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psnet.ahrq.gov/node/44334/psn-pdf
November 20, 2015 - Improvement in detection of wrong-patient errors when
radiologists include patient photographs in their
interpretation of portable chest radiographs.
November 20, 2015
Tridandapani S, Olsen K, Bhatti P. Improvement in Detection of Wrong-Patient Errors When Radiologists
Include Patient Photographs in Their Interpre…
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psnet.ahrq.gov/node/50622/psn-pdf
November 06, 2019 - Starting elective cardiac surgery after 3 pm does not
impact patient morbidity, mortality, or hospital costs.
November 6, 2019
Axtell AL, Moonsamy P, Melnitchouk S, et al. Starting elective cardiac surgery after 3 pm does not impact
patient morbidity, mortality, or hospital costs. J Thorac Cardiovasc Surg. 2019.
d…
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psnet.ahrq.gov/node/38995/psn-pdf
March 04, 2011 - Does computerized provider order entry reduce
prescribing errors for hospital inpatients? A systematic
review.
March 4, 2011
Reckmann MH, Westbrook JI, Koh Y, et al. Does computerized provider order entry reduce prescribing
errors for hospital inpatients? A systematic review. J Am Med Inform Assoc. 2009;16(5):613-…
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psnet.ahrq.gov/node/72474/psn-pdf
January 01, 2021 - Associations of physicians’ prescribing experience, work
hours, and workload with prescription errors.
November 18, 2020
Leviatan I, Oberman B, Zimlichman E, et al. Associations of physicians’ prescribing experience, work
hours, and workload with prescription errors. J Am Med Inform Assoc. 2021;28(6):1074-1080.
do…
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psnet.ahrq.gov/node/47385/psn-pdf
April 27, 2019 - Reasons for repeat rapid response team calls, and
associations with in-hospital mortality.
April 27, 2019
Chalwin R, Giles L, Salter A, et al. Reasons for Repeat Rapid Response Team Calls, and Associations with
In-Hospital Mortality. Jt Comm J Qual Patient Saf. 2019;45(4):268-275. doi:10.1016/j.jcjq.2018.10.005.
h…
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psnet.ahrq.gov/node/37903/psn-pdf
May 09, 2013 - Safe Surgery.
May 9, 2013
World Health Organization.
https://psnet.ahrq.gov/issue/safe-surgery-saves-lives-second-global-patient-safety-challenge
This initiative provides a surgical safety checklist and related educational and training materials building on
the Second Global Patient Safety Challenge vision to enco…
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psnet.ahrq.gov/node/843461/psn-pdf
January 01, 2024 - The impact of TeamSTEPPS training on obstetric team
attitudes and outcomes on the labor and delivery unit of a
regional perinatal center.
February 1, 2023
Kwon CS, Duzyj C. The impact of TeamSTEPPS training on obstetric team attitudes and outcomes on the
labor and delivery unit of a regional perinatal center. Am J…
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psnet.ahrq.gov/node/866866/psn-pdf
October 02, 2024 - New Analysis Shows Hospitals Improving Performance
on Key Patient Safety Measures Surpassing Pre-
pandemic Levels.
October 2, 2024
New Analysis Shows Hospitals Improving Performance On Key Patient Safety Measures Surpassing Pre-
Pandemic Levels. Chicago, IL: American Hospital Association; September 2024.
https://…
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psnet.ahrq.gov/node/866938/psn-pdf
October 09, 2024 - The Patient’s Role in Diagnostic Safety and Excellence:
From Passive Reception towards Co-Design.
October 9, 2024
Epstein HM, Haskell H, Hemmelgarn C, et al. The Patient’s Role In Diagnostic Safety And Excellence:
From Passive Reception Towards Co-Design. Rockville, MD: Agency for Healthcare Research and Quality;
…
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psnet.ahrq.gov/node/838195/psn-pdf
September 28, 2022 - National Plan for Health Workforce Well-Being.
