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  1. Nursing home staff turnover and perceived patient safety culture: results from a national survey. | PSNet

    psnet.ahrq.gov/issue/nursing-home-staff-turnover-and-perceived-patient-safety-culture-results-national-survey
    June 30, 2021 - Study Nursing home staff turnover and perceived patient safety culture: results from a national survey. Citation Text: Temkin-Greener H, Cen X, Li Y. Nursing home staff turnover and perceived patient safety culture: results from a national survey. Gerontologist. 2020;60(7):1303-1311. doi…

  2. Patient safety in nursing homes from an ecological perspective: an integrated review. | PSNet

    psnet.ahrq.gov/issue/patient-safety-nursing-homes-ecological-perspective-integrated-review
    December 07, 2022 - Review Patient safety in nursing homes from an ecological perspective: an integrated review. Citation Text: Min D, Park S, Kim S, et al. Patient safety in nursing homes from an ecological perspective: an integrated review. J Patient Saf. 2024;20(2):77-84. doi:10.1097/pts.0000000000001189…

  3. Using co-design to develop a collective leadership intervention for healthcare teams to improve safety culture. | PSNet

    psnet.ahrq.gov/issue/using-co-design-develop-collective-leadership-intervention-healthcare-teams-improve-safety
    October 02, 2019 - Commentary Emerging Classic Using co-design to develop a collective leadership intervention for healthcare teams to improve safety culture. Citation Text: Ward ME, De Brún A, Beirne D, et al. Using Co-Design to Develop a Collective Leadership Intervention for He…

  4. Effects of a clinical pharmacist service on health-related quality of life and prescribing of drugs: a randomised controlled trial. | PSNet

    psnet.ahrq.gov/issue/effects-clinical-pharmacist-service-health-related-quality-life-and-prescribing-drugs
    December 14, 2022 - Study Effects of a clinical pharmacist service on health-related quality of life and prescribing of drugs: a randomised controlled trial. Citation Text: Bladh L, Ottosson E, Karlsson J, et al. Effects of a clinical pharmacist service on health-related quality of life and prescribing of…

  5. Automated search methods for identifying wrong patient order entry-a scoping review. | PSNet

    psnet.ahrq.gov/issue/automated-search-methods-identifying-wrong-patient-order-entry-scoping-review
    June 14, 2023 - Study Automated search methods for identifying wrong patient order entry-a scoping review. Citation Text: Garrod M, Fox A, Rutter P. Automated search methods for identifying wrong patient order entry—a scoping review. JAMIA Open. 2023;6(3):ooad057. doi:10.1093/jamiaopen/ooad057. Copy C…

  6. Analyzing and mitigating the risks of patient harm during operating room to intensive care unit patient handoffs. | PSNet

    psnet.ahrq.gov/issue/analyzing-and-mitigating-risks-patient-harm-during-operating-room-intensive-care-unit-patient
    October 05, 2022 - Commentary Analyzing and mitigating the risks of patient harm during operating room to intensive care unit patient handoffs. Citation Text: Martins NRS, Martinez EZ, Simões CM, et al. Analyzing and mitigating the risks of patient harm during operating room to intensive care unit patient …

  7. Influence of socioeconomic bias on emergency medicine resident decision making and patient care. | PSNet

    psnet.ahrq.gov/issue/influence-socioeconomic-bias-emergency-medicine-resident-decision-making-and-patient-care
    March 02, 2022 - Study Influence of socioeconomic bias on emergency medicine resident decision making and patient care. Citation Text: Fasano HT, McCarter MSJ, Simonis JM, et al. Influence of socioeconomic bias on emergency medicine resident decision making and patient care. Simul Healthc. 2021;6(2):85-9…

  8. Inter-hospital transfer is an independent risk factor for hospital-associated infection. | PSNet

    psnet.ahrq.gov/issue/inter-hospital-transfer-independent-risk-factor-hospital-associated-infection
    August 26, 2011 - Study Inter-hospital transfer is an independent risk factor for hospital-associated infection. Citation Text: Gardner C, Rubinfeld IS, Gupta AH, et al. Inter-hospital transfer is an independent risk factor for hospital-associated infection. Surg Infect (Larchmt). 2024;25(2):125-132. doi:…

  9. Enhancing psychological safety in mental health services. | PSNet

    psnet.ahrq.gov/issue/enhancing-psychological-safety-mental-health-services
    May 12, 2021 - Commentary Classic Enhancing psychological safety in mental health services. Citation Text: Hunt DF, Bailey J, Lennox BR, et al. Enhancing psychological safety in mental health services. Int J Ment Health Syst. 2021;15(1):33. doi:10.1186/s13033-021-00439-1. Co…

  10. Inappropriate dosing of direct oral anticoagulants in patients with atrial fibrillation. | PSNet

    psnet.ahrq.gov/issue/inappropriate-dosing-direct-oral-anticoagulants-patients-atrial-fibrillation
    August 04, 2021 - Study Emerging Classic Inappropriate dosing of direct oral anticoagulants in patients with atrial fibrillation. Citation Text: Sugrue A, Sanborn D, Amin M, et al. Inappropriate dosing of direct oral anticoagulants in patients with atrial fibrillation. Am J Cardi…

