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  1. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/846764/psn-pdf
    March 29, 2023 - Senators threaten consequences after VA confirms 4 deaths tied to computer system tested in Spokane. March 29, 2023 Donovan-Smith O. Spokesman Review. March 15, 2023. https://psnet.ahrq.gov/issue/senators-threaten-consequences-after-va-confirms-4-deaths-tied-computer- system-tested-spokane Implementations of elec…
  2. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/47154/psn-pdf
    May 23, 2018 - Comparison of military and civilian methods for determining potentially preventable deaths: a systematic review. May 23, 2018 Janak JC, Sosnov JA, Bares JM, et al. Comparison of Military and Civilian Methods for Determining Potentially Preventable Deaths: A Systematic Review. JAMA Surg. 2018;153(4):367-375. doi:1…
  3. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/46899/psn-pdf
    March 21, 2018 - Patient Deaths at Arbour Health Systems—Westwood Lodge Hospital and Pembroke Hospital. March 21, 2018 Disability Law Center. Boston, MA: February 2018. https://psnet.ahrq.gov/issue/patient-deaths-arbour-health-systems-westwood-lodge-hospital-and- pembroke-hospital Patients with mental health concerns are vulnerab…
  4. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/47333/psn-pdf
    October 10, 2018 - Changing dynamics of the drug overdose epidemic in the United States from 1979 through 2016. October 10, 2018 Jalal H, Buchanich JM, Roberts MS, et al. Changing dynamics of the drug overdose epidemic in the United States from 1979 through 2016. Science (1979). 2018;361(6408). doi:10.1126/science.aau1184. https://p…
  5. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/43253/psn-pdf
    May 01, 2015 - Interim Report: Review of VHA's Patient Wait Times, Scheduling Practices, and Alleged Patient Deaths at the Phoenix Health Care System. May 1, 2015 Washington, DC: VA Office of the Inspector General; May 28, 2014. Report No. 14-02603-178. https://psnet.ahrq.gov/issue/interim-report-review-vhas-patient-wait-times-s…
  6. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/35365/psn-pdf
    February 17, 2011 - Accidental deaths, saved lives, and improved quality. February 17, 2011 Brennan TA, Gawande AA, Thomas EJ, et al. Accidental Deaths, Saved Lives, and Improved Quality. New England Journal of Medicine. 2005;353(13). doi:10.1056/nejmsb051157. https://psnet.ahrq.gov/issue/accidental-deaths-saved-lives-and-improved-qua…
  7. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/45862/psn-pdf
    February 08, 2017 - Learning, Candour and Accountability. A Review of the Way NHS Trusts Review and Investigate the Deaths of Patients in England. February 8, 2017 Newcastle Upon Tyne, UK: Care Quality Commission; December 2016. CQC-356-122016. https://psnet.ahrq.gov/issue/learning-candour-and-accountability-review-way-nhs-trusts-rev…
  8. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/36298/psn-pdf
    September 27, 2006 - Hospital Reporting of Deaths Related to Restraint and Seclusion.  September 27, 2006 Levinson DR. Washington DC: Office of the Inspector General; September 2006. OEI-09-04-00350 https://psnet.ahrq.gov/issue/hospital-reporting-deaths-related-restraint-and-seclusion This report presents findings from an investigatio…
  9. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/43444/psn-pdf
    August 27, 2014 - Patient-safety–related hospital deaths in England: thematic analysis of incidents reported to a national database, 2010–2012. August 27, 2014 Donaldson LJ, Panesar S, Darzi A. Patient-safety-related hospital deaths in England: thematic analysis of incidents reported to a national database, 2010-2012. PLoS Med. 201…
  10. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/43506/psn-pdf
    September 10, 2014 - Review of Alleged Patient Deaths, Patient Wait Times, and Scheduling Practices at the Phoenix VA Health Care System. September 10, 2014 Washington, DC: VA Office of the Inspector General; August 26, 2014. Report No.14-02603-267. https://psnet.ahrq.gov/issue/review-alleged-patient-deaths-patient-wait-times-and-sche…
