJ, et al. Sustained improvement in quality of patient handoffs after orthopaedic surgery I-PASS intervention. J Am Acad Orthop Surg Glob Res Rev. 2022;6(9):e22.0007… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/72792/psn-pdfMarch 03, 2021 - Avoiding a Med-Wreck: a structured medication reconciliation framework and standardized auditing tool utilized to optimize patient safety and reallocate hospital resources. March 3, 2021 Elbeddini A, Almasalkhi S, Prabaharan T, et al. Avoiding a Med-Wreck: a structured medication reconciliation framework and stan… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/46848/psn-pdfOctober 13, 2018 - Identifying what is known about improving operating room to intensive care handovers: a scoping review. October 13, 2018 Zjadewicz K, Deemer KS, Coulthard J, et al. Identifying What Is Known About Improving Operating Room to Intensive Care Handovers: A Scoping Review. Am J Med Qual. 2018;33(5):540-548. doi:10.1177… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/60326/psn-pdfMay 13, 2020 - Preventing diagnostic errors in ambulatory care: an electronic notification tool for incomplete radiology tests. May 13, 2020 Weingart SN, Yaghi O, Barnhart L, et al. Preventing diagnostic errors in ambulatory care: an electronic notification tool for incomplete radiology tests. Appl Clin Inform. 2020;11(02). doi:1… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/61021/psn-pdfOctober 14, 2020 - Deficiencies in provider-reported interpreter use in a clinical trial comparing telephonic and video interpretation in a pediatric emergency department. October 14, 2020 Gutman CK, Klein EJ, Follmer K, et al. Deficiencies in provider-reported interpreter use in a clinical trial comparing telephonic and video inter…
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