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  1. psnet.ahrq.gov/issue/tangible-handoff-team-approach-advancing-structured-communication-labor-and-delivery
    June 12, 2013 - Commentary The tangible handoff: a team approach for advancing structured communication in labor and delivery. Citation Text: Block M, Ehrenworth JF, Cuce VM, et al. The tangible handoff: a team approach for advancing structured communication in labor and delivery. Jt Comm J Qual Patient…
  2. psnet.ahrq.gov/issue/strategies-improving-communication-emergency-department-mediums-and-messages-noisy
    November 17, 2010 - Commentary Strategies for improving communication in the emergency department: mediums and messages in a noisy environment. Citation Text: Welch SJ, Cheung DS, Apker J, et al. Strategies for improving communication in the emergency department: mediums and messages in a noisy environ…
  3. psnet.ahrq.gov/issue/leading-clinical-handover-improvement-change-strategy-implement-best-practices-acute-care
    May 18, 2022 - Commentary Leading clinical handover improvement: a change strategy to implement best practices in the acute care setting. Citation Text: Clarke CM, Persaud DD. Leading Clinical Handover Improvement. J Patient Saf. 2011;7(1):11-18. doi:10.1097/pts.0b013e31820c98a8. Copy Citation …
  4. psnet.ahrq.gov/issue/cognitive-processes-involved-blame-and-blame-judgments-and-forgiveness-and-forgiveness
    August 23, 2017 - Study Cognitive processes involved in blame and blame-like judgments and in forgiveness and forgiveness-like judgments. Citation Text: Mullet E, Rivière S, Sastre MTM. Cognitive processes involved in blame and blame-like judgments and in forgiveness and forgiveness-like judgments. Am J…
  5. psnet.ahrq.gov/issue/using-ora-explore-relationship-nursing-unit-communication-patient-safety-and-quality-outcomes
    December 11, 2008 - Study Using ORA to explore the relationship of nursing unit communication to patient safety and quality outcomes. Citation Text: Effken JA, Carley KM, Gephart SM, et al. Using ORA to explore the relationship of nursing unit communication to patient safety and quality outcomes. Int J Me…
  6. psnet.ahrq.gov/issue/disclosing-medical-errors-prioritising-needs-patients-and-families
    November 11, 2020 - Commentary Disclosing medical errors: prioritising the needs of patients and families. Citation Text: Gallagher TH, Hemmelgarn C, Benjamin EM. Disclosing medical errors: prioritising the needs of patients and families. BMJ Qual Saf. 2023;32(10):557-561. doi:10.1136/bmjqs-2022-015880. C…
  7. psnet.ahrq.gov/web-mm/misplaced-nasogastric-tube-resulting-aspiration
    August 01, 2009 - Misplaced Nasogastric Tube Resulting in Aspiration Citation Text: Singh A, Huang C. Misplaced Nasogastric Tube Resulting in Aspiration. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2024. Copy Citation Format: Google S…
  8. psnet.ahrq.gov/issue/enhancing-teamwork-communication-and-patient-safety-responsiveness-paediatric-intensive-care
    March 10, 2021 - Study Enhancing teamwork communication and patient safety responsiveness in a paediatric intensive care unit using the daily safety huddle tool. Citation Text: Aldawood F, Kazzaz Y, AlShehri A, et al. Enhancing teamwork communication and patient safety responsiveness in a paediatric inte…
  9. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/46832/psn-pdf
    February 07, 2018 - FDA Drug Safety Communication: FDA requires labeling changes for prescription opioid cough and cold medicines to limit their use to adults 18 years and older. February 7, 2018 MedWatch Safety Alert. Silver Spring, MD: US Food and Drug Administration; January 11, 2018. https://psnet.ahrq.gov/issue/fda-drug-safety-c…
  10. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/42682/psn-pdf
    January 01, 2015 - Review article: improving the hospital clinical handover between paramedics and emergency department staff in the deteriorating patient. November 13, 2013 Dawson S, King L, Grantham H. Review article: Improving the hospital clinical handover between paramedics and emergency department staff in the deteriorating pa…