  11. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/41079/psn-pdf
    October 16, 2012 - Effects of nurse staffing and nurse education on patient deaths in hospitals with different nurse work environments. October 16, 2012 Aiken LH, Cimiotti JP, Sloane DM, et al. Effects of nurse staffing and nurse education on patient deaths in hospitals with different nurse work environments. Med Care. 2011;49(12):1…
  12. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/36383/psn-pdf
    March 03, 2011 - Patterns of errors contributing to trauma mortality: lessons learned from 2,594 deaths. March 3, 2011 Gruen RL, Jurkovich GJ, McIntyre LK, et al. Patterns of Errors Contributing to Trauma Mortality. Transactions of the .. Meeting of the American Surgical Association. 2006;124. doi:10.1097/01.sla.0000234655.83517.5…
  13. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/44586/psn-pdf
    June 21, 2016 - 2013 Annual Hospital-Acquired Condition Rate and Estimates of Cost Savings and Deaths Averted From 2010 to 2013. June 21, 2016 Rockville, MD: Agency for Healthcare Research and Quality; October 2015. AHRQ Publication No.16- 0006-EF. https://psnet.ahrq.gov/issue/2013-annual-hospital-acquired-condition-rate-and-est…
  14. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/42734/psn-pdf
    November 13, 2013 - Healthcare Inspection—Emergency Department Patient Deaths: Memphis VAMC, Memphis, Tennessee. November 13, 2013 Washington, DC: Department of Veterans Affairs, Office of Inspector General; October 23, 2013. Report No. 13-00505-348. https://psnet.ahrq.gov/issue/healthcare-inspection-emergency-department-patient-deat…
  15. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/37441/psn-pdf
    November 01, 2012 - Saving Mothers' Lives: Reviewing Maternal Deaths to Make Motherhood Safer—2003–2005. November 1, 2012 Lewis G, ed. London, England: Confidential Enquiry into Maternal and Child Health; 2007. ISBN: 9780953353682. https://psnet.ahrq.gov/issue/saving-mothers-lives-reviewing-maternal-deaths-make-motherhood-safer- 200…
  16. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/35186/psn-pdf
    July 13, 2005 - Saving lives: hospitals have signed on to a six-part plan to avoid a multitude of unnecessary deaths. July 13, 2005 Comarow A. US News & World Report. July 2005 https://psnet.ahrq.gov/issue/saving-lives-hospitals-have-signed-six-part-plan-avoid-multitude-unnecessary- deaths This article, accompanying the widely r…
  17. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/44701/psn-pdf
    June 07, 2016 - The problem with preventable deaths. June 7, 2016 Hogan H. The problem with preventable deaths. BMJ Qual Saf. 2016;25(5):320-3. doi:10.1136/bmjqs- 2015-004983. https://psnet.ahrq.gov/issue/problem-preventable-deaths A key goal of patient safety improvement is preventing error, but challenges remain in distinguishi…
  18. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/47211/psn-pdf
    November 16, 2018 - A conceptual framework to reduce inpatient preventable deaths. November 16, 2018 Davis DP, Aguilar SA, Lawrence B, et al. A Conceptual Framework to Reduce Inpatient Preventable Deaths. Jt Comm J Qual Patient Saf. 2018;44(7):413-420. doi:10.1016/j.jcjq.2018.01.003. https://psnet.ahrq.gov/issue/conceptual-framework-…
  19. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/38783/psn-pdf
    September 02, 2009 - Medical negligence in drug associated deaths. September 2, 2009 Madea B, Musshoff F, Preuss J. Medical negligence in drug associated deaths. Forensic Sci Int. 2009;190(1-3):67-73. doi:10.1016/j.forsciint.2009.05.014. https://psnet.ahrq.gov/issue/medical-negligence-drug-associated-deaths This study reports that acc…
  20. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/46249/psn-pdf
    July 12, 2017 - Zero preventable deaths after traumatic injury: an achievable goal. July 12, 2017 Spinella PC. Zero preventable deaths after traumatic injury. J Trauma Acute Care Surg. 2017;82:S2-S8. doi:10.1097/ta.0000000000001425. https://psnet.ahrq.gov/issue/zero-preventable-deaths-after-traumatic-injury-achievable-goal Criti…

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