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  1. Engaging patients in the use of real-time electronic clinical data to improve the safety and reliability of their own care. | PSNet

    psnet.ahrq.gov/issue/engaging-patients-use-real-time-electronic-clinical-data-improve-safety-and-reliability-their
    March 16, 2022 - Study Engaging patients in the use of real-time electronic clinical data to improve the safety and reliability of their own care. Citation Text: Schnock KO, Roulier S, Butler J, et al. Engaging patients in the use of real-time electronic clinical data to improve the safety and reliabilit…

  2. Implementation of a standardized tool for root cause analysis selection. | PSNet

    psnet.ahrq.gov/issue/implementation-standardized-tool-root-cause-analysis-selection
    November 06, 2024 - Study Implementation of a standardized tool for root cause analysis selection. Citation Text: Wahlstedt E, Levy BE, Scott E, et al. Implementation of a standardized tool for root cause analysis selection. J Patient Saf. 2025;21(2):101-105. doi:10.1097/pts.0000000000001291. Copy Citatio…

  3. Experiences with diagnostic delay among underserved racial and ethnic patients: a systematic review of the qualitative literature. | PSNet

    psnet.ahrq.gov/issue/experiences-diagnostic-delay-among-underserved-racial-and-ethnic-patients-systematic-review
    November 03, 2015 - Review Experiences with diagnostic delay among underserved racial and ethnic patients: a systematic review of the qualitative literature. Citation Text: Faugno E, Galbraith AA, Walsh KE, et al. Experiences with diagnostic delay among underserved racial and ethnic patients: a systematic r…

  4. Identifying hot spots for harm and blind spots across the care pathway from patient complaints about general practice. | PSNet

    psnet.ahrq.gov/issue/identifying-hot-spots-harm-and-blind-spots-across-care-pathway-patient-complaints-about
    May 04, 2022 - Study Identifying hot spots for harm and blind spots across the care pathway from patient complaints about general practice. Citation Text: O’Dowd E, Lydon S, Lambe KA, et al. Identifying hot spots for harm and blind spots across the care pathway from patient complaints about general pra…

  5. Long-term impacts faced by patients and families after harmful healthcare events. | PSNet

    psnet.ahrq.gov/issue/long-term-impacts-faced-patients-and-families-after-harmful-healthcare-events
    December 01, 2021 - Study Long-term impacts faced by patients and families after harmful healthcare events. Citation Text: Ottosen MJ, Sedlock E, Aigbe AO, et al. Long-term impacts faced by patients and families after harmful healthcare events. J Patient Saf. 2021;17(8):e1145-e1151. doi:10.1097/pts.00000000…

  6. Health system leaders' role in addressing racism: time to prioritize eliminating health care disparities. | PSNet

    psnet.ahrq.gov/issue/health-system-leaders-role-addressing-racism-time-prioritize-eliminating-health-care
    March 20, 2019 - Commentary Health system leaders' role in addressing racism: time to prioritize eliminating health care disparities. Citation Text: Austin JM, Weeks K, Pronovost PJ. Health System Leaders’ Role in Addressing Racism: Time to Prioritize Eliminating Health Care Disparities. Jt Comm J Qual …

  7. Development of the Leapfrog Group's bar code medication administration standard to address hospital inpatient medication safety. | PSNet

    psnet.ahrq.gov/issue/development-leapfrog-groups-bar-code-medication-administration-standard-address-hospital
    November 10, 2015 - Commentary Development of the Leapfrog Group's bar code medication administration standard to address hospital inpatient medication safety. Citation Text: Austin JM, Bane A, Gooder V, et al. Development of the Leapfrog Group's bar code medication administration standard to address hospit…

  8. A scoping review of distributed cognition in acute care clinical decision-making. | PSNet

    psnet.ahrq.gov/issue/scoping-review-distributed-cognition-acute-care-clinical-decision-making
    April 08, 2020 - Review A scoping review of distributed cognition in acute care clinical decision-making. Citation Text: Wilson E, Daniel M, Rao A, et al. A scoping review of distributed cognition in acute care clinical decision-making. Diagnosis (Berl). 2023;10(2):68-88. doi:10.1515/dx-2022-0095. Copy…

  9. Bundle interventions including nontechnical skills for surgeons can reduce operative time and improve patient safety. | PSNet

    psnet.ahrq.gov/issue/bundle-interventions-including-nontechnical-skills-surgeons-can-reduce-operative-time-and
    June 24, 2020 - Study Bundle interventions including nontechnical skills for surgeons can reduce operative time and improve patient safety. Citation Text: Koike D, Nomura Y, Nagai M, et al. Bundle interventions including nontechnical skills for surgeons can reduce operative time and improve patient safe…

  10. Interpreting and coding causal relationships for quality and safety using ICD-11. | PSNet

    psnet.ahrq.gov/issue/interpreting-and-coding-causal-relationships-quality-and-safety-using-icd-11
    November 15, 2017 - Commentary Interpreting and coding causal relationships for quality and safety using ICD-11. Citation Text: Januel J-M, Southern DA, Ghali WA. Interpreting and coding causal relationships for quality and safety using ICD-11. BMC Med Inform Decis Mak. 2023;21(Suppl 6):385. doi:10.1186/s12…

