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psnet.ahrq.gov/node/35786/psn-pdf
May 07, 2007 - When Things Go Wrong: Responding to Adverse Events.
May 7, 2007
Boston, MA: Massachusetts Coalition for the Prevention of Medical Errors; 2006.
https://psnet.ahrq.gov/issue/when-things-go-wrong-responding-adverse-events
This consensus paper of the Harvard-affiliated hospitals was prepared by clinicians, risk manage…
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psnet.ahrq.gov/node/862151/psn-pdf
February 07, 2024 - Taking up the challenge to improve name and role
recognition in the operating room.
February 7, 2024
Thota B, Rabinowitz A, Guttman OT. Taking up the challenge to improve name and role recognition in the
operating room. J Patient Saf. 2024;20(1):45-47. doi:10.1097/pts.0000000000001177.
https://psnet.ahrq.gov/issue…
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psnet.ahrq.gov/node/45198/psn-pdf
January 23, 2017 - Investigating teamwork in the operating room: engaging
stakeholders and setting the agenda.
January 23, 2017
Frasier LL, Quamme SRP, Becker A, et al. Investigating Teamwork in the Operating Room: Engaging
Stakeholders and Setting the Agenda. JAMA Surg. 2017;152(1):109-111.
doi:10.1001/jamasurg.2016.3110.
https://…
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psnet.ahrq.gov/node/44224/psn-pdf
June 10, 2015 - To be sued less, doctors should consider talking to
patients more.
June 10, 2015
Carroll AE.
https://psnet.ahrq.gov/issue/be-sued-less-doctors-should-consider-talking-patients-more
Reporting on trends associated with medical malpractice, how the same physicians tend to get sued, and
reasons patients file claims, …
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psnet.ahrq.gov/node/41534/psn-pdf
July 25, 2012 - Protecting patients from an unsafe system: the etiology
and recovery of intraoperative deviations in care.
July 25, 2012
Hu Y-Y, Arriaga AF, Roth EM, et al. Protecting patients from an unsafe system: the etiology and recovery
of intraoperative deviations in care. Ann Surg. 2012;256(2):203-10. doi:10.1097/SLA.0b013e…
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psnet.ahrq.gov/node/49857/psn-pdf
March 01, 2019 - handoff methods and
tools are available, such as forms and checklists, face-to-face and electronic communications … readmissions.(13) The Joint Commission Targeted Solutions
Tool can be used to examine current handoff communications
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psnet.ahrq.gov/web-mm/norepinephrine-dosing-error-associated-multiple-health-system-vulnerabilities
November 27, 2019 - In all communications among healthcare providers, complete dosing units should always be stated. … Reduce distractions and utilize closed-loop communications to reduce risk of errors.
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psnet.ahrq.gov/node/33661/psn-pdf
December 01, 2007 - A systematic review of discharge communications, conducted by the
joint Society of Hospital Medicine … recently provided complementary recommendations about
the content, format, and delivery of discharge communications
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psnet.ahrq.gov/innovation/battle-buddies-rapid-deployment-psychological-resilience-intervention-health-care
September 09, 2020 - Patient Safety Innovations
The I-READI Quality and Safety Framework: Strong Communications
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psnet.ahrq.gov/curated-library/rapid-response-systems
September 15, 2024 - contribution of knowledge deficits and cognitive biases to diagnostic errors and the importance of structured communications
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psnet.ahrq.gov/node/73434/psn-pdf
June 30, 2021 - practices for radiologists to follow.3 A summary of the Group's findings, in terms
of the timing of communications … that may not directly relate
to clinical presentation
In addition to emphasizing the timeliness of communications
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psnet.ahrq.gov/web-mm/consequences-miscommunication-regarding-possible-artifact
May 11, 2019 - practices for radiologists to follow. 3 A summary of the Group's findings, in terms of the timing of communications … not directly relate to clinical presentation
In addition to emphasizing the timeliness of communications
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psnet.ahrq.gov/node/854973/psn-pdf
October 31, 2023 - The Federal Communications Commission is currently working to support access to digital health
through
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psnet.ahrq.gov/web-mm/duplicate-insulin-order
May 04, 2012 - handoff methods and tools are available, such as forms and checklists, face-to-face and electronic communications … readmissions.( 13 ) The Joint Commission Targeted Solutions Tool can be used to examine current handoff communications
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psnet.ahrq.gov/issue/handoff-communication
October 16, 2019 - Special or Theme Issue
Handoff Communication.
Citation Text:
Handoff Communication. APSF Newsletter. October 2017;32:29-56.
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psnet.ahrq.gov/issue/teamwork-and-communication
February 06, 2019 - Special or Theme Issue
Teamwork and Communication.
Citation Text:
Teamwork and Communication. Pa Patient Saf Advis. June 2010;7(suppl 2):1-16.
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psnet.ahrq.gov/web-mm/communication-consultants
October 01, 2018 - Communication With Consultants
Citation Text:
Cohn SL. Communication With Consultants. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2016.
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psnet.ahrq.gov/perspective/becoming-patient-safety-organization
July 01, 2011 - trusted colleagues. 5 The rules governing preexisting protections (e.g., peer review, attorney–client communications … ), while reasonably secure in California, are oriented towards restricting communications to a limited … And in states with limited protections, communications even within small groups can be inhibited by fear
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psnet.ahrq.gov/perspective/conversation-withwilliam-b-munier-md-mba
July 01, 2011 - trusted colleagues. 5 The rules governing preexisting protections (e.g., peer review, attorney–client communications … ), while reasonably secure in California, are oriented towards restricting communications to a limited … And in states with limited protections, communications even within small groups can be inhibited by fear
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psnet.ahrq.gov/node/49519/psn-pdf
September 01, 2006 - Goal 2E, which requires all health care
providers to "implement a standardized approach to handoff communications … JCAHO's expectations for this goal include interactive communications, up-
to-date and accurate information