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psnet.ahrq.gov/node/49742/psn-pdf
September 01, 2015 - to develop novel care models and payment systems
that remove these perverse incentives and better encourage … The CARE Item Set and policy efforts to encourage better care transitions are likely to increase the
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psnet.ahrq.gov/node/33625/psn-pdf
January 01, 2006 - Some
states encourage, or even require, reporting, and some adverse events must be reported to the Joint … On July 29, 2005, federal legislation
was enacted to encourage the reporting of medical errors to Patient
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psnet.ahrq.gov/issue/effects-power-leadership-and-psychological-safety-resident-event-reporting
November 16, 2022 - Study
The effects of power, leadership and psychological safety on resident event reporting.
Citation Text:
Appelbaum NP, Dow A, Mazmanian PE, et al. The effects of power, leadership and psychological safety on resident event reporting. Med Edu. 2016;50(3):343-350. doi:10.1111/medu.12947…
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psnet.ahrq.gov/issue/strategies-improve-patient-safety-final-report-congress-required-patient-safety-and-quality
June 21, 2016 - Book/Report
Strategies to Improve Patient Safety: Final Report to Congress Required by the Patient Safety and Quality Improvement Act of 2005.
Citation Text:
Strategies to Improve Patient Safety: Final Report to Congress Required by the Patient Safety and Quality Improvement Act of 2005.…
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psnet.ahrq.gov/issue/effects-leadership-self-worth-inclusion-trust-and-psychological-safety-medical-error
March 30, 2022 - Study
The effects of leadership for self-worth, inclusion, trust, and psychological safety on medical error reporting.
Citation Text:
Brimhall KC, Tsai C-Y, Eckardt R, et al. The effects of leadership for self-worth, inclusion, trust, and psychological safety on medical error reporting. …
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psnet.ahrq.gov/issue/crowdsourced-feedback-improve-resident-physician-error-disclosure-skills-randomized-clinical
May 18, 2022 - Study
Crowdsourced feedback to improve resident physician error disclosure skills: a randomized clinical trial.
Citation Text:
White AA, King AM, D’Addario AE, et al. Crowdsourced feedback to improve resident physician error disclosure skills: a randomized clinical trial. JAMA Netw Open.…
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psnet.ahrq.gov/issue/imperfect-practice-makes-perfect-error-management-training-improves-transfer-learning
May 19, 2019 - Study
Imperfect practice makes perfect: error management training improves transfer of learning.
Citation Text:
Dyre L, Tabor A, Ringsted C, et al. Imperfect practice makes perfect: error management training improves transfer of learning. Med Educ. 2017;51(2):196-206. doi:10.1111/medu.13…
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psnet.ahrq.gov/issue/systematic-review-frequency-and-quality-reporting-patient-and-public-involvement-patient
February 17, 2021 - Review
Systematic review on the frequency and quality of reporting patient and public involvement in patient safety research.
Citation Text:
Hammoud S, Alsabek L, Rogers L, et al. Systematic review on the frequency and quality of reporting patient and public involvement in patient safety…
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psnet.ahrq.gov/node/38493/psn-pdf
March 18, 2009 - Finding a way to ask doctors tough questions.
March 18, 2009
https://psnet.ahrq.gov/issue/finding-way-ask-doctors-tough-questions
This article encourages patients to be assertive about their care and provides tips on effectively raising
concerns.
https://psnet.ahrq.gov/issue/finding-way-ask-doctors-tough-questions
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psnet.ahrq.gov/issue/team-disclosure-error-educational-activity-objective-outcomes
January 31, 2018 - Study
A team disclosure of error educational activity: objective outcomes.
Citation Text:
Krumwiede KH, Wagner JM, Kirk LM, et al. A Team Disclosure of Error Educational Activity: Objective Outcomes. J Am Geriatr Soc. 2019;67(6):1273-1277. doi:10.1111/jgs.15883.
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Forma…
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psnet.ahrq.gov/issue/rating-recommendations-consumers-about-patient-safety-sense-common-sense-or-nonsense
January 06, 2017 - Study
Rating recommendations for consumers about patient safety: sense, common sense, or nonsense?