  11. Computer-Based Provider Order Entry Implementation in Intensive Care Units - 2009 | Digital Healthcare Research

    digital.ahrq.gov/ahrq-funded-projects/computer-based-provider-order-entry-cpoe-implementation-intensive-care-units/annual-summary/2009
    January 01, 2009 - Computer-Based Provider Order Entry Implementation in Intensive Care Units - 2009 Project Name Computer-Based Provider Order Entry (CPOE) Implementation in Intensive Care Units (ICUs) Principal Investigator Carayon, Pascale Organization University of Wisconsin - Madison …

  12. Graduate medical education and patient safety: a busy--and occasionally hazardous--intersection. | PSNet

    psnet.ahrq.gov/issue/graduate-medical-education-and-patient-safety-busy-and-occasionally-hazardous-intersection
    March 02, 2011 - Commentary Classic Graduate medical education and patient safety: a busy--and occasionally hazardous--intersection. Citation Text: Shojania KG, Fletcher KE, Saint S. Graduate medical education and patient safety: a busy--and occasionally hazardous--intersectio…

  13. Rural emergency medical services clinicians' perceptions and preferences in receiving clinical feedback from hospitals: a qualitative needs assessment. | PSNet

    psnet.ahrq.gov/issue/rural-emergency-medical-services-clinicians-perceptions-and-preferences-receiving-clinical
    June 02, 2021 - Study Rural emergency medical services clinicians' perceptions and preferences in receiving clinical feedback from hospitals: a qualitative needs assessment. Citation Text: Schneider K, Williams M, Mohr NM, et al. Rural emergency medical services clinicians' perceptions and preferences i…

  14. Reducing the risk of diagnostic error in the COVID-19 era. | PSNet

    psnet.ahrq.gov/issue/reducing-risk-diagnostic-error-covid-19-era
    September 23, 2020 - Commentary Emerging Classic Reducing the risk of diagnostic error in the COVID-19 era. Citation Text: Gandhi TK, Singh H. Reducing the risk of diagnostic error in the COVID-19 era. J. Hosp Med. 2020;15(6):363-366. doi:10.12788/jhm.3461. Copy Citation Forma…

  15. Prospective validation of classification of intraoperative adverse events (ClassIntra): international, multicentre cohort study. | PSNet

    psnet.ahrq.gov/issue/prospective-validation-classification-intraoperative-adverse-events-classintra-international
    November 20, 2015 - Study Prospective validation of classification of intraoperative adverse events (ClassIntra): international, multicentre cohort study. Citation Text: Dell-Kuster S, Gomes NV, Gawria L, et al. Prospective validation of classification of intraoperative adverse events (ClassIntra): internat…

  16. A model for improving health care quality for transgender and gender nonconforming patients. | PSNet

    psnet.ahrq.gov/issue/model-improving-health-care-quality-transgender-and-gender-nonconforming-patients
    August 12, 2020 - Commentary A model for improving health care quality for transgender and gender nonconforming patients. Citation Text: Ding JM, Ehrenfeld JM, Edmiston EK, et al. A model for improving health care quality for transgender and gender nonconforming patients. Jt Comm J Qual Patient Saf. 2020;…

  17. Patients as diagnostic collaborators: sharing visit notes to promote accuracy and safety. | PSNet

    psnet.ahrq.gov/issue/patients-diagnostic-collaborators-sharing-visit-notes-promote-accuracy-and-safety
    April 15, 2020 - Commentary Patients as diagnostic collaborators: sharing visit notes to promote accuracy and safety. Citation Text: Blease CR, Bell SK. Patients as diagnostic collaborators: sharing visit notes to promote accuracy and safety. Diagnosis (Berl). 2019;6(3):213-221. doi:10.1515/dx-2018-0106.…

  18. Healthcare team resilience during COVID-19: a qualitative study. | PSNet

    psnet.ahrq.gov/issue/healthcare-team-resilience-during-covid-19-qualitative-study
    February 20, 2019 - Study Healthcare team resilience during COVID-19: a qualitative study. Citation Text: Ambrose JW, Catchpole K, Evans HL, et al. Healthcare team resilience during COVID-19: a qualitative study. BMC Health Serv Res. 2024;24(1):459. doi:10.1186/s12913-024-10895-3. Copy Citation Format…

  19. The TeamSTEPPS for Improving Diagnosis Team Assessment Tool: scale development and psychometric evaluation. | PSNet

    psnet.ahrq.gov/issue/teamstepps-improving-diagnosis-team-assessment-tool-scale-development-and-psychometric
    January 22, 2025 - Study The TeamSTEPPS for Improving Diagnosis Team Assessment Tool: scale development and psychometric evaluation. Citation Text: Ali KJ, Goeschel CA, Eckroade MM, et al. The TeamSTEPPS for Improving Diagnosis Team Assessment Tool: scale development and psychometric evaluation. Jt Comm J …

  20. Application of human factors to improve usability of clinical decision support for diagnostic decision-making: a scenario-based simulation study. | PSNet

    psnet.ahrq.gov/issue/application-human-factors-improve-usability-clinical-decision-support-diagnostic-decision
    May 11, 2022 - Study Application of human factors to improve usability of clinical decision support for diagnostic decision-making: a scenario-based simulation study. Citation Text: Carayon P, Hoonakker P, Hundt AS, et al. Application of human factors to improve usability of clinical decision support f…
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