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psnet.ahrq.gov/issue/multiple-points-system-failure-underpin-continuous-subcutaneous-infusion-safety-incidents
December 16, 2020 - Study
Multiple points of system failure underpin continuous subcutaneous infusion safety incidents in palliative care: a mixed methods analysis.
Citation Text:
Brown AJ, Yardley S, Bowers B, et al. Multiple points of system failure underpin continuous subcutaneous infusion safety inciden…
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psnet.ahrq.gov/issue/infusional-chemotherapy-and-medication-errors-tertiary-care-pediatric-cancer-unit-resource
October 29, 2012 - Study
Infusional chemotherapy and medication errors in a tertiary care pediatric cancer unit in a resource-limited setting.
Citation Text:
Dhamija M, Kapoor G, Juneja A. Infusional chemotherapy and medication errors in a tertiary care pediatric cancer unit in a resource-limited setting. …
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psnet.ahrq.gov/issue/assessment-overuse-medical-tests-and-treatments-us-hospitals-using-medicare-claims
August 11, 2021 - Study
Assessment of overuse of medical tests and treatments at US hospitals using Medicare claims.
Citation Text:
Chalmers K, Smith P, Garber J, et al. Assessment of overuse of medical tests and treatments at US hospitals using Medicare claims. JAMA Netw Open. 2021;4(4):e218075. doi:10.1…
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psnet.ahrq.gov/issue/screening-electronic-health-record-related-patient-safety-reports-using-machine-learning
May 30, 2016 - Study
Screening electronic health record–related patient safety reports using machine learning.
Citation Text:
Marella WM, Sparnon E, Finley E. Screening Electronic Health Record–Related Patient Safety Reports Using Machine Learning. J Patient Saf. 2014;13(1):31-36. doi:10.1097/pts.00000…
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psnet.ahrq.gov/issue/medication-errors-among-adults-and-children-cancer-outpatient-setting
January 16, 2010 - Study
Medication errors among adults and children with cancer in the outpatient setting.
Citation Text:
Walsh KE, Dodd KS, Seetharaman K, et al. Medication errors among adults and children with cancer in the outpatient setting. J Clin Oncol. 2009;27(6):891-6. doi:10.1200/JCO.2008.18.60…
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psnet.ahrq.gov/issue/injury-and-liability-associated-monitored-anesthesia-care-closed-claims-analysis
June 23, 2009 - Study
Injury and liability associated with monitored anesthesia care: a closed claims analysis.
Citation Text:
Bhananker SM, Posner KL, Cheney FW, et al. Injury and liability associated with monitored anesthesia care: a closed claims analysis. Anesthesiology. 2006;104(2):228-234.
Cop…
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psnet.ahrq.gov/issue/system-issues-leading-found-floor-incidents-multi-incident-analysis
August 04, 2021 - Study
System issues leading to "found-on-floor" incidents: a multi-incident analysis.
Citation Text:
Shaw J, Bastawrous M, Burns S, et al. System Issues Leading to “Found-on-Floor” Incidents: A Multi-Incident Analysis. J Patient Saf. 2021;17(1):30-35. doi:10.1097/pts.0000000000000294.
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psnet.ahrq.gov/issue/integrating-principles-safety-culture-and-just-culture-nursing-homes-lessons-pandemic
October 28, 2020 - Commentary
Integrating principles of safety culture and just culture into nursing homes: lessons from the pandemic.
Citation Text:
Gaur S, Kumar R, Gillespie SM, et al. Integrating Principles of Safety Culture and Just Culture Into Nursing Homes: Lessons From the Pandemic. J Am Med Dir A…
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psnet.ahrq.gov/issue/quality-framework-remote-antenatal-care-qualitative-study-women-healthcare-professionals-and
October 21, 2020 - Study
Quality framework for remote antenatal care: qualitative study with women, healthcare professionals and system-level stakeholders.
Citation Text:
Hinton L, Dakin FH, Kuberska K, et al. Quality framework for remote antenatal care: qualitative study with women, healthcare professiona…
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psnet.ahrq.gov/issue/learning-mistakes-easier-said-done-group-and-organizational-influences-detection-and
September 25, 2024 - Study
Classic
Learning from mistakes is easier said than done: group and organizational influences on the detection and correction of human error.
Citation Text:
Edmondson AC. Learning from Mistakes is Easier Said Than Done: Group and Organizational Influences o…
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psnet.ahrq.gov/issue/experiences-and-perceptions-healthcare-stakeholders-disclosing-errors-and-adverse-events
July 31, 2024 - Study
Experiences and perceptions of healthcare stakeholders in disclosing errors and adverse events to historically marginalized patients.
Citation Text:
Olazo K, Gallagher TH, Sarkar U. Experiences and perceptions of healthcare stakeholders in disclosing errors and adverse events to hi…
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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.
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digital.ahrq.gov/ahrq-funded-projects/using-health-information-technology-improve-transitions-complex-elderly/annual-summary/2011
January 01, 2011 - Using Health Information Technology to Improve Transitions of Complex Elderly Patients from Skilled Nursing Facilities (SNF) to Home - 2011
Project Name
Using Health Information Technology to Improve Transitions of Complex Elderly Patients from Skilled Nursing Facilities (SNF) to Home
Princi…
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psnet.ahrq.gov/issue/preserving-organizational-resilience-patient-safety-and-staff-retention-during-covid-19
May 08, 2019 - Commentary
Classic
Preserving organizational resilience, patient safety, and staff retention during COVID-19 requires a holistic consideration of the psychological safety of healthcare workers
Citation Text:
Rangachari P, L. Woods J. Preserving organizational re…
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hcup-us.ahrq.gov/db/nation/kid/kidrelatedreports.jsp
December 01, 2022 - KID Related Reports
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hcup-us.ahrq.gov/reports/methods/2005-07.pdf
January 01, 2005 - This document describes how to calculate simple statistics, including variances, from the KID,
taking … This document describes how to calculate statistics, including variances, from the KID, taking
into
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effectivehealthcare.ahrq.gov/sites/default/files/pdf/methods-balancing-harms-benefits_research.pdf
February 01, 2014 - Table 2 describes assumptions that apply to both approaches, except relative
weights are not required
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cds.ahrq.gov/sites/default/files/cds/artifact/1061/CDS%20Connect_Year%203%20Pilot%20Report_Final.pdf
September 01, 2019 - This section describes the
integration of the CDS logic into b.well’s IT platform, as well as associated
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cds.ahrq.gov/sites/default/files/cds/artifact/1061/2019%20CDS%20Connect_Year%203%20Pilot%20Report_Final.pdf
January 01, 2019 - This section describes the
integration of the CDS logic into b.well’s IT platform, as well as associated
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cds.ahrq.gov/sites/default/files/cds/artifact/1056/CDS%20Connect_Year%203%20Pilot%20Report_Final.pdf
September 01, 2019 - This section describes the
integration of the CDS logic into b.well’s IT platform, as well as associated