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Ensuring medication safety for consumers from ethnic minority backgrounds: the need to address unconscious bias within health systems. | PSNet

psnet.ahrq.gov/issue/ensuring-medication-safety-consumers-ethnic-minority-backgrounds-need-address-unconscious

July 29, 2020 - Commentary Ensuring medication safety for consumers from ethnic minority backgrounds: the need to address unconscious bias within health systems. Citation Text: Chauhan A, Walpola RL. Ensuring medication safety for consumers from ethnic minority backgrounds: the need to address unconscio…

The problem with medication reconciliation. | PSNet

psnet.ahrq.gov/issue/problem-medication-reconciliation

May 08, 2017 - Commentary The problem with medication reconciliation. Citation Text: Pevnick JM, Shane R, Schnipper JL. The problem with medication reconciliation. BMJ Qual Saf. 2016;25(9):726-730. doi:10.1136/bmjqs-2015-004734. Copy Citation Format: DOI Google Scholar PubMed BibTeX EndNo…

Dual-process cognitive interventions to enhance diagnostic reasoning: a systematic review. | PSNet

psnet.ahrq.gov/issue/dual-process-cognitive-interventions-enhance-diagnostic-reasoning-systematic-review

March 20, 2019 - Review Dual-process cognitive interventions to enhance diagnostic reasoning: a systematic review. Citation Text: Lambe KA, O'Reilly G, Kelly BD, et al. Dual-process cognitive interventions to enhance diagnostic reasoning: a systematic review. BMJ Qual Saf. 2016;25(10):808-820. doi:10.113…

Improving patient care. The cognitive psychology of missed diagnoses. | PSNet

psnet.ahrq.gov/issue/improving-patient-care-cognitive-psychology-missed-diagnoses

October 03, 2012 - Commentary Improving patient care. The cognitive psychology of missed diagnoses. Citation Text: Redelmeier DA. Improving patient care. The cognitive psychology of missed diagnoses. Ann Intern Med. 2005;142(2):115-120. Copy Citation Format: Google Scholar PubMed BibTeX End…

To tell the truth: ethical and practical issues in disclosing medical mistakes to patients. | PSNet

psnet.ahrq.gov/issue/tell-truth-ethical-and-practical-issues-disclosing-medical-mistakes-patients

April 19, 2011 - Commentary Classic To tell the truth: ethical and practical issues in disclosing medical mistakes to patients. Citation Text: Wu AW, Cavanaugh TA, McPhee SJ, et al. To tell the truth. J Gen Intern Med. 2003;12(12). doi:10.1046/j.1525-1497.1997.07163.x. Copy …

Apology laws and malpractice liability: what have we learned? | PSNet

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March 18, 2020 - Commentary Apology laws and malpractice liability: what have we learned? Citation Text: Fields AC, Mello MM, Kachalia A. Apology laws and malpractice liability: what have we learned? BMJ Qual Saf. 2021;30(1):64-67. doi:10.1136/bmjqs-2020-010955. Copy Citation Format: DOI G…

The real malady of Marcel Proust and what it reveals about diagnostic errors in medicine. | PSNet

psnet.ahrq.gov/issue/real-malady-marcel-proust-and-what-it-reveals-about-diagnostic-errors-medicine

September 27, 2022 - Commentary The real malady of Marcel Proust and what it reveals about diagnostic errors in medicine. Citation Text: Douglas Y. The real malady of Marcel Proust and what it reveals about diagnostic errors in medicine. Med Hypotheses. 2016;90:14-8. doi:10.1016/j.mehy.2016.02.024. Copy Ci…

Care of the clinician after an adverse event. | PSNet

psnet.ahrq.gov/issue/care-clinician-after-adverse-event

March 03, 2021 - Review Care of the clinician after an adverse event. Citation Text: Pratt SD, Jachna BR. Care of the clinician after an adverse event. Int J Obstet Anesth. 2014;24(1):54-63. doi:10.1016/j.ijoa.2014.10.001. Copy Citation Format: DOI Google Scholar BibTeX EndNote X3 XML EndN…

Guide to Patient and Family Engagement in Hospital Quality and Safety. | PSNet

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December 24, 2008 - Multi-use Website Guide to Patient and Family Engagement in Hospital Quality and Safety. Citation Text: Guide to Patient and Family Engagement in Hospital Quality and Safety. Rockville, MD: Agency for Healthcare Research and Quality; June 2013. Copy Citation Save …

A health system that won't learn from its mistakes. | PSNet

psnet.ahrq.gov/issue/health-system-wont-learn-its-mistakes

October 26, 2022 - Commentary A health system that won't learn from its mistakes. Citation Text: Keller C. A health system that won't learn from its mistakes. Health Aff (Millwood). 2022;41(9):1353-1356. doi:10.1377/hlthaff.2022.00581. Copy Citation Format: DOI Google Scholar BibTeX EndNote X…