September 28, 2022
Dzau VJ, Kirch D, Murthy V, Nasca T, eds; NAM’s Action Collaborative on Clinician Well-Being and
Resilience. Washington DC: The National Academies Press; 2022. ISBN 9780309694674.
https://psnet.ahrq.gov/issue/national-plan-health-workforce-well-…
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psnet.ahrq.gov/node/837672/psn-pdf
July 13, 2022 - Optimizing post-acute care patient safety: a scoping
review of multifactorial fall prevention interventions for
older adults.
July 13, 2022
Leland NE, Lekovitch C, Martínez J, et al. Optimizing post-acute care patient safety: a scoping review of
multifactorial fall prevention interventions for older adults. J Appl…
-
psnet.ahrq.gov/node/867687/psn-pdf
March 05, 2025 - Simulation-debriefing enhanced needs assessment to
address quality markers in health care: an innovation for
prospective hazard analysis.
March 5, 2025
Barker LT, Bond WF, Willemsen-Dunlap AM, et al. Simulation-debriefing enhanced needs assessment to
address quality markers in health care: an innovation for prospe…
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psnet.ahrq.gov/node/867693/psn-pdf
March 05, 2025 - Leveraging artificial intelligence to reduce diagnostic
errors in emergency medicine: challenges, opportunities,
and future directions.
March 5, 2025
Taylor RA, Sangal RB, Smith ME, et al. Leveraging artificial intelligence to reduce diagnostic errors in
emergency medicine: challenges, opportunities, and future di…
-
psnet.ahrq.gov/node/46818/psn-pdf
April 18, 2018 - Barriers and facilitators to hospital pharmacists'
engagement in medication safety activities: a qualitative
study using the theoretical domains framework.
April 18, 2018
Mekonnen AB, McLachlan AJ, Brien J-AE, et al. Barriers and facilitators to hospital pharmacists'
engagement in medication safety activities: a q…
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psnet.ahrq.gov/node/47440/psn-pdf
April 07, 2019 - Improving inpatient mental health medication safety
through the process of obtaining HIMSS Stage 7: a case
report.
April 7, 2019
Sulkers H, Tajirian T, Paterson J, et al. JAMIA Open. 2019;2:35–39.
https://psnet.ahrq.gov/issue/improving-inpatient-mental-health-medication-safety-through-process-
obtaining-himss-sta…
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psnet.ahrq.gov/node/866351/psn-pdf
July 24, 2024 - Seeking systems-based facilitators of safety and
healthcare resilience: a thematic review of incident
reports.
July 24, 2024
Leon C, Hogan H, Jani YH. Seeking systems-based facilitators of safety and healthcare resilience: a
thematic review of incident reports. Int J Qual Health Care. 2024;36(3):mzae057.
doi:10.1…
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psnet.ahrq.gov/node/73488/psn-pdf
July 14, 2021 - Influences of physical layout and space on patient safety
and communication in ambulatory oncology practices: a
multisite, mixed method investigation.
July 14, 2021
Fauer AJ. Influences of physical layout and space on patient safety and communication in ambulatory
oncology practices: a multisite, mixed method inve…
-
psnet.ahrq.gov/node/35398/psn-pdf
February 24, 2011 - Residency work-hours reform: a cost analysis including
preventable adverse events.
February 24, 2011
Nuckols TK, Escarce JJ. Residency work-hours reform. A cost analysis including preventable adverse
events. J Gen Intern Med. 2005;20(10):873-8.
https://psnet.ahrq.gov/issue/residency-work-hours-reform-cost-analysis…
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psnet.ahrq.gov/node/46455/psn-pdf
April 24, 2018 - ISMP Medication Safety Self Assessment for High-Alert
Medications.
April 24, 2018
Horsham, PA: Institute for Safe Medication Practices; 2017.
https://psnet.ahrq.gov/issue/ismp-medication-safety-self-assessment-high-alert-medications
High-alert medications have the potential to cause substantial patient harm if adm…
-
psnet.ahrq.gov/node/60232/psn-pdf
April 15, 2020 - Sustaining innovations in complex health care
environments: a multiple-case study of rapid response
teams.
April 15, 2020
Stolldorf DP, Havens DS, Jones CB. Sustaining innovations in complex health care environments: a
multiple-case study of rapid response teams. J Patient Saf. 2020;16(1).
doi:10.1097/pts.0000000…