-
psnet.ahrq.gov/issue/value-improving-patient-safety-health-economic-considerations-rapid-response-systems-rapid
January 07, 2015 - Review
Value of improving patient safety: health economic considerations for rapid response systems-a rapid review of the literature and expert round table.
Citation Text:
Subbe CP, Hughes DA, Lewis S, et al. Value of improving patient safety: health economic considerations for rapid res…
-
psnet.ahrq.gov/issue/urgent-need-improve-health-care-quality-institute-medicine-national-roundtable-health-care
May 27, 2015 - Commentary
Classic
The urgent need to improve health care quality. Institute of Medicine National Roundtable on Health Care Quality.
Citation Text:
Chassin MR, Galvin RW. The urgent need to improve health care quality. Institute of Medicine National Roundtable o…
-
psnet.ahrq.gov/issue/how-does-routine-disclosure-medical-error-affect-patients-propensity-sue-and-their-assessment
December 04, 2016 - Study
How does routine disclosure of medical error affect patients' propensity to sue and their assessment of provider quality?: Evidence from survey data.
Citation Text:
Helmchen LA, Richards MR, McDonald TB. How does routine disclosure of medical error affect patients' propensity to …
-
psnet.ahrq.gov/issue/medical-misadventures-errors-and-mistakes-and-motor-vehicular-accidents-disproportionate
March 05, 2025 - Study
Medical misadventures as errors and mistakes and motor vehicular accidents in the disproportionate burden of childhood mortality among Blacks/African Americans in the United States: CDC Dataset, 1968-2015.
Citation Text:
Holmes L, Enwere M, Mason R, et al. Medical misadventures as …
-
psnet.ahrq.gov/issue/identifying-factors-influencing-clinicians-reporting-medication-errors-systematic-review-and
December 11, 2013 - Review
Identifying factors influencing clinicians' reporting of medication errors: a systematic review and qualitative evidence synthesis using the theoretical domains framework.
Citation Text:
Takhtinejad NJ, Stewart D, Nazar Z, et al. Identifying factors influencing clinicians’ reporti…
-
psnet.ahrq.gov/issue/patient-safety-external-beam-radiotherapy-guidelines-risk-assessment-and-analysis-adverse
March 15, 2017 - Study
Patient safety in external beam radiotherapy—guidelines on risk assessment and analysis of adverse error-events and near misses: introducing the ACCIRAD project.
Citation Text:
Malicki J, Bly R, Bulot M, et al. Patient safety in external beam radiotherapy - guidelines on risk asses…
-
psnet.ahrq.gov/issue/application-digital-quality-measure-cancer-diagnosis-epic-cosmos
November 13, 2024 - Study
Application of a digital quality measure for cancer diagnosis in Epic Cosmos.
Citation Text:
Zimolzak AJ, Khan SP, Singh H, et al. Application of a digital quality measure for cancer diagnosis in Epic Cosmos. J Am Med Inform Assoc. 2025;32(1):227-229. doi:10.1093/jamia/ocae253.
C…
-
psnet.ahrq.gov/issue/adverse-drug-events-after-hospital-discharge-older-adults-types-severity-and-involvement
August 11, 2010 - Study
Adverse drug events after hospital discharge in older adults: types, severity, and involvement of Beers criteria medications.
Citation Text:
Kanaan AO, Donovan JL, Duchin NP, et al. Adverse drug events after hospital discharge in older adults: types, severity, and involvement of …
-
psnet.ahrq.gov/issue/implicit-bias-healthcare-clinical-practice-research-and-decision-making
May 25, 2022 - Review
Classic
Implicit bias in healthcare: clinical practice, research and decision making.
Citation Text:
Gopal DP, Chetty U, O'Donnell P, et al. Implicit bias in healthcare: clinical practice, research and decision making. Future Healthc J. 2021;8(1):40-48. d…
-
psnet.ahrq.gov/issue/understanding-roles-three-academic-communities-prospective-learning-health-ecosystem
October 19, 2022 - Study
Understanding the roles of three academic communities in a prospective learning health ecosystem for diagnostic excellence.
Citation Text:
Satterfield K, Rubin JC, Yang D, et al. Understanding the roles of three academic communities in a prospective learning health ecosystem for di…
-
psnet.ahrq.gov/issue/resident-duty-hours-enhancing-sleep-supervision-and-safety
July 12, 2016 - Book/Report
Classic
Resident Duty Hours: Enhancing Sleep, Supervision, and Safety.