Does a unit shift report "blackout" period improve patient safety? | PSNet

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August 04, 2021 - Commentary Does a unit shift report "blackout" period improve patient safety? Citation Text: Olmstead J. Does a unit shift report "blackout" period improve patient safety? Nurs Manage. 2019;50(3):8-10. doi:10.1097/01.NUMA.0000553500.85897.51. Copy Citation Format: DOI Googl…

Procuring Interoperability: Achieving High-Quality, Connected, and Person-Centered Care. | PSNet

psnet.ahrq.gov/issue/procuring-interoperability-achieving-high-quality-connected-and-person-centered-care

September 19, 2018 - Book/Report Procuring Interoperability: Achieving High-Quality, Connected, and Person-Centered Care. Citation Text: Procuring Interoperability: Achieving High-Quality, Connected, and Person-Centered Care. Pronovost P, Johns MME, Palmer S, et al, eds. Washington, DC: National Academy of M…

Organisational failure: rethinking whistleblowing for tomorrow's doctors. | PSNet

psnet.ahrq.gov/issue/organisational-failure-rethinking-whistleblowing-tomorrows-doctors

May 18, 2022 - Commentary Organisational failure: rethinking whistleblowing for tomorrow's doctors. Citation Text: Taylor DJ, Goodwin D. Organisational failure: rethinking whistleblowing for tomorrow’s doctors. J Med Ethics. 2022;48(10):672-677. doi:10.1136/jme-2022-108328. Copy Citation Format: …

Application of human error theory in case analysis of wrong procedures. | PSNet

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November 14, 2018 - Study Application of human error theory in case analysis of wrong procedures. Citation Text: Duthie EA. Application of Human Error Theory in Case Analysis of Wrong Procedures. J Patient Saf. 2010;6(2):108-114. doi:10.1097/pts.0b013e3181de47f9. Copy Citation Format: DOI Goo…

Safety, performance, and satisfaction outcomes in the operating room: a literature review. | PSNet

psnet.ahrq.gov/issue/safety-performance-and-satisfaction-outcomes-operating-room-literature-review

April 03, 2019 - Review Emerging Classic Safety, performance, and satisfaction outcomes in the operating room: a literature review. Citation Text: Joseph A, Bayramzadeh S, Zamani Z, et al. Safety, Performance, and Satisfaction Outcomes in the Operating Room: A Literature Review.…

Deaths in Acute Hospitals: Caring to the End? | PSNet

psnet.ahrq.gov/issue/deaths-acute-hospitals-caring-end

March 17, 2011 - Book/Report Deaths in Acute Hospitals: Caring to the End? Citation Text: Deaths in Acute Hospitals: Caring to the End? Cooper H, Findlay G, Goodwin APL, et al. London, UK: National Confidential Enquiry into Patient Outcome and Death; November 2009. ISBN: 9780956088222. Copy Citat…

Pain Management and Prescription Opioid-related Harms: Exploring the State of the Evidence: Proceedings of a Workshop—in Brief. | PSNet

psnet.ahrq.gov/issue/pain-management-and-prescription-opioid-related-harms-exploring-state-evidence-proceedings

July 05, 2008 - Meeting/Conference Proceedings Pain Management and Prescription Opioid-related Harms: Exploring the State of the Evidence: Proceedings of a Workshop—in Brief. Citation Text: Pain Management and Prescription Opioid-related Harms: Exploring the State of the Evidence: Proceedings of a Works…

Prevention of 3 "never events" in the operating room: fires, gossypiboma, and wrong-site surgery. | PSNet

psnet.ahrq.gov/issue/prevention-3-never-events-operating-room-fires-gossypiboma-and-wrong-site-surgery

February 10, 2012 - Review Prevention of 3 "never events" in the operating room: fires, gossypiboma, and wrong-site surgery. Citation Text: Zahiri HR, Stromberg J, Skupsky H, et al. Prevention of 3 "never events" in the operating room: fires, gossypiboma, and wrong-site surgery. Surg Innov. 2011;18(1):55-…

Barriers to self-reporting patient safety incidents by paramedics: a mixed methods study. | PSNet

psnet.ahrq.gov/issue/barriers-self-reporting-patient-safety-incidents-paramedics-mixed-methods-study

November 16, 2022 - Study Barriers to self-reporting patient safety incidents by paramedics: a mixed methods study. Citation Text: Sinclair JE, Austin MA, Bourque C, et al. Barriers to Self-Reporting Patient Safety Incidents by Paramedics: A Mixed Methods Study. Prehosp Emerg Care. 2018;22(6):762-772. doi:1…

Evaluation of 12 strategies for obtaining second opinions to improve interpretation of breast histopathology: simulation study. | PSNet

psnet.ahrq.gov/issue/evaluation-12-strategies-obtaining-second-opinions-improve-interpretation-breast

November 03, 2015 - Study Evaluation of 12 strategies for obtaining second opinions to improve interpretation of breast histopathology: simulation study. Citation Text: Elmore JG, Tosteson AN, Pepe MS, et al. Evaluation of 12 strategies for obtaining second opinions to improve interpretation of breast histo…

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