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psnet.ahrq.gov/node/48030/psn-pdf
May 22, 2019 - A culture of openness is associated with lower mortality
rates among 137 English National Health Service acute
trusts.
May 22, 2019
Toffolutti V, Stuckler D. A Culture Of Openness Is Associated With Lower Mortality Rates Among 137
English National Health Service Acute Trusts. Health Aff (Millwood). 2019;38(5):844-…
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psnet.ahrq.gov/node/44471/psn-pdf
September 27, 2016 - Two sides of the safety coin?: how patient engagement
and safety climate jointly affect error occurrence in
hospital units.
September 27, 2016
Schiffinger M, Latzke M, Steyrer J. Two sides of the safety coin?: How patient engagement and safety
climate jointly affect error occurrence in hospital units. Health Care …
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psnet.ahrq.gov/node/857449/psn-pdf
December 06, 2023 - "ChatGPT, can you help me save my child's life?" -
Diagnostic accuracy and supportive capabilities to lay
rescuers by ChatGPT in prehospital basic life support and
paediatric advanced life support cases - an in-silico
analysis.
December 6, 2023
Bushuven S, Bentele M, Bentele S, et al. "ChatGPT, can you help me sa…
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psnet.ahrq.gov/node/44039/psn-pdf
December 23, 2016 - Safe use of health information technology.
December 23, 2016
Sentinel Event Alert. March 31, 2015;(54):1-6.
https://psnet.ahrq.gov/issue/safe-use-health-information-technology
The introduction of information technology (IT) has transformed health care, but it is clear that the rapid
uptake of IT has profoundly cha…
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psnet.ahrq.gov/node/40618/psn-pdf
August 27, 2012 - Predictors of likelihood of speaking up about safety
concerns in labour and delivery.
August 27, 2012
Lyndon A, Sexton B, Simpson KR, et al. Correction. BMJ Qual Saf. 2011;22(2):791-799.
doi:10.1136/bmjqs.2010.050211.
https://psnet.ahrq.gov/issue/predictors-likelihood-speaking-about-safety-concerns-labour-and-deli…
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psnet.ahrq.gov/node/41941/psn-pdf
February 11, 2013 - A cross-sectional study on the relationship between
utilization of root cause analysis and patient safety at 139
Department of Veterans Affairs medical centers.
February 11, 2013
Percarpio KB, Watts V. A cross-sectional study on the relationship between utilization of root cause
analysis and patient safety at 139 …
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psnet.ahrq.gov/node/45167/psn-pdf
May 25, 2016 - AHRQ Communication and Optimal Resolution (CANDOR)
Toolkit.
May 25, 2016
Rockville, MD: Agency for Healthcare Research and Quality; May 2016.
https://psnet.ahrq.gov/issue/ahrq-communication-and-optimal-resolution-candor-toolkit
Traditionally, health systems have disclosed adverse events to patients only through a …
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psnet.ahrq.gov/node/42352/psn-pdf
January 14, 2014 - Doing well by doing good: assessing the cost savings of
an intervention to reduce central line-associated
bloodstream infections in a Hawaii hospital.
January 14, 2014
Hsu E, Lin D, Evans SJ, et al. Doing well by doing good: assessing the cost savings of an intervention to
reduce central line-associated bloodstrea…
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psnet.ahrq.gov/node/46232/psn-pdf
February 10, 2018 - Implications of electronic health record downtime: an
analysis of patient safety event reports.
February 10, 2018
Larsen E, Fong A, Wernz C, et al. Implications of electronic health record downtime: an analysis of patient
safety event reports. J Am Med Inform Assoc. 2018;25(2):187-191. doi:10.1093/jamia/ocx057.
ht…
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psnet.ahrq.gov/node/47104/psn-pdf
December 04, 2018 - Deriving a framework for a systems approach to agitated
patient care in the emergency department.
December 4, 2018
Wong AH, Ruppel H, Crispino LJ, et al. Deriving a Framework for a Systems Approach to Agitated Patient
Care in the Emergency Department. Jt Comm J Qual Patient Saf. 2018;44(5):279-292.
doi:10.1016/j.j…
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psnet.ahrq.gov/node/40586/psn-pdf
March 21, 2017 - Adopting real-time surveillance dashboards as a
component of an enterprisewide medication safety
strategy.
