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psnet.ahrq.gov/issue/examination-maternal-near-miss-experiences-hospital-setting-among-black-women-united-states
August 26, 2020 - Study
Examination of maternal near-miss experiences in the hospital setting among Black women in the United States.
Citation Text:
Byrd TE, Ingram LA, Okpara N. Examination of maternal near-miss experiences in the hospital setting among Black women in the United States. Womens Health (Lo…
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psnet.ahrq.gov/issue/intravenous-medication-safety-and-smart-infusion-systems-lessons-learned-and-future
January 09, 2008 - Commentary
Intravenous medication safety and smart infusion systems: lessons learned and future opportunities.
Citation Text:
Keohane C, Hayes J, Saniuk C, et al. Intravenous medication safety and smart infusion systems: lessons learned and future opportunities. J Infus Nurs. 2005;28(5…
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psnet.ahrq.gov/issue/safety-analysis-over-time-seven-major-changes-adverse-event-investigation
September 24, 2018 - Commentary
Safety analysis over time: seven major changes to adverse event investigation.
Citation Text:
Vincent CA, Carthey J, Macrae C, et al. Safety analysis over time: seven major changes to adverse event investigation. Implementation Science. 2017;12(1). doi:10.1186/s13012-017-0695-…
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psnet.ahrq.gov/issue/did-hospital-engagement-networks-actually-improve-care
July 18, 2016 - Commentary
Did hospital engagement networks actually improve care?
Citation Text:
Pronovost P, Jha AK. Did hospital engagement networks actually improve care? N Engl J Med. 2014;371(8):691-693. doi:10.1056/NEJMp1405800.
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psnet.ahrq.gov/issue/operating-room-briefings-working-same-page
September 28, 2010 - Commentary
Operating room briefings: working on the same page.
Citation Text:
Makary MA, Holzmueller CG, Thompson DA, et al. Operating room briefings: working on the same page. Jt Comm J Qual Patient Saf. 2006;32(6):351-5.
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psnet.ahrq.gov/issue/six-steps-head-hand-simulator-based-transfer-oriented-psychological-training-improve-patient
August 20, 2018 - Commentary
Six steps from head to hand: a simulator based transfer oriented psychological training to improve patient safety.
Citation Text:
Müller MP, Hänsel M, Stehr SN, et al. Six steps from head to hand: a simulator based transfer oriented psychological training to improve patient …
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psnet.ahrq.gov/issue/2019-update-pediatric-medical-overuse-systematic-review
May 11, 2019 - Review
2019 update on pediatric medical overuse: a systematic review.
Citation Text:
Money NM, Schroeder AR, Quinonez RA, et al. 2019 Update on Pediatric Medical Overuse. JAMA Pediatr. 2020;174(4):375-382. doi:10.1001/jamapediatrics.2019.5849.
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psnet.ahrq.gov/issue/leadership-framework-culture-change-health-care
January 02, 2017 - Commentary
A leadership framework for culture change in health care.
Citation Text:
Rose JS, Thomas CS, Tersigni AR, et al. A leadership framework for culture change in health care. Jt Comm J Qual Patient Saf. 2006;32(8):433-42.
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psnet.ahrq.gov/issue/using-smart-pumps-understand-and-evaluate-clinician-practice-patterns-ensure-patient-safety
September 01, 2016 - Study
Using smart pumps to understand and evaluate clinician practice patterns to ensure patient safety.
Citation Text:
Mansfield J, Jarrett S. Using smart pumps to understand and evaluate clinician practice patterns to ensure patient safety. Hosp Pharm. 2013;48(11):942-950. doi:10.1310…
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psnet.ahrq.gov/issue/debriefing-or-quality-improvement-project
April 24, 2018 - Commentary
Debriefing in the OR: a quality improvement project.
Citation Text:
Finch EP, Langston M, Erickson D, et al. Debriefing in the OR: A Quality Improvement Project. AORN J. 2019;109(3):336-344. doi:10.1002/aorn.12616.
