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  1. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/37193/psn-pdf
    October 06, 2011 - Incomplete EHR adoption: late uptake of patient safety and cost control functions. October 6, 2011 Menachemi N, Ford E, Beitsch LM, et al. Incomplete EHR adoption: late uptake of patient safety and cost control functions. Am J Med Qual. 2007;22(5):319-26. https://psnet.ahrq.gov/issue/incomplete-ehr-adoption-late-u…
  2. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/838930/psn-pdf
    October 26, 2022 - Artificial Intelligence in Health Care: Benefits and Challenges of Machine Learning Technologies for Medical Diagnostics. October 26, 2022 Washington DC: United States Government Accountability Office and National Academy of Medicine;  September 2022. Report no. GAO-22-104629. https://psnet.ahrq.gov/issue/ar…
  3. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/50424/psn-pdf
    September 04, 2019 - From box ticking to the black box: the evolution of operating room safety. September 4, 2019 Goldenberg MG, Elterman D. From box ticking to the black box: the evolution of operating room safety. World J Urol. 2019;38(6):1369-1372. doi:10.1007/s00345-019-02886-5. https://psnet.ahrq.gov/issue/box-ticking-black-box-e…
  4. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/42655/psn-pdf
    February 21, 2015 - Perceptions of medical errors in cancer care: an analysis of how the news media describe sentinel events. February 21, 2015 Li JW, Morway L, Velasquez A, et al. Perceptions of medical errors in cancer care: an analysis of how the news media describe sentinel events. J Patient Saf. 2015;11(1):42-51. doi:10.1097/PTS…
  5. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/44800/psn-pdf
    November 23, 2016 - Patients' and families' perspectives of patient safety at the end of life: a video-reflexive ethnography study. November 23, 2016 Collier A, Sorensen R, Iedema R. Patients' and families' perspectives of patient safety at the end of life: a video-reflexive ethnography study. Int J Qual Health Care. 2016;28(1):66-73.…
  6. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/839834/psn-pdf
    November 09, 2022 - Medicare fines for high hospital readmissions drop, but nearly 2,300 facilities are still penalized. November 9, 2022 Rau J.  Kaiser Health News. November 1, 2022. https://psnet.ahrq.gov/issue/medicare-fines-high-hospital-readmissions-drop-nearly-2300-facilities-are-still- penalized The COVID-19 pandemic nec…
  7. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/44290/psn-pdf
    April 10, 2023 - Retained surgical sponge (gossypiboma) and other retained surgical items: prevention and management. April 10, 2023 Copeland AW. UpToDate. April 10, 2023. https://psnet.ahrq.gov/issue/retained-surgical-sponge-gossypiboma-and-other-retained-surgical-items- prevention-and Retained surgical items are rare and potent…
  8. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/47574/psn-pdf
    November 21, 2018 - The architecture of safety: an emerging priority for improving patient safety. November 21, 2018 Joseph A, Henriksen K, Malone E. The Architecture Of Safety: An Emerging Priority For Improving Patient Safety. Health Aff (Millwood). 2018;37(11):1884-1891. doi:10.1377/hlthaff.2018.0643. https://psnet.ahrq.gov/issue/…
  9. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/44677/psn-pdf
    June 07, 2016 - Computerised prescribing for safer medication ordering: still a work in progress. June 7, 2016 Schiff G, Hickman T-TT, Volk LA, et al. Computerised prescribing for safer medication ordering: still a work in progress. BMJ Qual Saf. 2016;25(5):315-9. doi:10.1136/bmjqs-2015-004677. https://psnet.ahrq.gov/issue/comput…
  10. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/45341/psn-pdf
    July 27, 2016 - How to avoid catastrophic events on the ward. July 27, 2016 Bein B, Seewald S, Gräsner J-T. How to avoid catastrophic events on the ward. Best Pract Res Clin Anaesthesiol. 2016;30(2):237-45. doi:10.1016/j.bpa.2016.04.003. https://psnet.ahrq.gov/issue/how-avoid-catastrophic-events-ward Hospitals require robust esca…
