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psnet.ahrq.gov/node/41898/psn-pdf
December 05, 2012 - Pharmacy dispensing of electronically discontinued
medications.
December 5, 2012
Allen AS, Sequist TD. Pharmacy dispensing of electronically discontinued medications. Ann Intern Med.
2012;157(10):700-705. doi:10.7326/0003-4819-157-10-201211200-00006.
https://psnet.ahrq.gov/issue/pharmacy-dispensing-electronically-…
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psnet.ahrq.gov/node/851348/psn-pdf
July 12, 2023 - Widespread misinterpretation of advance directives and
Portable Orders for Life-Sustaining Treatments threatens
patient safety and causes undertreatment and
overtreatment.
July 12, 2023
Mirarchi FL, Pope TM. Widespread misinterpretation of advance directives and Portable Orders for Life-
Sustaining Treatments thr…
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psnet.ahrq.gov/node/850161/psn-pdf
June 07, 2023 - Analysis of the nature and contributory factors of
medication safety incidents following hospital discharge
using National Reporting and Learning System (NRLS)
data from England and Wales: a multi-method study.
June 7, 2023
Alqenae FA, Steinke DT, Carson-Stevens A, et al. Analysis of the nature and contributory fa…
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psnet.ahrq.gov/node/844043/psn-pdf
February 08, 2023 - In situ simulation: a strategy to restore patient safety in
intensive care units after the COVID-19 pandemic?
February 8, 2023
Gómez-Pérez V, Escrivá Peiró D, Sancho-Cantus D, et al. In Situ Simulation: A Strategy to Restore Patient
Safety in Intensive Care Units after the COVID-19 Pandemic? Systematic Review. Heal…
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psnet.ahrq.gov/node/41794/psn-pdf
January 31, 2013 - Safety culture and complications after bariatric surgery.
January 31, 2013
Birkmeyer NJO, Finks JF, Greenberg CK, et al. Safety culture and complications after bariatric surgery.
Ann Surg. 2013;257(2):260-5. doi:10.1097/SLA.0b013e31826c0085.
https://psnet.ahrq.gov/issue/safety-culture-and-complications-after-bariat…
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psnet.ahrq.gov/node/37534/psn-pdf
February 13, 2008 - Measurable outcomes of quality improvement in the
trauma intensive care unit: the impact of a daily quality
rounding checklist.
February 13, 2008
DuBose JJ, Inaba K, Shiflett A, et al. Measurable outcomes of quality improvement in the trauma intensive
care unit: the impact of a daily quality rounding checklist. J …
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psnet.ahrq.gov/node/840153/psn-pdf
November 16, 2022 - Team debriefing in the COVID-19 pandemic: a qualitative
study of a hospital-wide clinical event debriefing program
and a novel qualitative model to analyze debriefing
content.
November 16, 2022
Welch-Horan TB, Mullan PC, Momin Z, et al. Team debriefing in the COVID-19 pandemic: a qualitative
study of a hospital-w…
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psnet.ahrq.gov/node/60539/psn-pdf
July 10, 2017 - Understanding facilitators and barriers to care
transitions: insights from Project ACHIEVE Site Visits.
July 10, 2017
Scott AM, Li J, Oyewole-Eletu S, et al. Understanding facilitators and barriers to care transitions: insights
from Project ACHIEVE Site Visits. Jt Comm J Qual Patient Saf. 2017;43(9):433-447.
doi:1…
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psnet.ahrq.gov/node/839817/psn-pdf
January 01, 2023 - Ethical leadership supports safety voice by increasing
risk perception and reducing ethical ambiguity: evidence
from the COVID-19 pandemic.
November 9, 2022
Cakir MS, Wardman JK, Trautrims A. Ethical leadership supports safety voice by increasing risk perception
and reducing ethical ambiguity: evidence from the CO…
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psnet.ahrq.gov/node/43117/psn-pdf
December 12, 2014 - Is your hospital really as safe as you think? Our updated
hospital safety score can help you find out.
