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5081. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/39281/psn-pdf
      March 05, 2010 - Health Care Leader Action Guide to Reduce Avoidable Readmissions. March 5, 2010 Osei-Anto A, Joshi M, Audet AJ, Berman A, Jencks SF. New York, NY: The Commonwealth Fund, The John Hartford Foundation, Health Research and Educational Trust; January 25, 2010. https://psnet.ahrq.gov/issue/health-care-leader-action-gui…

5082. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/72558/psn-pdf
      December 09, 2020 - Escape Room. December 9, 2020 Harrisburg, PA: Pennsylvania Safety Authority; 2020. https://psnet.ahrq.gov/issue/escape-room Time pressure can negatively impact critical thinking, information gathering, and communication abilities. This tool builds teamwork and decision-making skills by testing participants as they…

5083. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/35230/psn-pdf
      January 02, 2017 - A morning briefing: setting the stage for a clinically and operationally good day. January 2, 2017 Thompson DA, Holzmueller CG, Hunt D, et al. A morning briefing: setting the stage for a clinically and operationally good day. Jt Comm J Qual Patient Saf. 2005;31(8):476-9. https://psnet.ahrq.gov/issue/morning-briefi…

5084. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/36112/psn-pdf
      September 28, 2010 - A common body of care: the ethics and politics of teamwork in the operating theater are inseparable. September 28, 2010 Bleakley A. A common body of care: the ethics and politics of teamwork in the operating theater are inseparable. J Med Philos. 2006;31(3):305-22. https://psnet.ahrq.gov/issue/common-body-care-eth…

5085. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/43674/psn-pdf
      November 12, 2014 - Living with cancer: not talking about medical mistakes. November 12, 2014 Gubar S. https://psnet.ahrq.gov/issue/living-cancer-not-talking-about-medical-mistakes This newspaper article describes how surgical complications, health care–associated infections, and ineffective patient–provider communication contributed…

5086. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/33982/psn-pdf
      December 22, 2008 - Patient safety: it's not just carefulness, it's a culture. December 22, 2008 Powell S. Patient Safety: it's not just carefulness, it's a culture. Lippincotts Case Manag. 2004;9(5):211- 212. doi:10.1097/00129234-200409000-00001. https://psnet.ahrq.gov/issue/patient-safety-its-not-just-carefulness-its-culture This e…

5087. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/37786/psn-pdf
      March 23, 2011 - A theoretical framework and competency-based approach to improving handoffs. March 23, 2011 Arora VM, Johnson JK, Meltzer DO, et al. A theoretical framework and competency-based approach to improving handoffs. Qual Saf Health Care. 2008;17(1):11-4. doi:10.1136/qshc.2006.018952. https://psnet.ahrq.gov/issue/theoret…

5088. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/38073/psn-pdf
      June 09, 2011 - Are you listening...Are you really listening? June 9, 2011 Denham CR, Dingman J, Foley M, et al. Are You Listening…Are You Really Listening? J Patient Saf. 2008;4(3):148-161. doi:10.1097/pts.0b013e318184db52. https://psnet.ahrq.gov/issue/are-you-listeningare-you-really-listening This article discusses verbal commu…

5089. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/33969/psn-pdf
      April 03, 2009 - Silence Kills: The Seven Crucial Conversations for Healthcare. April 3, 2009 Maxfield D, Grenny J, McMillan R, Patterson K, Switzler A. Provo, UT: VitalSmarts, L.C; 2005.  https://psnet.ahrq.gov/issue/silence-kills-seven-crucial-conversations-healthcare The American Association of Critical-Care Nurses (AACN) …

5090. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/35442/psn-pdf
      September 18, 2009 - Management of adverse surgical events: a structured education module for residents. September 18, 2009 Brewster LP, Risucci DA, Joehl RJ, et al. Management of adverse surgical events: a structured education module for residents. Am J Surg. 2005;190(5):687-90. https://psnet.ahrq.gov/issue/management-adverse-surgica…