  11. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/839322/psn-pdf
    November 02, 2022 - A perfect storm averted: flawed systems, a dropped ball, and cognitive biases delay a critical diagnosis. November 2, 2022 Roberts TJ, Sellars MC, Sands JM, et al. A perfect storm averted: flawed systems, a dropped ball, and cognitive biases delay a critical diagnosis. JCO Oncol Pract. 2022;18(12):833-839. doi:10.…
  12. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/46175/psn-pdf
    September 24, 2017 - Applying lessons from social psychology to transform the culture of error disclosure. September 24, 2017 Han J, LaMarra D, Vapiwala N. Applying lessons from social psychology to transform the culture of error disclosure. Med Educ. 2017;51(10):996-1001. doi:10.1111/medu.13345. https://psnet.ahrq.gov/issue/applying-…
  13. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/46426/psn-pdf
    September 28, 2017 - Toward more proactive approaches to safety in the electronic health record era. September 28, 2017 Sittig DF, Singh H. Toward More Proactive Approaches to Safety in the Electronic Health Record Era. Jt Comm J Qual Patient Saf. 2017;43(10):540-547. doi:10.1016/j.jcjq.2017.06.005. https://psnet.ahrq.gov/issue/toward…
  14. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/46315/psn-pdf
    December 16, 2017 - Recognition and prevention of nosocomial malnutrition: a review and a call to action! December 16, 2017 Kirkland LL, Shaughnessy E. Recognition and Prevention of Nosocomial Malnutrition: A Review and A Call to Action!. Am J Med. 2017;130(12):1345-1350. doi:10.1016/j.amjmed.2017.07.034. https://psnet.ahrq.gov/issue…
  15. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/46011/psn-pdf
    January 17, 2018 - Health and Social Care Ergonomics: Patient Safety in Practice. January 17, 2018 Hignett S, Albolino S, Catchpole K, eds. Ergonomics. 2018;61:1-161. https://psnet.ahrq.gov/issue/health-and-social-care-ergonomics-patient-safety-practice Human factors engineering strategies offer a range of solutions to improve proce…
  16. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/45669/psn-pdf
    January 23, 2017 - Overdiagnosis of coronary artery disease detected by coronary computed tomography angiography: a teachable moment. January 23, 2017 Schmidt T, Maag R, Foy AJ. Overdiagnosis of Coronary Artery Disease Detected by Coronary Computed Tomography Angiography: A Teachable Moment. JAMA Intern Med. 2016;176(12):1747-1748. …
  17. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/44210/psn-pdf
    September 09, 2015 - The future of graduate medical education: a systems- based approach to ensure patient safety. September 9, 2015 Bagian JP. The Future of Graduate Medical Education: A Systems-Based Approach to Ensure Patient Safety. Acad Med. 2015;90(9):1199-202. doi:10.1097/ACM.0000000000000824. https://psnet.ahrq.gov/issue/futur…
  18. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/851665/psn-pdf
    July 26, 2023 - Adverse Events Toolkit: Medical Record Review Methodology. July 26, 2023 Maxwell A. Washington, DC: US Department of Health and Human Services, Office of the Inspector General; July 2023. Report no. OEI-06-21-00030. https://psnet.ahrq.gov/issue/adverse-events-toolkit-medical-record-review-methodology Medical…
  19. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/849122/psn-pdf
    May 17, 2023 - Structural racism in behavioral health presentation and management. May 17, 2023 Rainer T, Lim JK, He Y, et al. Structural racism in behavioral health presentation and management. Hosp Pediatr. 2023;13(5):461-470. doi:10.1542/hpeds.2023-007133. https://psnet.ahrq.gov/issue/structural-racism-behavioral-health-prese…
  20. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/838193/psn-pdf
    September 28, 2022 - Economics of Medication Safety. Improving Medication Safety Through Collective, Real-time Learning. September 28, 2022 de Bienassis K, Esmail L, Lopert R, Klazinga N for the Organisation for Economic Co-operation and Development. Paris, France: OECD Publishing; 2022. OECD Health Working Papers, No. 147. …