Citation Text:
Resident Duty Hours: Enhancing Sleep, Supervision, and Safety. Ulmer C, Wolman DM, Johns MME, eds. Committee on Optimizing Graduate Medical Trainee (Resident) Hours…
-
psnet.ahrq.gov/issue/prevalence-potentially-inappropriate-medication-prescribing-us-nursing-homes-2013-2017
March 27, 2024 - Study
Prevalence of potentially inappropriate medication prescribing in US nursing homes, 2013-2017.
Citation Text:
Riester MR, Goyal P, Steinman MA, et al. Prevalence of potentially inappropriate medication prescribing in US nursing homes, 2013-2017. J Gen Intern Med. 2023;38(6):1563-15…
-
psnet.ahrq.gov/issue/stoppstart-criteria-potentially-inappropriate-prescribing-older-people-version-2
March 23, 2012 - Study
STOPP/START criteria for potentially inappropriate prescribing in older people: version 2.
Citation Text:
O'Mahony D, O'Sullivan D, Byrne S, et al. STOPP/START criteria for potentially inappropriate prescribing in older people: version 2. Age Ageing. 2015;44(2):213-218. doi:10.1093…
-
psnet.ahrq.gov/issue/identification-latent-safety-threats-using-high-fidelity-simulation-based-training
June 26, 2019 - Study
Identification of latent safety threats using high-fidelity simulation-based training with multidisciplinary neonatology teams.
Citation Text:
Wetzel EA, Lang TR, Pendergrass TL, et al. Identification of Latent Safety Threats Using High-Fidelity Simulation-Based Training with Mult…
-
psnet.ahrq.gov/issue/identifying-list-healthcare-never-events-effect-system-change-systematic-review-and-narrative
April 24, 2019 - Review
Identifying a list of healthcare 'never events' to effect system change: a systematic review and narrative synthesis.
Citation Text:
Bowman CL, De Gorter R, Zaslow J, et al. Identifying a list of healthcare ‘never events’ to effect system change: a systematic review and narrative …
-
psnet.ahrq.gov/issue/using-assessment-reasoning-tool-facilitate-feedback-about-diagnostic-reasoning
February 23, 2022 - Study
Using the Assessment of Reasoning Tool to facilitate feedback about diagnostic reasoning.
Citation Text:
Cohen AL, Sur M, Falco C, et al. Using the Assessment of Reasoning Tool to facilitate feedback about diagnostic reasoning. Diagnosis (Berl). 2022;9(4):476-484. doi:10.1515/dx-20…
-
psnet.ahrq.gov/issue/contributors-diagnostic-error-or-delay-acute-care-setting-survey-clinical-stakeholders
May 26, 2021 - Study
Contributors to diagnostic error or delay in the acute care setting: a survey of clinical stakeholders.
Citation Text:
Redmond S, Barwise A, Zornes S, et al. Contributors to diagnostic error or delay in the acute care setting: a survey of clinical stakeholders. Health Serv Insights…
-
psnet.ahrq.gov/issue/quantification-and-classification-errors-associated-hand-repackaging-medications-long-term
April 21, 2021 - Study
Quantification and classification of errors associated with hand-repackaging of medications in long-term care facilities in Germany.
Citation Text:
Gerber A, Kohaupt I, Lauterbach KW, et al. Quantification and classification of errors associated with hand-repackaging of medicat…
-
psnet.ahrq.gov/issue/effect-facility-complexity-perceptions-safety-climate-operating-room-size-matters
December 21, 2014 - Study
The effect of facility complexity on perceptions of safety climate in the operating room: size matters.
Citation Text:
Carney BT, West P, Neily J, et al. The effect of facility complexity on perceptions of safety climate in the operating room: size matters. Am J Med Qual. 2010;25…
-
psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.359_slideshow.ppt
October 01, 2015 - PowerPoint Presentation
Spotlight
The Risks of Absent Interoperability:
Medication-Induced Hemolysis in a Patient With a Known Allergy
1
This presentation is based on the October 2015
AHRQ WebM&M Spotlight Case
See the full article at https://psnet.ahrq.gov/
CME credit is available
Commentary by: Jacob Reider,…