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psnet.ahrq.gov/issue/second-opinions-improve-healthcare-outcomes-and-reduce-costs
April 12, 2023 - Newspaper/Magazine Article
Second opinions improve healthcare outcomes and reduce costs.
Citation Text:
Hébert AR. Second opinions improve healthcare outcomes and reduce costs. Employee Benefit News. 2020;June 8.
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psnet.ahrq.gov/issue/death-due-pharmacy-compounding-error-reinforces-need-safety-focus
May 31, 2017 - Newspaper/Magazine Article
Death due to pharmacy compounding error reinforces need for safety focus.
Citation Text:
Death due to pharmacy compounding error reinforces need for safety focus. ISMP Medication Safety Alert! Acute Care Edition. June 15, 2017;22:1-4.
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psnet.ahrq.gov/issue/cognitive-systems-engineering-health-care
October 11, 2016 - Book/Report
Cognitive Systems Engineering in Health Care.
Citation Text:
Cognitive Systems Engineering in Health Care. Bisantz AM, Burns CM, Fairbanks RJ, eds. Boca Raton, FL: CRC Press; 2014. ISBN: 9781466587960.
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psnet.ahrq.gov/issue/perinatal-patient-safety-and-quality
January 19, 2022 - Commentary
Perinatal patient safety and quality.
Citation Text:
Simpson KR. Perinatal patient safety and quality. J Perinat Neonatal Nurs. 2011;25(2):103-107. doi:10.1097/JPN.0b013e318215b9e5.
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psnet.ahrq.gov/issue/mean-girls-er-alarming-nurse-culture-bullying-and-hazing
November 01, 2017 - Newspaper/Magazine Article
Mean girls of the ER: the alarming nurse culture of bullying and hazing.
Citation Text:
Mean girls of the ER: the alarming nurse culture of bullying and hazing. Robbins A. Good Housekeeping. May 20, 2016.
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psnet.ahrq.gov/issue/latent-and-active-failures-perfectly-align-allow-preventable-adverse-event-reach-patient
March 14, 2023 - Newspaper/Magazine Article
Latent and active failures perfectly align to allow a preventable adverse event to reach a patient.
Citation Text:
Latent and active failures perfectly align to allow a preventable adverse event to reach a patient. ISMP Medication Safety Alert! Acute care editi…
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psnet.ahrq.gov/issue/risk-society-and-system-failure
November 29, 2023 - Commentary
Risk, society and system failure.
Citation Text:
Scalliet P. Risk, society and system failure. Radiotherapy and Oncology. 2006;80(3). doi:10.1016/j.radonc.2006.07.003.
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psnet.ahrq.gov/issue/ncicle-pathways-excellence-expectations-optimal-clinical-learning-environment-achieve-safe
October 18, 2017 - Book/Report
NCICLE Pathways to Excellence: Expectations for an Optimal Clinical Learning Environment to Achieve Safe and High-Quality Patient Care, 2021.
Citation Text:
NCICLE Pathways to Excellence: Expectations for an Optimal Clinical Learning Environment to Achieve Safe and High-Quali…
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psnet.ahrq.gov/issue/costs-medical-injuries-utah-and-colorado
June 30, 2021 - Study
Classic
Costs of medical injuries in Utah and Colorado.
Citation Text:
Costs of medical injuries in Utah and Colorado. Thomas EJ; Studdert DM; Newhouse JP; Zbar BI; Howard KM; Williams EJ; Brennan TA
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psnet.ahrq.gov/issue/medication-errors-year-review
May 02, 2018 - Newspaper/Magazine Article
Medication errors: the year in review.
Citation Text:
Medication errors: the year in review. Valentine D, Ingram V, Fobi B et al. Pharmacy Practice News. September 10, 2019.
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psnet.ahrq.gov/issue/learning-others-legal-aspects-sharing-patient-safety-data-using-provider-consortia
May 04, 2019 - Commentary
Learning from others: legal aspects of sharing patient safety data using provider consortia.
Citation Text:
Learning from others: legal aspects of sharing patient safety data using provider consortia. Liang BA; Weinger MB; Suydam S. J Patient Saf 2005;1:83–89
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psnet.ahrq.gov/issue/improving-americas-hospitals-joint-commissions-annual-report-quality-and-safety-2009
September 21, 2011 - Book/Report
Improving America's Hospitals: The Joint Commission's Annual Report on Quality and Safety 2009.
Citation Text:
Improving America's Hospitals: The Joint Commission's Annual Report on Quality and Safety 2009. Oakbrook Terrace, IL: The Joint Commission; January 2010.
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psnet.ahrq.gov/issue/handoff-checklists-improve-reliability-patient-handoffs-operating-room-and-postanesthesia
December 29, 2014 - Study
Handoff checklists improve the reliability of patient handoffs in the operating room and postanesthesia care unit.
Citation Text:
Boat AC, Spaeth JP. Handoff checklists improve the reliability of patient handoffs in the operating room and postanesthesia care unit. Paediatr Anaes…
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psnet.ahrq.gov/issue/science-improvement
August 04, 2021 - Commentary
Classic
The science of improvement.
Citation Text:
Berwick DM. The science of improvement. JAMA. 2008;299(10):1182-4. doi:10.1001/jama.299.10.1182.
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psnet.ahrq.gov/issue/improving-medication-reconciliation-hospitals
October 25, 2017 - Commentary
Improving medication reconciliation in hospitals.
Citation Text:
Improving medication reconciliation in hospitals. Schnipper JL. Ann Intern Med. 2022;175(8):ho2-ho3.
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psnet.ahrq.gov/issue/patient-centered-approach-improving-prescription-drug-warning-labels
January 05, 2012 - Study
Patient-centered approach for improving prescription drug warning labels.
Citation Text:
Webb J, Davis TC, Bernadella P, et al. Patient-centered approach for improving prescription drug warning labels. Patient Educ Couns. 2008;72(3):443-9. doi:10.1016/j.pec.2008.05.019.
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psnet.ahrq.gov/issue/standardization-inpatient-handoff-communication
April 26, 2023 - Organizational Policy/Guidelines
Standardization of inpatient handoff communication.
Citation Text:
Jewell JA. Standardization of Inpatient Handoff Communication. Pediatrics. 2016;138(5):e20162681. doi:10.1542/peds.2016-2681.
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psnet.ahrq.gov/issue/error-traps-acute-pain-management-children
August 24, 2022 - Commentary
Error traps in acute pain management in children.
Citation Text:
Vecchione TM, Agarwal R, Monitto CL. Error traps in acute pain management in children. Paediatr Anaesth. 2022;32(9):982-992. doi:10.1111/pan.14514.
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psnet.ahrq.gov/issue/patient-safety-listen-whistleblowers
May 22, 2019 - Commentary
Patient safety: listen to whistleblowers.
Citation Text:
Kirkup B, Titcombe J. Patient safety: listen to whistleblowers. BMJ. 2023;382:1972. doi:10.1136/bmj.p1972.
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psnet.ahrq.gov/issue/examples-medical-device-misconnections
March 04, 2015 - Multi-use Website
Examples of Medical Device Misconnections.
Citation Text:
Examples of Medical Device Misconnections. Food and Drug Administration. February 23. 2023.
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