  11. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/46981/psn-pdf
    May 04, 2019 - Lessons learned from implementing a principled approach to resolution following patient harm. May 4, 2019 Smith KM, Smith LL, (Jack) Gentry JC, et al. Lessons learned from implementing a principled approach to resolution following patient harm. J Patient Saf Risk Manag. 2018;24(2):83-89. doi:10.1177/25160435188138…
  12. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/41725/psn-pdf
    January 01, 2013 - Improving patient handovers from hospital to primary care: a systematic review. October 3, 2012 Hesselink G, Schoonhoven L, Barach P, et al. Improving patient handovers from hospital to primary care: a systematic review. Ann Intern Med. 2013;157(6):417. doi:10.7326/0003-4819-157-6-201209180-00006. https://psnet.ah…
  13. psnet.ahrq.gov/web-mm/engaging-seriously-ill-older-patients-advance-care-planning
    December 22, 2018 - SPOTLIGHT CASE Engaging Seriously Ill Older Patients in Advance Care Planning Citation Text: Heyland DK. Engaging Seriously Ill Older Patients in Advance Care Planning. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2017. …
  14. psnet.ahrq.gov/web-mm/critical-echocardiogram-result-lost-follow
    July 31, 2023 - Critical Echocardiogram Result Lost to Follow-up Citation Text: Boctor N, Molla M. Critical Echocardiogram Result Lost to Follow-up.. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2023. Copy Citation Format: Google Sch…
  15. psnet.ahrq.gov/issue/using-communication-and-teamwork-skills-cats-assessment-measure-health-care-team-performance
    July 05, 2013 - Commentary Using the Communication and Teamwork Skills (CATS) assessment to measure health care team performance. Citation Text: Frankel A, Gardner R, Maynard L, et al. Using the Communication and Teamwork Skills (CATS) Assessment to measure health care team performance. Jt Comm J Qual P…
  16. psnet.ahrq.gov/issue/effects-physical-environments-medical-wards-medication-communication-processes-affecting
    November 17, 2021 - Study The effects of physical environments in medical wards on medication communication processes affecting patient safety. Citation Text: Liu W, Manias E, Gerdtz M. The effects of physical environments in medical wards on medication communication processes affecting patient safety. Heal…
  17. psnet.ahrq.gov/issue/misuse-pediatric-medications-and-parent-physician-communication-interactive-voice-response
    May 27, 2011 - Study Misuse of pediatric medications and parent–physician communication: an interactive voice response intervention. Citation Text: Walsh KE, Bacic J, Phillips BD, et al. Misuse of Pediatric Medications and Parent-Physician Communication: An Interactive Voice Response Intervention. J Pa…
  18. psnet.ahrq.gov/issue/lost-translation-challenges-and-opportunities-physician-physician-communication-during
    April 12, 2011 - Study Lost in translation: challenges and opportunities in physician-to-physician communication during patient handoffs. Citation Text: Solet DJ, Norvell M, Rutan GH, et al. Lost in translation: challenges and opportunities in physician-to-physician communication during patient handoff…
  19. psnet.ahrq.gov/issue/transforming-communication-and-safety-culture-intrapartum-care-multi-organization-blueprint
    May 21, 2019 - Commentary Transforming communication and safety culture in intrapartum care: a multi-organization blueprint. Citation Text: Lyndon A, Johnson C, Bingham D, et al. Transforming communication and safety culture in intrapartum care: a multi-organization blueprint. Obstet Gynecol. 2015;125(…
  20. psnet.ahrq.gov/issue/cardinal-health-recalls-argyle-uvc-insertion-tray-due-missing-instructions-use-safety-scalpel
    August 20, 2021 - Press Release/Announcement Cardinal Health recalls Argyle UVC insertion tray due to missing instructions for use for the Safety Scalpel N11. Citation Text: Cardinal Health recalls Argyle UVC insertion tray due to missing instructions for use for the Safety Scalpel N11. MedWatch Safety Al…

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