5091. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/41460/psn-pdf
      June 13, 2012 - Help your patient "get" what you just said: a health literacy guide. June 13, 2012 Roett MA, Wessel L. Help your patient "get" what you just said: a health literacy guide. J Family Pract. 2012;61(4):190-196. https://psnet.ahrq.gov/issue/help-your-patient-get-what-you-just-said-health-literacy-guide This commentar…

5092. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/39719/psn-pdf
      July 28, 2010 - Bedside shift report improves patient safety and nurse accountability. July 28, 2010 Baker SJ. Bedside shift report improves patient safety and nurse accountability. Journal of emergency nursing: JEN : official publication of the Emergency Department Nurses Association. 2010;36(4):355-8. doi:10.1016/j.jen.2010.03.…

5093. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/34011/psn-pdf
      April 03, 2009 - AACN Standards for Establishing and Sustaining Healthy Work Environments: A Journey to Excellence. April 3, 2009 https://psnet.ahrq.gov/issue/aacn-standards-establishing-and-sustaining-healthy-work-environments- journey-excellence In the face of evidence that outlines the impact work environments play on providing…

5094. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/38966/psn-pdf
      September 23, 2009 - Information loss in emergency medical services handover of trauma patients. September 23, 2009 Carter AJE, Davis KA, Evans L, et al. Information loss in emergency medical services handover of trauma patients. Prehosp Emerg Care. 2009;13(3):280-5. doi:10.1080/10903120802706260. https://psnet.ahrq.gov/issue/informat…

5095. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/38615/psn-pdf
      May 06, 2009 - Developing a team performance framework for the intensive care unit. May 6, 2009 Reader TW, Flin R, Mearns K, et al. Developing a team performance framework for the intensive care unit. Crit Care Med. 2009;37(5):1787-1793. doi:10.1097/CCM.0b013e31819f0451. https://psnet.ahrq.gov/issue/developing-team-performance-f…

5096. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/40860/psn-pdf
      March 02, 2012 - Patient safety issues in advanced practice nursing students' care settings. March 2, 2012 Schnall R, Cook S, John RM, et al. Patient Safety Issues in Advanced Practice Nursing Students? Care Settings. J Nurs Care Qual. 2011;27(2). doi:10.1097/ncq.0b013e3182310d27. https://psnet.ahrq.gov/issue/patient-safety-issues…

5097. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/47678/psn-pdf
      December 19, 2018 - When mistakes happen. December 19, 2018 Beck DL. ASH Clinical News. December 1, 2018. https://psnet.ahrq.gov/issue/when-mistakes-happen This article provides an overview of efforts to understand and improve patient safety and covers topics such as the epidemiology of error, its impact on the individuals involved, …

5098. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/43338/psn-pdf
      July 09, 2014 - In military care, a pattern of errors but not scrutiny. July 9, 2014 LaFraniere S, Lehren AW. New York Times. June 28, 2014. https://psnet.ahrq.gov/issue/military-care-pattern-errors-not-scrutiny Reporting on serious lapses in the care provided by the military health system, this newspaper article highlights how s…

5099. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/47053/psn-pdf
      May 23, 2018 - TeamSTEPPS Canada. May 23, 2018 Canadian Patient Safety Institute. https://psnet.ahrq.gov/issue/teamstepps-canada The TeamSTEPPS program was developed to support effective communication and teamwork skills in various health care settings. This site supports the Canadian TeamSTEPPS initiative. The program will pre…

5100. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/40630/psn-pdf
      September 07, 2016 - Cause for concern: drug shortages disrupt operations, tax hospitalists' treatment patterns. September 7, 2016 Collins TR. The Hospitalist. July 2011. https://psnet.ahrq.gov/issue/cause-concern-drug-shortages-disrupt-operations-tax-hospitalists-treatment- patterns This article discusses how drug shortages in hospi…