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psnet.ahrq.gov/node/45811/psn-pdf
May 08, 2017 - A National Web Conference on Improving Health IT Safety
Through the Use of Natural Language Processing to
Improve Accuracy of EHR Documentation.
May 8, 2017
Agency for Healthcare Research and Quality. February 7, 2017.
https://psnet.ahrq.gov/issue/national-web-conference-improving-health-it-safety-through-use-natu…
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psnet.ahrq.gov/web-mm/empiric-steroids-good-bad-and-ugly
June 01, 2015 - SPOTLIGHT CASE
Empiric Steroids: the Good, the Bad, and the Ugly
Citation Text:
Harris ED. Empiric Steroids: the Good, the Bad, and the Ugly. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2008.
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psnet.ahrq.gov/node/35739/psn-pdf
July 15, 2010 - CT for suspected appendicitis in children: an analysis of
diagnostic errors.
July 15, 2010
Taylor GA, Callahan MJ, Rodriguez D, et al. CT for suspected appendicitis in children: an analysis of
diagnostic errors. Pediatr Radiol. 2006;36(4):331-7.
https://psnet.ahrq.gov/issue/ct-suspected-appendicitis-children-analy…
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psnet.ahrq.gov/perspective/diagnostic-errors-new-chapter-patient-safety-science-policy-and-practice
January 01, 2016 - That's an important statement that was missing from the earlier definitions.
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psnet.ahrq.gov/node/34707/psn-pdf
September 29, 2017 - National Patient Safety Foundation agenda for research
and development in patient safety.
September 29, 2017
Cooper JB, Gaba DM, Liang B, et al. The National Patient Safety Foundation agenda for research and
development in patient safety. MedGenMed. 2000;2(3):E38.
https://psnet.ahrq.gov/issue/national-patient-safe…
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psnet.ahrq.gov/node/45589/psn-pdf
January 23, 2017 - Do pharmacist-led medication reviews in hospitals help
reduce hospital readmissions? A systematic review and
meta-analysis.
January 23, 2017
Renaudin P, Boyer L, Esteve M-A, et al. Do pharmacist-led medication reviews in hospitals help reduce
hospital readmissions? A systematic review and meta-analysis. Br J Anaes…
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psnet.ahrq.gov/node/45013/psn-pdf
April 13, 2016 - Good Practice Guides on Medication Errors: Part 1 and
Part 2.
April 13, 2016
Goedecke T, Ord K, Newbould V, et al. Medication Errors: New Eu Good Practice Guide On Risk
Minimisation And Error Prevention. Springer Science and Business Media LLC; 2016. doi:10.1007/s40264-
016-0410-4.
https://psnet.ahrq.gov/issue/go…
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psnet.ahrq.gov/node/34680/psn-pdf
February 09, 2011 - Estimating hospital deaths due to medical errors:
preventability is in the eye of the reviewer.
February 9, 2011
Hayward RA, Hofer TP. Estimating hospital deaths due to medical errors: preventability is in the eye of the
reviewer. JAMA. 2001;286(4):415-20.
https://psnet.ahrq.gov/issue/estimating-hospital-deaths-du…
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psnet.ahrq.gov/node/33742/psn-pdf
December 01, 2012 - twists here is
that using the outcome measure of delirium is still problematic because of the various definitions
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psnet.ahrq.gov/web-mm/diagnosing-diagnostic-mistakes
April 30, 2014 - We think that the designation of “missed or delayed diagnoses” is fraught with ambiguity and unclear definitions … Summary Hindsight bias, especially in the face of subjective criteria for definitions of disease and
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psnet.ahrq.gov/node/45238/psn-pdf
September 29, 2017 - Unprofessional behaviors among tomorrow's physicians:
review of the literature with a focus on risk factors,
temporal trends, and future directions.
September 29, 2017
Fargen KM, Drolet BC, Philibert I. Unprofessional Behaviors Among Tomorrow's Physicians: Review of the
Literature With a Focus on Risk Factors, Tem…
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psnet.ahrq.gov/node/37292/psn-pdf
May 24, 2015 - Guilty, afraid, and alone — struggling with medical error.
