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  1. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/45364/psn-pdf
    September 04, 2016 - A piece of my mind. Changing the narrative. September 4, 2016 Allen-Dicker J. Changing the Narrative. JAMA. 2016;316(3). doi:10.1001/jama.2016.3029. https://psnet.ahrq.gov/issue/piece-my-mind-changing-narrative Storytelling can share knowledge and build community among physicians. However, if clinicians communicat…
  2. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/45749/psn-pdf
    January 11, 2017 - Instrument count sheets and set reviews as patient safety tools. January 11, 2017 Spear J. Instrument Count Sheets and Set Reviews as Patient Safety Tools. AORN J. 2016;104(6):588- 592. doi:10.1016/j.aorn.2016.10.007. https://psnet.ahrq.gov/issue/instrument-count-sheets-and-set-reviews-patient-safety-tools Inaccu…
  3. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/46460/psn-pdf
    January 17, 2018 - Association between organisational and workplace cultures, and patient outcomes: systematic review. January 17, 2018 Braithwaite J, Herkes J, Ludlow K, et al. Association between organisational and workplace cultures, and patient outcomes: systematic review. BMJ Open. 2017;7(11). doi:10.1136/bmjopen-2017-017708. h…
  4. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/47708/psn-pdf
    February 13, 2019 - The role of purple pens in learning to prescribe. February 13, 2019 Kinston R, McCarville N, Hassell A. The role of purple pens in learning to prescribe. Clin Teach. 2019;16(6):598-603. doi:10.1111/tct.12991. https://psnet.ahrq.gov/issue/role-purple-pens-learning-prescribe Interventions utilizing color as visual c…
  5. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/47414/psn-pdf
    May 01, 2019 - Impact of teamwork improvement training on communication and teamwork climate in ambulatory reproductive health care. May 1, 2019 Dodge LE, Nippita S, Hacker MR, et al. Impact of teamwork improvement training on communication and teamwork climate in ambulatory reproductive health care. J Healthc Risk Manag. 2019;3…
  6. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/46444/psn-pdf
    December 19, 2017 - Nil per os orders for imaging: a teachable moment. December 19, 2017 Wickerham AL, Schultz EJ, Lewine EB. Nil per Os Orders for Imaging: A Teachable Moment. JAMA Intern Med. 2017;177(11):1670-1671. doi:10.1001/jamainternmed.2017.3943. https://psnet.ahrq.gov/issue/nil-os-orders-imaging-teachable-moment Patients are…
  7. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/45160/psn-pdf
    May 18, 2016 - Clues to better health care from old malpractice lawsuits. May 18, 2016 Landro L. https://psnet.ahrq.gov/issue/clues-better-health-care-old-malpractice-lawsuits Closed claims have been considered a source for adverse event data for years, and recently such data has been utilized to inform safety improvement work. …
  8. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/47358/psn-pdf
    August 29, 2018 - Double reading in breast cancer screening: cohort evaluation in the CO-OPS trial. August 29, 2018 Taylor-Phillips S, Jenkinson D, Stinton C, et al. Double Reading in Breast Cancer Screening: Cohort Evaluation in the CO-OPS Trial. Radiology. 2018;287(3):749-757. doi:10.1148/radiol.2018171010. https://psnet.ahrq.gov…
  9. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/46253/psn-pdf
    August 28, 2017 - Diagnostic stewardship—leveraging the laboratory to improve antimicrobial use. August 28, 2017 Morgan DJ, Malani P, Diekema DJ. Diagnostic Stewardship-Leveraging the Laboratory to Improve Antimicrobial Use. JAMA. 2017;318(7):607-608. doi:10.1001/jama.2017.8531. https://psnet.ahrq.gov/issue/diagnostic-stewardship-l…
  10. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/43126/psn-pdf
    April 23, 2014 - Safe and appropriate use of insulin and other antihyperglycemic agents in hospital. April 23, 2014 Cornish W. Safe and appropriate use of insulin and other antihyperglycemic agents in hospital. Can J Diabetes. 2014;38(2):94-100. doi:10.1016/j.jcjd.2014.01.002. https://psnet.ahrq.gov/issue/safe-and-appropriate-use-…
  11. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/46714/psn-pdf
    January 10, 2018 - A system-based approach to managing patient safety in ambulatory care (and beyond). January 10, 2018 Burger C, Eaton P, Hess K, et al. Patient Saf Qual Healthc. December 12, 2017. https://psnet.ahrq.gov/issue/system-based-approach-managing-patient-safety-ambulatory-care-and-beyond Systems-based improvements are ke…
  12. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/43321/psn-pdf
    August 02, 2015 - Costs associated with surgical site infections in Veterans Affairs hospitals. August 2, 2015 Schweizer ML, Cullen JJ, Perencevich E, et al. Costs Associated With Surgical Site Infections in Veterans Affairs Hospitals. JAMA Surg. 2014;149(6):575-81. doi:10.1001/jamasurg.2013.4663. https://psnet.ahrq.gov/issue/costs…
  13. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/72761/psn-pdf
    February 17, 2021 - Using ventilator splitters during the COVID-19 pandemic-- letter to health care providers. February 17, 2021 Silver Spring, MD: Division of Industry and Consumer Education, US Food and Drug Administration; February 9. 2021. https://psnet.ahrq.gov/issue/using-ventilator-splitters-during-covid-19-pandemic-letter-hea…
  14. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/60766/psn-pdf
    August 05, 2020 - Dermatology faces a reckoning: lack of darker skin in textbooks and journals harms care for patients of color. August 5, 2020 McFarling UL. Stat. July 21, 2020. https://psnet.ahrq.gov/issue/dermatology-faces-reckoning-lack-darker-skin-textbooks-and-journals-harms- care-patients-color Dermatologists rely on v…
  15. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/42135/psn-pdf
    April 22, 2013 - Interprofessional education in team communication: working together to improve patient safety. April 22, 2013 Brock DM, Abu-Rish E, Chiu C-R, et al. Interprofessional education in team communication: working together to improve patient safety. BMJ Qual Saf. 2013;22(5):414-23. doi:10.1136/bmjqs-2012-000952. https:/…
  16. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/45547/psn-pdf
    October 05, 2016 - Sick children face potentially deadly danger: medication errors. October 5, 2016 Furfaro H. Wall Street Journal. September 25, 2016. https://psnet.ahrq.gov/issue/sick-children-face-potentially-deadly-danger-medication-errors Medication errors in pediatric care are common in the hospital and at home. This newspaper…
  17. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/39197/psn-pdf
    January 06, 2010 - root-cause-analysis https://psnet.ahrq.gov/primer/never-events https://psnet.ahrq.gov/issue/resident-duty-hours-enhancing-sleep-supervision-and-safety
  18. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/43027/psn-pdf
    July 23, 2014 - improving-team-information-sharing-structured-call-out-anaesthetic-emergencies-randomized https://psnet.ahrq.gov/issue/enhancing-patient-safety-during-hand-offs-standardized-communication-and-teamwork-using-sbar
  19. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/44513/psn-pdf
    September 23, 2015 - recommendations to improve diagnosis, including promoting teamwork among interdisciplinary health care teams, enhancing
  20. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/47516/psn-pdf
    December 19, 2018 - Diverse stakeholders in Australia established an agenda for enhancing test result management, which

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