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  1. Randomized controlled evaluation of an insulin pen storage policy. | PSNet

    psnet.ahrq.gov/issue/randomized-controlled-evaluation-insulin-pen-storage-policy
    January 23, 2017 - Study Randomized controlled evaluation of an insulin pen storage policy. Citation Text: Gibbs HG, McLernon T, Call R, et al. Randomized controlled evaluation of an insulin pen storage policy. Am J Health Syst Pharm. 2017;74(24):2054-2059. doi:10.2146/ajhp160348. Copy Citation Forma…

  2. Parents' medication administration errors: role of dosing instruments and health literacy. | PSNet

    psnet.ahrq.gov/issue/parents-medication-administration-errors-role-dosing-instruments-and-health-literacy
    May 31, 2017 - Study Parents' medication administration errors: role of dosing instruments and health literacy. Citation Text: Yin S, Mendelsohn A, Wolf MS, et al. Parents' medication administration errors: role of dosing instruments and health literacy. Arch Pediatr Adolesc Med. 2010;164(2):181-6. doi…

  3. Root cause analysis of ICU adverse events in the Veterans Health Administration. | PSNet

    psnet.ahrq.gov/issue/root-cause-analysis-icu-adverse-events-veterans-health-administration
    June 23, 2021 - Study Root cause analysis of ICU adverse events in the Veterans Health Administration. Citation Text: Corwin GS, Mills PD, Shanawani H, et al. Root Cause Analysis of ICU Adverse Events in the Veterans Health Administration. Jt Comm J Qual Patient Saf. 2017;43(11):580-590. doi:10.1016/j.j…

  4. Clinic design for safety during the pandemic: safety or teamwork, can we only pick one? | PSNet

    psnet.ahrq.gov/issue/clinic-design-safety-during-pandemic-safety-or-teamwork-can-we-only-pick-one
    November 11, 2015 - Commentary Clinic design for safety during the pandemic: safety or teamwork, can we only pick one? Citation Text: Lim L, Zimring CM, DuBose JR, et al. Clinic design for safety during the pandemic: safety or teamwork, can we only pick one? HERD. 2022;15(3):28-41. doi:10.1177/1937586722109…

  5. Implementation of a custom alert to prevent medication-timing errors associated with computerized prescriber order entry. | PSNet

    psnet.ahrq.gov/issue/implementation-custom-alert-prevent-medication-timing-errors-associated-computerized
    April 25, 2016 - Study Implementation of a custom alert to prevent medication-timing errors associated with computerized prescriber order entry. Citation Text: Idemoto LM, Williams BL, Ching JM, et al. Implementation of a custom alert to prevent medication-timing errors associated with computerized presc…

  6. Assessing and improving safety culture throughout an academic medical centre: a prospective cohort study. | PSNet

    psnet.ahrq.gov/issue/assessing-and-improving-safety-culture-throughout-academic-medical-centre-prospective-cohort
    January 02, 2017 - Study Assessing and improving safety culture throughout an academic medical centre: a prospective cohort study. Citation Text: Paine LA, Rosenstein BJ, Sexton B, et al. Assessing and improving safety culture throughout an academic medical centre: a prospective cohort study. Qual Saf He…

  7. Register-based research of adverse events revealing incomplete records threatening patient safety. | PSNet

    psnet.ahrq.gov/issue/register-based-research-adverse-events-revealing-incomplete-records-threatening-patient
    October 06, 2021 - Review Register-based research of adverse events revealing incomplete records threatening patient safety. Citation Text: Kinnunen U-M, Kivekäs E, Palojoki S, et al. Register-based research of adverse events revealing incomplete records threatening patient safety. Stud Health Technol Info…

  8. Artificial intelligence in the provision of health care: an American College of Physicians policy position paper. | PSNet

    psnet.ahrq.gov/issue/artificial-intelligence-provision-health-care-american-college-physicians-policy-position
    February 18, 2011 - Organizational Policy/Guidelines Artificial intelligence in the provision of health care: an American College of Physicians policy position paper. Citation Text: Daneshvar N, Pandita D, Erickson S, et al. Artificial Intelligence in the Provision of Health Care: An American College of Phy…

  9. Decreasing handoff-related care failures in children's hospitals. | PSNet

    psnet.ahrq.gov/issue/decreasing-handoff-related-care-failures-childrens-hospitals
    April 24, 2018 - Study Decreasing handoff-related care failures in children's hospitals. Citation Text: Bigham MT, Logsdon TR, Manicone PE, et al. Decreasing handoff-related care failures in children's hospitals. Pediatrics. 2014;134(2):e572-e579. doi:10.1542/peds.2013-1844. Copy Citation Format: …

  10. The potential of artificial intelligence to improve patient safety: a scoping review. | PSNet

    psnet.ahrq.gov/issue/potential-artificial-intelligence-improve-patient-safety-scoping-review
    March 09, 2022 - Review Classic The potential of artificial intelligence to improve patient safety: a scoping review. Citation Text: Bates DW, Levine DM, Syrowatka A, et al. The potential of artificial intelligence to improve patient safety: a scoping review. NPJ Digit Med. 2021…