May 24, 2015
Delbanco T, Bell SK. Guilty, afraid, and alone--struggling with medical error. N Engl J Med.
2007;357(17):1682-3.
https://psnet.ahrq.gov/issue/guilty-afraid-and-alone-struggling-medical-error
Disclosure of medical errors remains an important a…
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psnet.ahrq.gov/node/44508/psn-pdf
November 20, 2015 - Outcomes associated with the nationwide introduction of
rapid response systems in the Netherlands.
November 20, 2015
Ludikhuize J, Brunsveld-Reinders AH, Dijkgraaf MGW, et al. Outcomes Associated With the Nationwide
Introduction of Rapid Response Systems in The Netherlands. Crit Care Med. 2015;43(12):2544-51.
doi:…
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psnet.ahrq.gov/node/39233/psn-pdf
August 02, 2013 - Rapid response teams: a systematic review and meta-
analysis.
August 2, 2013
Chan PS, Jain R, Nallmothu BK, et al. Rapid Response Teams: A Systematic Review and Meta-analysis.
Arch Intern Med. 2010;170(1):18-26. doi:10.1001/archinternmed.2009.424.
https://psnet.ahrq.gov/issue/rapid-response-teams-systematic-review…
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psnet.ahrq.gov/node/34758/psn-pdf
January 29, 2019 - Normal Accidents: Living with High-Risk Technologies.
January 29, 2019
Perrow C. Princeton NJ: Princeton University Press; 1999.
https://psnet.ahrq.gov/issue/normal-accidents-living-high-risk-technologies
Though less often cited than high-reliability theory in the health care literature, normal accidents theor…
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psnet.ahrq.gov/node/34685/psn-pdf
September 29, 2017 - The urgent need to improve health care quality. Institute
of Medicine National Roundtable on Health Care Quality.
September 29, 2017
Chassin MR, Galvin RW. The urgent need to improve health care quality. Institute of Medicine National
Roundtable on Health Care Quality. JAMA. 1998;280(11):1000-1005.
https://psnet.a…
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psnet.ahrq.gov/node/38142/psn-pdf
April 30, 2014 - Medical error disclosure among pediatricians: choosing
carefully what we might say to parents.
April 30, 2014
Loren DJ, Klein EJ, Garbutt J, et al. Medical Error Disclosure Among Pediatricians. Arch Pediatr Adolesc
Med. 2008;162(10):922-927. doi:10.1001/archpedi.162.10.922.
https://psnet.ahrq.gov/issue/medical-err…
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psnet.ahrq.gov/node/39314/psn-pdf
December 21, 2014 - Patient characteristics and the occurrence of never
events.
December 21, 2014
Fry DE, Pine M, Jones BL, et al. Patient characteristics and the occurrence of never events. Arch Surg.
2010;145(2):148-51. doi:10.1001/archsurg.2009.277.
https://psnet.ahrq.gov/issue/patient-characteristics-and-occurrence-never-events
…
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psnet.ahrq.gov/node/41250/psn-pdf
December 21, 2014 - Disclosure of "nonharmful" medical errors and other
events: duty to disclose.
December 21, 2014
Chamberlain CJ, Koniaris LG, Wu AW, et al. Disclosure of "nonharmful" medical errors and other events:
duty to disclose. Arch Surg. 2012;147(3):282-6. doi:10.1001/archsurg.2011.1005.
https://psnet.ahrq.gov/issue/disclos…
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psnet.ahrq.gov/node/47178/psn-pdf
July 10, 2018 - Defining, estimating, and communicating overdiagnosis
in cancer screening.
July 10, 2018
Davies L, Petitti DB, Martin L, et al. Defining, estimating, and communicating overdiagnosis in cancer
screening. Ann Intern Med. 2018;169(1):36-43. doi:10.7326/M18-0694.
https://psnet.ahrq.gov/issue/defining-estimating-and-co…