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psnet.ahrq.gov/issue/oral-chemotherapy-safety-practices-us-cancer-centres-questionnaire-survey
July 23, 2014 - Study
Oral chemotherapy safety practices at US cancer centres: questionnaire survey.
Citation Text:
Weingart SN, Flug J, Brouillard D, et al. Oral chemotherapy safety practices at US cancer centres: questionnaire survey. BMJ. 2007;334(7590). doi:10.1136/bmj.39069.489757.55.
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psnet.ahrq.gov/issue/observation-assessment-clinician-performance-narrative-review
September 09, 2015 - Review
Observation for assessment of clinician performance: a narrative review.
Citation Text:
Yanes AF, McElroy LM, Abecassis ZA, et al. Observation for assessment of clinician performance: a narrative review. BMJ Qual Saf. 2016;25(1):46-55. doi:10.1136/bmjqs-2015-004171.
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psnet.ahrq.gov/issue/piece-my-mind-patient-you-least-want-see
August 14, 2024 - Commentary
A piece of my mind. The patient you least want to see.
Citation Text:
Chen JH. A PIECE OF MY MIND. The Patient You Least Want to See. JAMA. 2016;315(16):1701-2. doi:10.1001/jama.2016.0221.
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psnet.ahrq.gov/issue/innovative-application-bayesian-disease-mapping-methods-patient-safety-research-canadian
October 19, 2022 - Study
An innovative application of Bayesian disease mapping methods to patient safety research: a Canadian adverse medical event study.
Citation Text:
MacNab YC, Kmetic A, Gustafson P, et al. An innovative application of Bayesian disease mapping methods to patient safety research: a Ca…
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psnet.ahrq.gov/issue/advancing-patient-safety-through-clinical-application-framework-focused-communication
December 02, 2020 - Review
Advancing patient safety through the clinical application of a framework focused on communication.
Citation Text:
Manojlovich M, Hofer TP, Krein SL. Advancing Patient Safety Through the Clinical Application of a Framework Focused on Communication. J Patient Saf. 2021;17(8):e732-e7…
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psnet.ahrq.gov/issue/medication-errors-involving-wrong-administration-technique
January 05, 2017 - Study
Medication errors involving wrong administration technique.
Citation Text:
Santell JP, Cousins DD. Medication Errors Involving Wrong Administration Technique. The Joint Commission Journal on Quality and Patient Safety. 2016;31(9). doi:10.1016/s1553-7250(05)31068-3.
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psnet.ahrq.gov/issue/israel-center-medical-simulation-paradigm-cultural-change-medical-education
May 04, 2014 - Commentary
The Israel Center for Medical Simulation: a paradigm for cultural change in medical education.
Citation Text:
Ziv A, Erez D, Munz Y, et al. The Israel Center for Medical Simulation: a paradigm for cultural change in medical education. Acad Med. 2006;81(12):1091-7.
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psnet.ahrq.gov/issue/unintended-errors-ehr-based-result-management-case-series
April 29, 2018 - Commentary
Unintended errors with EHR-based result management: a case series.
Citation Text:
Yackel TR, Embi P. Unintended errors with EHR-based result management: a case series. J Am Med Inform Assoc. 2010;17(1):104-7. doi:10.1197/jamia.M3294.
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psnet.ahrq.gov/issue/prevention-potential-errors-resuscitation-medications-orders-means-computerised-physician
July 05, 2013 - Study
Prevention of potential errors in resuscitation medications orders by means of a computerised physician order entry in paediatric critical care.
Citation Text:
Prevention of potential errors in resuscitation medications orders by means of a computerised physician order entry in p…
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psnet.ahrq.gov/issue/second-victim-contested-term
December 08, 2021 - Study
The second victim: a contested term?
Citation Text:
Tumelty M-E. The second victim: a contested term? J Patient Saf. 2021;17(8):e1488-e1493. doi:10.1097/pts.0000000000000558.
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