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psnet.ahrq.gov/issue/identifying-what-known-about-improving-operating-room-intensive-care-handovers-scoping-review
September 23, 2020 - Review
Identifying what is known about improving operating room to intensive care handovers: a scoping review.
Citation Text:
Zjadewicz K, Deemer KS, Coulthard J, et al. Identifying What Is Known About Improving Operating Room to Intensive Care Handovers: A Scoping Review. Am J Med Qual.…
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psnet.ahrq.gov/issue/safer-delivery-surgical-services-program-s3-explaining-its-differential-effectiveness-and
January 20, 2015 - Study
The Safer Delivery of Surgical Services Program (S3): explaining its differential effectiveness and exploring implications for improving quality in complex systems.
Citation Text:
Flynn LC, McCulloch P, Morgan LJ, et al. The Safer Delivery of Surgical Services Program (S3): Explain…
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psnet.ahrq.gov/issue/improving-patient-safety-operating-theatre-and-perioperative-care-obstacles-interventions-and
April 21, 2015 - Review
Improving patient safety in the operating theatre and perioperative care: obstacles, interventions, and priorities for accelerating progress.
Citation Text:
Sevdalis N, Hull L, Birnbach DJ. Improving patient safety in the operating theatre and perioperative care: obstacles, inter…
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psnet.ahrq.gov/issue/untangling-infusion-confusion-comparative-evaluation-interventions-simulated-intensive-care
September 01, 2021 - Study
Untangling infusion confusion: a comparative evaluation of interventions in a simulated intensive care setting.
Citation Text:
Pinkney SJ, Fan M, Koczmara C, et al. Untangling Infusion Confusion: A Comparative Evaluation of Interventions in a Simulated Intensive Care Setting. Crit …
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psnet.ahrq.gov/issue/evaluation-web-based-education-program-reducing-medication-dosing-error-multicenter
May 18, 2022 - Study
Evaluation of a Web-based education program on reducing medication dosing error: a multicenter, randomized controlled trial.
Citation Text:
Frush K, Hohenhaus S, Luo X, et al. Evaluation of a Web-based education program on reducing medication dosing error: a multicenter, randomiz…
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psnet.ahrq.gov/issue/pharmacist-linkage-care-transitions-academic-medical-center-community
November 16, 2022 - Study
Pharmacist linkage in care transitions: from academic medical center to community.
Citation Text:
Bloodworth LS, Malinowski SS, Lirette ST, et al. Pharmacist linkage in care transitions: from academic medical center to community. J Am Pharm Assoc . 2019;59(6):896-904. doi:10.1016/j…
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psnet.ahrq.gov/issue/design-evidence-based-second-victim-curriculum-nurse-anesthetists
February 15, 2023 - Commentary
Design of an evidence-based "second victim" curriculum for nurse anesthetists.
Citation Text:
Daniels RG, McCorkle R. Design of an Evidence-Based "Second Victim" Curriculum for Nurse Anesthetists. AANA J. 2016;84(2):107-113.
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psnet.ahrq.gov/issue/closing-loop-mixed-methods-study-about-resident-learning-outcome-feedback-after-patient
November 17, 2016 - Study
"Closing the loop": a mixed-methods study about resident learning from outcome feedback after patient handoffs.
Citation Text:
Shenvi EC, Feupe SF, Yang H, et al. "Closing the loop": a mixed-methods study about resident learning from outcome feedback after patient handoffs. Diagnos…
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psnet.ahrq.gov/issue/simulation-executive-suite-lessons-learned-building-patient-safety-leadership
July 21, 2017 - Study
Simulation in the executive suite: lessons learned for building patient safety leadership.
Citation Text:
Rosen MA, Goeschel CA, Che X-X, et al. Simulation in the Executive Suite: Lessons Learned for Building Patient Safety Leadership. Simul Healthc. 2015;10(6):372-377.
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psnet.ahrq.gov/issue/barriers-and-enablers-affecting-patient-engagement-managing-medications-within-specialty
December 12, 2014 - Study
Barriers and enablers affecting patient engagement in managing medications within specialty hospital settings.
