-
psnet.ahrq.gov/node/36088/psn-pdf
September 28, 2010 - Lucian Leape also discussed the issue of problem doctors and disruptive behavior
from a systems standpoint
-
psnet.ahrq.gov/node/41958/psn-pdf
April 17, 2013 - An incident of wrong-site surgery is
discussed in an AHRQ WebM&M commentary.
-
psnet.ahrq.gov/node/47204/psn-pdf
July 18, 2018 - A PSNet perspective discussed opioid overdose as a patient safety
problem.
-
psnet.ahrq.gov/node/44688/psn-pdf
February 23, 2018 - An Annual Perspective discussed advances in
the field of diagnostic error.
-
psnet.ahrq.gov/node/42964/psn-pdf
May 10, 2014 - what-learning-review-safety-literature-define-learning-incidents-accidents-and-
disasters
Health care has discussed
-
psnet.ahrq.gov/node/45247/psn-pdf
August 15, 2016 - A recent PSNet interview discussed handoffs and the implementation and findings of the
landmark I-PASS
-
psnet.ahrq.gov/node/44716/psn-pdf
April 15, 2016 - disabilities, such as impaired hearing or speech, are at risk for adverse events
while hospitalized, as discussed
-
psnet.ahrq.gov/node/37659/psn-pdf
March 02, 2011 - difficulty of interpreting and applying evidence from clinical trials to
patient safety efforts, as discussed
-
psnet.ahrq.gov/node/36700/psn-pdf
July 20, 2011 - A previous commentary
discussed the role of preventable and non-preventable patient errors in contributing
-
psnet.ahrq.gov/node/37411/psn-pdf
March 28, 2012 - A
past AHRQ WebM&M commentary also discussed professionalism and the challenges it raises in training
-
psnet.ahrq.gov/node/47027/psn-pdf
June 19, 2018 - Tactics discussed include clear articulation of the problem and contributing factors, use of
theory-driven
-
psnet.ahrq.gov/node/44596/psn-pdf
December 04, 2016 - A previous AHRQ WebM&M interview discussed the importance of
health literacy for patient safety.
-
psnet.ahrq.gov/node/45922/psn-pdf
April 19, 2017 - A past PSNet perspective discussed an approach to reduce interruptions.
-
psnet.ahrq.gov/node/47523/psn-pdf
December 05, 2018 - A
past Annual Perspective discussed how robust handoffs may improve safety outcomes.
-
psnet.ahrq.gov/node/45966/psn-pdf
April 05, 2017 - A past WebM&M commentary discussed operating room fires and how to prevent them.
-
psnet.ahrq.gov/node/44742/psn-pdf
January 06, 2016 - A previous PSNet interview discussed the second victim phenomenon.
-
psnet.ahrq.gov/node/45340/psn-pdf
August 17, 2016 - A past
PSNet Annual Perspective discussed safety and medical education.
-
psnet.ahrq.gov/node/47031/psn-pdf
December 19, 2018 - A WebM&M commentary
discussed an incident involving a patient-detected medication error.
-
psnet.ahrq.gov/node/36046/psn-pdf
June 21, 2006 - Issues discussed include
overcrowding, fragmentation of care, a shortage of on-call specialists, a lack
-
psnet.ahrq.gov/node/47187/psn-pdf
September 05, 2018 - Albert Wu discussed ways
that organizations can support second victims.