March 21, 2017
Waitman LR, Phillips IE, McCoy AB, et al. Adopting real-time surveillance dashboards as a component of
an enterprisewide medication safety strategy. Jt Comm J Qual Patient Saf. 2011;37(7):326-3…
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psnet.ahrq.gov/node/41535/psn-pdf
December 31, 2014 - Understanding and preventing wrong-patient electronic
orders: a randomized controlled trial.
December 31, 2014
Adelman JS, Kalkut GE, Schechter CB, et al. Understanding and preventing wrong-patient electronic
orders: a randomized controlled trial. J Am Med Inform Assoc. 2013;20(2):305-310. doi:10.1136/amiajnl-
201…
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psnet.ahrq.gov/node/47875/psn-pdf
July 19, 2019 - Observer-based tools for non-technical skills assessment
in simulated and real clinical environments in healthcare:
a systematic review.
July 19, 2019
Higham H, Greig PR, Rutherford J, et al. Observer-based tools for non-technical skills assessment in
simulated and real clinical environments in healthcare: a syste…
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psnet.ahrq.gov/node/40946/psn-pdf
January 19, 2012 - Effects of a multicentre teamwork and communication
programme on patient outcomes: results from the Triad
for Optimal Patient Safety (TOPS) project.
January 19, 2012
Auerbach AD, Sehgal NL, Blegen MA, et al. Effects of a multicentre teamwork and communication
programme on patient outcomes: results from the Triad f…
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psnet.ahrq.gov/node/43687/psn-pdf
November 12, 2014 - Changes in medical errors after implementation of a
handoff program.
November 12, 2014
Starmer AJ, Spector ND, Srivastava R, et al. Changes in medical errors after implementation of a handoff
program. New Engl J Med. 2014;371(19):1803-1812. doi:10.1056/NEJMsa1405556.
https://psnet.ahrq.gov/issue/changes-medical-er…
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psnet.ahrq.gov/node/42298/psn-pdf
December 31, 2014 - Using statistical text classification to identify health
information technology incidents.
December 31, 2014
Chai KEK, Anthony S, Coiera E, et al. Using statistical text classification to identify health information
technology incidents. J Am Med Inform Assoc. 2013;20(5):980-5. doi:10.1136/amiajnl-2012-001409.
htt…
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psnet.ahrq.gov/node/47742/psn-pdf
February 20, 2019 - AHRQ Nursing Home Survey on Patient Safety Culture:
2019 User Comparative Database Report.
February 20, 2019
Famolaro T, Yount ND, Hare R, et al. Rockville, MD: Agency for Healthcare Research and Quality;
February 2019. AHRQ Publication No. 19-0027-EF.
https://psnet.ahrq.gov/issue/ahrq-nursing-home-survey-patient-…
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psnet.ahrq.gov/node/38829/psn-pdf
January 03, 2017 - Implementing standardized operating room briefings and
debriefings at a large regional medical center.
January 3, 2017
Berenholtz SM, Schumacher K, Hayanga AJ, et al. Implementing standardized operating room briefings
and debriefings at a large regional medical center. Jt Comm J Qual Patient Saf. 2009;35(8):391-7.
…
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psnet.ahrq.gov/node/46245/psn-pdf
June 28, 2017 - Associations between patient factors and adverse events
in the home care setting: a secondary data analysis of
two Canadian adverse event studies.
June 28, 2017
Sears NA, Blais R, Spinks M, et al. Associations between patient factors and adverse events in the home
care setting: a secondary data analysis of two can…
-
psnet.ahrq.gov/node/45113/psn-pdf
May 11, 2016 - Medical error—the third leading cause of death in the US.
May 11, 2016
Makary MA, Daniel M. Medical error-the third leading cause of death in the US. BMJ. 2016;353:i2139.
doi:10.1136/bmj.i2139.
https://psnet.ahrq.gov/issue/medical-error-third-leading-cause-death-us
How many patients die each year due to preventabl…