  11. Systems engineering analysis of diagnostic referral closed-loop processes. | PSNet

    psnet.ahrq.gov/issue/systems-engineering-analysis-diagnostic-referral-closed-loop-processes
    December 07, 2022 - Study Systems engineering analysis of diagnostic referral closed-loop processes. Citation Text: Nehls N, Yap TS, Salant T, et al. Systems engineering analysis of diagnostic referral closed-loop processes. BMJ Open Qual. 2021;10(4):e001603. doi:10.1136/bmjoq-2021-001603. Copy Citation …

  12. Prescribing patterns of heart failure-exacerbating medications following a heart failure hospitalization. | PSNet

    psnet.ahrq.gov/issue/prescribing-patterns-heart-failure-exacerbating-medications-following-heart-failure
    January 26, 2022 - Study Prescribing patterns of heart failure-exacerbating medications following a heart failure hospitalization. Citation Text: Goyal P, Kneifati-Hayek J, Archambault A, et al. Prescribing patterns of heart failure-exacerbating medications following a heart failure hospitalization. JACC H…

  13. Provider-to-provider communication during transitions of care from outpatient to acute care: a systematic review. | PSNet

    psnet.ahrq.gov/issue/provider-provider-communication-during-transitions-care-outpatient-acute-care-systematic
    October 29, 2017 - Review Provider-to-provider communication during transitions of care from outpatient to acute care: a systematic review. Citation Text: Luu N-P, Pitts S, Petty BG, et al. Provider-to-Provider Communication during Transitions of Care from Outpatient to Acute Care: A Systematic Review. J G…

  14. Patient safety strategies targeted at diagnostic errors: a systematic review. | PSNet

    psnet.ahrq.gov/issue/patient-safety-strategies-targeted-diagnostic-errors-systematic-review
    March 20, 2013 - Review Patient safety strategies targeted at diagnostic errors: a systematic review. Citation Text: McDonald KM, Matesic B, Contopoulos-Ioannidis DG, et al. Patient safety strategies targeted at diagnostic errors: a systematic review. Ann Intern Med. 2013;158(5 Pt 2):381-389. doi:10.7…

  15. Patient handover from surgery to intensive care: using Formula 1 pit-stop and aviation models to improve safety and quality. | PSNet

    psnet.ahrq.gov/issue/patient-handover-surgery-intensive-care-using-formula-1-pit-stop-and-aviation-models-improve
    October 03, 2011 - Study Patient handover from surgery to intensive care: using Formula 1 pit-stop and aviation models to improve safety and quality. Citation Text: Catchpole K, de Leval MR, McEwan A, et al. Patient handover from surgery to intensive care: using Formula 1 pit-stop and aviation models to …

  16. Can medical record reviewers reliably identify errors and adverse events in the ED? | PSNet

    psnet.ahrq.gov/issue/can-medical-record-reviewers-reliably-identify-errors-and-adverse-events-ed
    October 11, 2023 - Study Can medical record reviewers reliably identify errors and adverse events in the ED? Citation Text: Klasco RS, Wolfe RE, Lee T, et al. Can medical record reviewers reliably identify errors and adverse events in the ED? Am J Emerg Med. 2016;34(6):1043-8. doi:10.1016/j.ajem.2016.03.00…

  17. 20 years after To Err Is Human: a bibliometric analysis of ‘the IOM report’s’ impact on research on patient safety. | PSNet

    psnet.ahrq.gov/issue/20-years-after-err-human-bibliometric-analysis-iom-reports-impact-research-patient-safety
    July 15, 2020 - Review 20 years after To Err Is Human: a bibliometric analysis of ‘the IOM report’s’ impact on research on patient safety. Citation Text: St.Pierre M, Grawe P, Bergström J, et al. 20 years after To Err Is Human: a bibliometric analysis of ‘the IOM report’s’ impact on research on patient …

  18. It depends who you ask: divergences in staff and external stakeholder narratives about the causes of a healthcare failure. | PSNet

    psnet.ahrq.gov/issue/it-depends-who-you-ask-divergences-staff-and-external-stakeholder-narratives-about-causes
    August 05, 2020 - Study It depends who you ask: divergences in staff and external stakeholder narratives about the causes of a healthcare failure. Citation Text: Hald EJ, Gillespie A, Reader TW. It depends who you ask: divergences in staff and external stakeholder narratives about the causes of a healthca…

  19. Associations between patient safety culture and workplace safety culture in hospital settings. | PSNet

    psnet.ahrq.gov/issue/associations-between-patient-safety-culture-and-workplace-safety-culture-hospital-settings
    December 09, 2020 - Study Associations between patient safety culture and workplace safety culture in hospital settings. Citation Text: Hesgrove B, Zebrak K, Yount N, et al. Associations between patient safety culture and workplace safety culture in hospital settings. BMC Health Serv Res. 2024;24(1):568. do…

  20. Closing the loop: follow-up and feedback in a patient safety program. | PSNet

    psnet.ahrq.gov/issue/closing-loop-follow-and-feedback-patient-safety-program
    January 04, 2017 - Study Closing the loop: follow-up and feedback in a patient safety program. Citation Text: Gandhi TK, Graydon-Baker E, Huber CN, et al. Closing the loop: follow-up and feedback in a patient safety program. Jt Comm J Qual Patient Saf. 2005;31(11):614-21. Copy Citation Format: …
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