December 12, 2014
Consumer Reports. March 27, 2014.
https://psnet.ahrq.gov/issue/your-hospital-really-safe-you-think-our-updated-hospital-safety-score-can-help-
you-find-out
Despite lack of consensus on the valu…
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psnet.ahrq.gov/node/35935/psn-pdf
June 16, 2011 - Operating room teamwork among physicians and nurses:
teamwork in the eye of the beholder.
June 16, 2011
Makary MA, Sexton B, Freischlag JA, et al. Operating room teamwork among physicians and nurses:
teamwork in the eye of the beholder. J Am Coll Surg. 2006;202(5):746-52.
https://psnet.ahrq.gov/issue/operating-roo…
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psnet.ahrq.gov/node/848817/psn-pdf
May 10, 2023 - Impact of patient safety climate on infection prevention
practices and healthcare worker and patient outcomes.
May 10, 2023
Hessels AJ, Guo J, Johnson CT, et al. Impact of patient safety climate on infection prevention practices
and healthcare worker and patient outcomes. Am J Infect Control. 2023;51(5):482-489.
d…
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psnet.ahrq.gov/node/41860/psn-pdf
November 28, 2012 - Stakeholder perspectives on handovers between hospital
staff and general practitioners: an evaluation through the
microsystems lens.
November 28, 2012
Göbel B, Zwart DLM, Hesselink G, et al. Stakeholder perspectives on handovers between hospital staff and
general practitioners: an evaluation through the microsyste…
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psnet.ahrq.gov/node/60342/psn-pdf
May 20, 2020 - Occurrence, prevention, and management of the
psychological effects of emerging virus outbreaks on
healthcare workers: rapid review and meta-analysis.
May 20, 2020
Kisely S, Warren N, McMahon L, et al. Occurrence, prevention, and management of the psychological
effects of emerging virus outbreaks on healthcare wor…
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psnet.ahrq.gov/node/837311/psn-pdf
June 01, 2022 - Effects of healthcare organization actions and policies
related to COVID-19 on perceived organizational support
among U.S. internists: a national study.
June 1, 2022
Sonis J, Pathman DE, Read S, et al. Effects of healthcare organization actions and policies related to
COVID-19 on perceived organizational support a…
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psnet.ahrq.gov/node/840484/psn-pdf
November 30, 2022 - Interdisciplinary collaboration across secondary and
primary care to improve medication safety in the elderly
(The IMMENSE study) - a randomized controlled trial.
November 30, 2022
Johansen JS, Halvorsen KH, Svendsen K, et al. Interdisciplinary collaboration across secondary and
primary care to improve medication …
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psnet.ahrq.gov/node/866854/psn-pdf
January 01, 2025 - Charting diagnostic safety: exploring patient-provider
discordance in medical record documentation.
October 2, 2024
Giardina TD, Vaghani V, Upadhyay DK, et al. Charting diagnostic safety: exploring patient-provider
discordance in medical record documentation. J Gen Intern Med. 2025;40(4):773-781. doi:10.1007/s11606…
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psnet.ahrq.gov/node/847538/psn-pdf
April 12, 2023 - Crisis scenarios for simulation-based nontechnical skills
training for cardiac surgery teams: a national survey
among cardiac anesthesiologists, cardiac surgeons,
clinical perfusionists, and cardiac operating room nurses.
April 12, 2023
Kemper T, van Haperen M, Eberl S, et al. Crisis scenarios for simulation-based…
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psnet.ahrq.gov/node/867007/psn-pdf
October 23, 2024 - Development and psychometric analysis of a patient-
reported measure of diagnostic excellence for emergency
and urgent care settings.
October 23, 2024
Gleason KT, Dukhanin V, Peterson SK, et al. Development and psychometric analysis of a patient-reported
measure of diagnostic excellence for emergency and urgent ca…
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psnet.ahrq.gov/node/47247/psn-pdf
December 19, 2018 - Preventing central line–associated bloodstream
infections in the intensive care unit: application of high-
reliability principles.
December 19, 2018
McCraw B, Crutcher T, Polancich S, et al. Preventing Central Line-Associated Bloodstream Infections in
the Intensive Care Unit: Application of High-Reliability Princi…