Citation Text:
Manias E, Rixon S, Williams A, et al. Barriers and enablers affecting patient engagement in managing medications within specialty hospital settings. Health …
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psnet.ahrq.gov/issue/inappropriate-prescribing-defined-stopp-and-start-criteria-and-its-association-adverse-drug
July 05, 2023 - Study
Inappropriate prescribing defined by STOPP and START criteria and its association with adverse drug events among hospitalized older patients: a multicentre, prospective study.
Citation Text:
Fahrni ML, Azmy MT, Usir E, et al. Inappropriate prescribing defined by STOPP and START cri…
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psnet.ahrq.gov/issue/method-measuring-system-safety-and-latent-errors-associated-pediatric-procedural-sedation
April 11, 2011 - Study
A method for measuring system safety and latent errors associated with pediatric procedural sedation.
Citation Text:
Blike G, Christoffersen K, Cravero JP, et al. A method for measuring system safety and latent errors associated with pediatric procedural sedation. Anesth Analg. 2…
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psnet.ahrq.gov/issue/mortality-among-patients-acute-myocardial-infarction-influences-patient-centered-care-and
April 10, 2024 - Study
Mortality among patients with acute myocardial infarction: the influences of patient-centered care and evidence-based medicine.
Citation Text:
Meterko M, Wright S, Lin H, et al. Mortality among patients with acute myocardial infarction: the influences of patient-centered care and…
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psnet.ahrq.gov/issue/exploring-causes-copd-misdiagnosis-primary-care-mixed-methods-study
September 23, 2020 - Study
Exploring the causes of COPD misdiagnosis in primary care: a mixed methods study.
Citation Text:
Patel K, Smith DJ, Huntley CC, et al. Exploring the causes of COPD misdiagnosis in primary care: a mixed methods study. PLoS ONE. 2024;19(3):e0298432. doi:10.1371/journal.pone.0298432. …
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psnet.ahrq.gov/issue/application-failure-mode-effect-analysis-improve-care-septic-patients-admitted-through
February 01, 2013 - Study
Application of failure mode effect analysis to improve the care of septic patients admitted through the emergency department.
Citation Text:
Alamry A, Owais SMA, Marini AM, et al. Application of Failure Mode Effect Analysis to Improve the Care of Septic Patients Admitted Through th…
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psnet.ahrq.gov/issue/how-health-care-complexity-leads-cooperation-and-affects-autonomy-health-care-professionals
October 27, 2021 - Study
How health care complexity leads to cooperation and affects the autonomy of health care professionals.
Citation Text:
Molleman E, Broekhuis M, Stoffels R, et al. How health care complexity leads to cooperation and affects the autonomy of health care professionals. Health Care Ana…
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psnet.ahrq.gov/issue/discrepancies-between-home-medications-listed-hospital-admission-and-reported-medical
November 03, 2021 - Study
Discrepancies between home medications listed at hospital admission and reported medical conditions.
Citation Text:
Slain D, Kincaid SE, Dunsworth TS. Discrepancies between home medications listed at hospital admission and reported medical conditions. Am J Geriatr Pharmacother.…
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psnet.ahrq.gov/node/41201/psn-pdf
March 07, 2012 - Crisis resource management in emergency medicine.
March 7, 2012
Carne B, Kennedy M, Gray T. Review article: Crisis resource management in emergency medicine.
Emergency Medicine Australasia. 2011;24(1). doi:10.1111/j.1742-6723.2011.01495.x.
https://psnet.ahrq.gov/issue/crisis-resource-management-emergency-medicine
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psnet.ahrq.gov/node/47977/psn-pdf
August 14, 2019 - Reducing Diagnostic Error: Measurement Considerations.
August 14, 2019
National Quality Forum
https://psnet.ahrq.gov/issue/reducing-diagnostic-error-measurement-considerations
This website tracks the progress of a project focused on the development and review of measures to
enhance viability, reporting, accountabi…
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psnet.ahrq.gov/node/44906/psn-pdf
February 17, 2016 - Hospitals find a way to say, 'I'm sorry.'
February 17, 2016
Landro L.
https://psnet.ahrq.gov/issue/hospitals-find-way-say-im-sorry
Communication and resolution strategies that emphasize early disclosure after a medical error can
enhance patient safety. This newspaper article reports on communication and resolution…