  11. Warm Handoffs: A Guide for Clinicians (pdf file)

    www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-family-engagement/pfeprimarycare/warm-handoff-guide-for-clinicians.pdf
    June 02, 2025 - Warm Handoffs: A Guide for Clinicians Why is it important? Communication breakdowns can result in medical errors. Warm handoffs can help address communication issues and: ■ Engage patients and families and encourage them to ask questions. ■ Allow patients to clarify or correct the information exchanged. ■…

  12. Warm Handoffs: A Guide for Staff (pdf file)

    www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-family-engagement/pfeprimarycare/warm-handoff-guide-for-staff.pdf
    June 02, 2025 - Warm Handoffs: A Guide for Staff Why is it important? Warm handoffs can: ■ Engage patients and families as team members. ■ Allow patients to clarify or correct the information exchanged. ■ Build relationships. ■ Provide a safety check. Guide to Patient and Family Engagement in Primary Care How do I conduc…

  13. Levels of agreement on the grading, analysis and reporting of significant events by general practitioners: a cross-sectional study. | PSNet

    psnet.ahrq.gov/issue/levels-agreement-grading-analysis-and-reporting-significant-events-general-practitioners
    April 06, 2011 - Study Levels of agreement on the grading, analysis and reporting of significant events by general practitioners: a cross-sectional study. Citation Text: McKay J, Bowie P, Murray L, et al. Levels of agreement on the grading, analysis and reporting of significant events by general practit…

  14. Opioid dependence and overdose after surgery: rate, risk factors, and reasons. | PSNet

    psnet.ahrq.gov/issue/opioid-dependence-and-overdose-after-surgery-rate-risk-factors-and-reasons
    August 05, 2020 - Study Opioid dependence and overdose after surgery: rate, risk factors, and reasons. Citation Text: Wylie JA, Kong L, Barth RJ. Opioid dependence and overdose after surgery: rate, risk factors, and reasons. Ann Surg. 2022;276(3):e192-e198. doi:10.1097/sla.0000000000005546. Copy Citatio…

  15. A randomized trial of electronic clinical reminders to improve medication laboratory monitoring. | PSNet

    psnet.ahrq.gov/issue/randomized-trial-electronic-clinical-reminders-improve-medication-laboratory-monitoring
    June 11, 2014 - Study Classic A randomized trial of electronic clinical reminders to improve medication laboratory monitoring. Citation Text: Matheny ME, Sequist TD, Seger AC, et al. A randomized trial of electronic clinical reminders to improve medication laboratory monitori…

  16. Motivation for patient engagement in patient safety: a multi-perspective, explorative survey. | PSNet

    psnet.ahrq.gov/issue/motivation-patient-engagement-patient-safety-multi-perspective-explorative-survey
    June 17, 2020 - Study Motivation for patient engagement in patient safety: a multi-perspective, explorative survey. Citation Text: Raab C, Gambashidze N, Brust L, et al. Motivation for patient engagement in patient safety: a multi-perspective, explorative survey. BMC Health Serv Res. 2024;24(1):1052. do…

  17. AHRQ Quality Indicators™ Prevention Quality Indicators (pdf file)

    qualityindicators.ahrq.gov/Downloads/Modules/PQI/V50/PQI_Brochure.pdf
    April 01, 2022 - AHRQ Quality Indicators™ Prevention Quality Indicators AHRQ Quality Indicators™ Prevention Quality Indicators Measures to help assess quality and access to health care in the community Prevention Quality Indicators— ■ …

  18. The role of AI in detecting and mitigating human errors in safety-critical industries: a review. | PSNet

    psnet.ahrq.gov/issue/role-ai-detecting-and-mitigating-human-errors-safety-critical-industries-review
    January 15, 2025 - Review The role of AI in detecting and mitigating human errors in safety-critical industries: a review. Citation Text: Gursel E, Madadi M, Coble JB, et al. The role of AI in detecting and mitigating human errors in safety-critical industries: a review. Reliability Eng System Saf. 2025;25…

  19. Nurse managers' leadership, patient safety, and quality of care: a systematic review. | PSNet

    psnet.ahrq.gov/issue/nurse-managers-leadership-patient-safety-and-quality-care-systematic-review
    September 09, 2020 - Review Nurse managers' leadership, patient safety, and quality of care: a systematic review. Citation Text: Lee SE, Hyunjie L, Sang S. Nurse managers' leadership, patient safety, and quality of care: a systematic review. West J Nurs Res. 2023;45(2):176-185. doi:10.1177/01939459221114079.…

  20. Racism in health services for adolescents: a scoping review. | PSNet

    psnet.ahrq.gov/issue/racism-health-services-adolescents-scoping-review
    July 19, 2023 - Review Racism in health services for adolescents: a scoping review. Citation Text: Hilario C, Louie-Poon S, Taylor M, et al. Racism in health services for adolescents: a scoping review. Int J Soc Determinants Health Health Serv. 2023;53(3):343-353. doi:10.1177/27551938231162560. Copy C…
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