Citation Text:
Weingart SN, Morway L, Brouillard D, et al. Rating recommendations for consumers about patient safety: sense, common sense, or nonsense? Jt Comm J Qual Patient Saf. 2009;35(4…
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psnet.ahrq.gov/node/73431/psn-pdf
June 23, 2021 - Drive to Deprescribe.
June 23, 2021
The Society for Post-Acute and Long-Term Care Medicine.
https://psnet.ahrq.gov/issue/drive-deprescribe
Polypharmacy is a known challenge to patient safety. This collective program encourages long-term care
organizations, physicians, and pharmacists to take part in a learning net…
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psnet.ahrq.gov/node/36606/psn-pdf
January 31, 2007 - Cause of death: sloppy doctors.
January 31, 2007
Caplan J. Time. January 15, 2007.
https://psnet.ahrq.gov/issue/cause-death-sloppy-doctors
This article reports on an industry-supported initiative to reduce medication errors by encouraging
physicians to use electronic prescribing through a free Web-based tool.
htt…
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psnet.ahrq.gov/issue/wisdom-patients-and-families-ignore-it-our-peril
March 13, 2013 - Commentary
The wisdom of patients and families: ignore it at our peril.
Citation Text:
Donaldson LJ. The wisdom of patients and families: ignore it at our peril. BMJ Qual Saf. 2015;24(10):603-604. doi:10.1136/bmjqs-2015-004573.
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Format:
DOI Google Scholar PubMe…
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psnet.ahrq.gov/node/837708/psn-pdf
July 20, 2022 - Without question.
July 20, 2022
Liebowitz J. Without Question. N Engl J Med. 2022;386(26):2456-2457. doi:10.1056/nejmp2204361.
https://psnet.ahrq.gov/issue/without-question
Diagnostic errors caused by premature closure and anchoring bias occur when clinicians rely on initial
diagnosis despite receiving subsequent …
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psnet.ahrq.gov/node/50677/psn-pdf
November 20, 2019 - What Happens When Doctors Make Diagnostic Errors?
November 20, 2019
The Peoples Pharmacy. Show 1186: National Public Radio. October 24, 2019.
https://psnet.ahrq.gov/issue/what-happens-when-doctors-make-diagnostic-errors
Misdiagnosis growing area of concern in health care. This radio feature explores three commonly
…
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psnet.ahrq.gov/node/41236/psn-pdf
March 29, 2018 - Speak Up video posters.
March 29, 2018
Oakbrook Terrace, IL: Joint Commission.
https://psnet.ahrq.gov/issue/speak-video-posters
The Speak Up video series encourages patients to actively participate in their care. Posters to complement
the video series, in both English and Spanish are available upon request.
htt…
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psnet.ahrq.gov/node/72770/psn-pdf
February 24, 2021 - Communication about medical errors.
February 24, 2021
Kaldjian LC. Communication about medical errors. Patient Educ Couns. 2021;104(5):989-993.
doi:10.1016/j.pec.2020.11.035.
https://psnet.ahrq.gov/issue/communication-about-medical-errors
Disclosure of and communication about errors and adverse events is increasin…
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psnet.ahrq.gov/node/50657/psn-pdf
November 13, 2019 - Disclosure after adverse medical outcomes: a
multidimensional challenge.
November 13, 2019
O’Connell D. J Clin Outcomes Manag. 2019;26(5):213-218.
https://psnet.ahrq.gov/issue/disclosure-after-adverse-medical-outcomes-multidimensional-challenge
Disclosure of errors and adverse events is increasingly encouraged in …
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psnet.ahrq.gov/node/39182/psn-pdf
May 22, 2019 - ACOG Committee Opinion No. 447: patient safety in
obstetrics and gynecology.
May 22, 2019
Improvement AC of O and GCC on PS and Q. ACOG Committee Opinion No. 447: Patient safety in
obstetrics and gynecology. Obstet Gynecol. 2009;114(6):1424-7. doi:10.1097/AOG.0b013e3181c6f90e.
https://psnet.ahrq.gov/issue/acog-com…