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psnet.ahrq.gov/issue/briefings-checklists-geese-and-surgical-safety
August 02, 2015 - Commentary
Briefings, checklists, geese, and surgical safety.
Citation Text:
Karl R. Briefings, checklists, geese, and surgical safety. Ann Surg Oncol. 2010;17(1):8-11. doi:10.1245/s10434-009-0794-9.
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psnet.ahrq.gov/issue/retained-lumbar-catheter-tip
June 07, 2017 - Commentary
Retained lumbar catheter tip.
Citation Text:
DeLancey JO, Barnard C, Bilimoria KY. Retained Lumbar Catheter Tip. JAMA. 2017;317(12):1269-1270. doi:10.1001/jama.2017.1713.
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psnet.ahrq.gov/issue/quantifying-distraction-and-interruption-urological-surgery
March 11, 2009 - Study
Quantifying distraction and interruption in urological surgery.
Citation Text:
Healey A, Primus CP, Koutantji M. Quantifying distraction and interruption in urological surgery. Qual Saf Health Care. 2007;16(2):135-9.
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psnet.ahrq.gov/issue/high-reliability-truly-achieving-healthcare-quality-and-safety
March 18, 2019 - Commentary
High reliability: truly achieving healthcare quality and safety.
Citation Text:
Kaplan GS. Pursuing the perfect patient experience. Front Health Serv Manage. 2013;29(3):16-27.
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psnet.ahrq.gov/issue/human-factors-subsystems-approach-trauma-care
October 08, 2013 - Study
A human factors subsystems approach to trauma care.
Citation Text:
Catchpole K, Ley EJ, Wiegmann D, et al. A human factors subsystems approach to trauma care. JAMA Surg. 2014;149(9):962-8.
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psnet.ahrq.gov/issue/safety-ii-and-resilience-way-ahead-patient-safety-anaesthesiology
October 08, 2016 - Review
Safety-II and resilience: the way ahead in patient safety in anaesthesiology.
Citation Text:
Staender S. Safety-II and resilience: the way ahead in patient safety in anaesthesiology. Curr Opin Anaesthesiol. 2015;28(6):735-9. doi:10.1097/ACO.0000000000000252.
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psnet.ahrq.gov/issue/are-you-well-positioned-resolve-conflicts-safety-order-learning-physicians-homicide-trial-and
May 18, 2022 - Newspaper/Magazine Article
Are you well positioned to resolve conflicts with the safety of an order? Learning from a physician’s homicide trial and the firing of multiple healthcare workers.
Citation Text:
Are you well positioned to resolve conflicts with the safety of an order? Learning…
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psnet.ahrq.gov/issue/unlocking-solutions-imaging-working-together-learn-failings-nhs
October 07, 2020 - Book/Report
Unlocking Solutions in Imaging: Working Together to Learn from Failings in the NHS.
Citation Text:
Unlocking Solutions in Imaging: Working Together to Learn from Failings in the NHS. Manchester, UK: Parliamentary and Health Service Ombudsman; 2021. ISBN 9781528627016.
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psnet.ahrq.gov/issue/doctors-unconscious-bias-affects-quality-health-care-services-research-shows
October 21, 2020 - Audiovisual
Doctors' unconscious bias affects quality of health care services, research shows.
Citation Text:
Doctors' unconscious bias affects quality of health care services, research shows. Dembosky A. All Things Considered. National Public Radio. October 15, 2020.
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psnet.ahrq.gov/issue/patient-safety-systems-case-management
December 22, 2008 - Review
Patient safety systems for case management.
Citation Text:
Greenberg L. Patient safety systems for case management. Lippincotts Case Manag. 2004;9(5):223-229. doi:10.1097/00129234-200409000-00004.
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psnet.ahrq.gov/issue/theres-science-team-development-interventions-organizations
January 15, 2020 - Review
There's a science for that: team development interventions in organizations.
Citation Text:
Shuffler ML, DiazGranados D, Salas E. There’s a Science for That. Curr Dir Psychol Sci. 2011;20(6). doi:10.1177/0963721411422054.
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psnet.ahrq.gov/issue/antiretroviral-medication-errors-national-medication-error-database
January 06, 2017 - Study
Antiretroviral medication errors in a national medication error database.
Citation Text:
Gray J, Hicks RW, Hutchings C. Antiretroviral medication errors in a national medication error database. AIDS Patient Care STDS. 2005;19(12):803-12.
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www.ahrq.gov/sites/default/files/wysiwyg/teamstepps-program/dx-improvement/dxsafety-facilitator-roadmap.pdf
February 01, 2022 - Facilitator’s Implementation Roadmap: TeamSTEPPS® Diagnosis Improvement
Facilitator’s Implementation Roadmap:
TeamSTEPPS® Diagnosis Improvement
This implementation roadmap provides an overview of the steps a course facilitator should follow
for implementing the TeamSTEPPS® for Diagnosis Improvement Course and the …
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psnet.ahrq.gov/issue/achieving-high-reliability-organization-through-implementation-arcc-model-systemwide
March 21, 2018 - Commentary
Achieving a high-reliability organization through implementation of the ARCC model for systemwide sustainability of evidence-based practice.
Citation Text:
Melnyk BM. Achieving a high-reliability organization through implementation of the ARCC model for systemwide sustainabi…
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psnet.ahrq.gov/issue/medicines-related-harm-elderly-post-hospital-discharge
February 07, 2024 - Commentary
Medicines-related harm in the elderly post-hospital discharge.
Citation Text:
Medicines-related harm in the elderly post-hospital discharge. Cheong V-L, Tomlinson J, Khan S, et al. Prescriber. 2019;30:29-34.
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psnet.ahrq.gov/issue/office-based-anesthesia-safety-and-outcomes
February 18, 2019 - Review
Office-based anesthesia: safety and outcomes.
Citation Text:
Shapiro FE, Punwani N, Rosenberg NM, et al. Office-Based Anesthesia. Anesth Analg. 2014;119(2):276-285. doi:10.1213/ane.0000000000000313.
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psnet.ahrq.gov/issue/patient-safety-story
February 02, 2020 - Commentary
The patient safety story.
Citation Text:
Elwyn G, Corrigan JM. The patient safety story. BMJ. 2005;331(7512):302-304. doi:10.1136/bmj.38562.690104.43.
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psnet.ahrq.gov/issue/involuntary-automaticity-work-system-induced-risk-safe-health-care
June 22, 2009 - Commentary
Involuntary automaticity: a work-system induced risk to safe health care.
Citation Text:
Toft B, Mascie-Taylor H. Involuntary automaticity: a work-system induced risk to safe health care. Health Serv Manage Res. 2005;18(4):211-6.
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psnet.ahrq.gov/issue/otolaryngologists-responses-errors-and-adverse-events
October 27, 2010 - Study
Otolaryngologists' responses to errors and adverse events.
Citation Text:
Lander LI, Connor JA, Shah RK, et al. Otolaryngologists' responses to errors and adverse events. Laryngoscope. 2006;116(7):1114-20.
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psnet.ahrq.gov/issue/review-educational-philosophies-applied-radiation-safety-training-medical-institutions
May 31, 2017 - Commentary
A review of educational philosophies as applied to radiation safety training at medical institutions.
Citation Text:
Dauer LT, St Germain J. A review of educational philosophies as applied to radiation safety training at medical institutions. Health Phys. 2006;90(5 Suppl):S6…