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psnet.ahrq.gov/issue/unintended-doses-radiotherapy-over-under-and-outside
August 27, 2009 - Commentary
Unintended doses in radiotherapy—over, under and outside?
Citation Text:
Eaton DJ, Byrne JP, Cosgrove VP, et al. Unintended doses in radiotherapy-over, under and outside? Br J Radiol. 2018;91(1084):20170863. doi:10.1259/bjr.20170863.
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psnet.ahrq.gov/issue/identifying-and-addressing-preventable-process-errors-trauma-care
June 17, 2015 - Study
Identifying and addressing preventable process errors in trauma care.
Citation Text:
Pucher PH, Aggarwal R, Twaij A, et al. Identifying and addressing preventable process errors in trauma care. World J Surg. 2013;37(4):752-8. doi:10.1007/s00268-013-1917-9.
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psnet.ahrq.gov/issue/it-time-safeguards-adoption-robotic-surgery
December 04, 2019 - Commentary
Is it time for safeguards in the adoption of robotic surgery?
Citation Text:
Sheetz KH, Dimick JB. Is It Time for Safeguards in the Adoption of Robotic Surgery? JAMA. 2019;321(20):1971-1972. doi:10.1001/jama.2019.3736.
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psnet.ahrq.gov/issue/spreading-human-factors-expertise-healthcare-untangling-knots-people-and-systems
May 01, 2024 - Commentary
Spreading human factors expertise in healthcare: untangling the knots in people and systems.
Citation Text:
Catchpole K. Spreading human factors expertise in healthcare: untangling the knots in people and systems. BMJ Qual Saf. 2013;22(10):793-7. doi:10.1136/bmjqs-2013-002036…
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psnet.ahrq.gov/issue/va-health-care-selected-credentialing-requirements-seven-medical-facilities-met-aspect
July 05, 2006 - Government Resource
VA Health Care: Selected Credentialing Requirements at Seven Medical Facilities Met, but an Aspect of Privileging Process Needs Improvement.
Citation Text:
VA Health Care: Selected Credentialing Requirements at Seven Medical Facilities Met, but an Aspect of Privileg…
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psnet.ahrq.gov/issue/reduction-chemotherapy-order-errors-computerised-physician-order-entry-and-clinical-decision
October 22, 2014 - Study
Reduction in chemotherapy order errors with computerised physician order entry and clinical decision support systems.
Citation Text:
Reduction in chemotherapy order errors with computerised physician order entry and clinical decision support systems. HIM J. 2015;44.
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psnet.ahrq.gov/issue/incorporating-metacognition-morbidity-and-mortality-rounds-next-frontier-quality-improvement
September 21, 2016 - Review
Incorporating metacognition into morbidity and mortality rounds: the next frontier in quality improvement.
Citation Text:
Katz D, Detsky AS. Incorporating metacognition into morbidity and mortality rounds: The next frontier in quality improvement. J Hosp Med. 2016;11(2):120-2. doi…
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psnet.ahrq.gov/issue/safe-and-equitable-pediatric-clinical-use-ai
February 26, 2025 - Commentary
Safe and equitable pediatric clinical use of AI.
Citation Text:
Handley JL, Lehmann CU, Ratwani RM. Safe and equitable pediatric clinical use of AI. JAMA Pediatr. 2024;178(7):637-638. doi:10.1001/jamapediatrics.2024.0897.
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psnet.ahrq.gov/issue/quality-minute-new-brief-and-structured-technique-quality-improvement-education-during
January 09, 2019 - Commentary
The "Quality Minute"—a new, brief, and structured technique for quality improvement education during the morbidity and mortality conference.
Citation Text:
Hoffman RL, Morris JB, Kelz RR. The “Quality Minute”—A New, Brief, and Structured Technique for Quality Improvement Educa…
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psnet.ahrq.gov/issue/managing-risk-hazardous-conditions-improvisation-not-enough
November 06, 2024 - Commentary
Managing risk in hazardous conditions: improvisation is not enough.
Citation Text:
Amalberti R, Vincent CA. Managing risk in hazardous conditions: improvisation is not enough. BMJ Qual Saf. 2020;29(1):60-63. doi:10.1136/bmjqs-2019-009443.
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psnet.ahrq.gov/issue/artificial-intelligence-systems-complex-decision-making-acute-care-medicine-review
March 16, 2011 - Review
Emerging Classic
Artificial intelligence systems for complex decision-making in acute care medicine: a review.
Citation Text:
Lynn LA. Artificial intelligence systems for complex decision-making in acute care medicine: a review. Patient Saf Surg. 2019;13:…
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psnet.ahrq.gov/issue/patient-safety-and-collaboration-intensive-care-unit-team
February 17, 2010 - Commentary
Patient safety and collaboration of the intensive care unit team.
Citation Text:
Despins LA. Patient safety and collaboration of the intensive care unit team. Crit Care Nurse. 2009;29(2):85-91. doi:10.4037/ccn2009281.
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psnet.ahrq.gov/issue/joint-statement-multiple-patients-ventilator
May 24, 2015 - Organizational Policy/Guidelines
Joint Statement on Multiple Patients Per Ventilator.
Citation Text:
Joint Statement on Multiple Patients Per Ventilator. The Anesthesia Patient Safety Foundation, Society of Critical Care Medicine, American Association for Respiratory Care, American Soc…
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psnet.ahrq.gov/issue/adverse-drug-events-incidence-and-risk-reduction-across-care-continuum
April 12, 2019 - Image/Poster
ADVERSE drug events: incidence and risk reduction across the care continuum.
Citation Text:
Wanderer JP, Rathmell JP. ADVERSE Drug Events: Incidence & risk reduction across the care continuum. Anesthesiology. 2016;124(1):A23. doi:10.1097/01.anes.0000473722.20007.03.
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psnet.ahrq.gov/issue/changing-narratives-patient-safety
April 17, 2019 - Commentary
Changing the narratives for patient safety.
Citation Text:
Pronovost P, Sutcliffe K, Basu L, et al. Changing the narratives for patient safety. Bull World Health Organ. 2017;95(6):478-480. doi:10.2471/BLT.16.178392.
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psnet.ahrq.gov/issue/medication-related-clinical-decision-support-computerized-provider-order-entry-systems-review
March 11, 2011 - Review
Medication-related clinical decision support in computerized provider order entry systems: a review.
Citation Text:
Kuperman GJ, Bobb A, Payne TH, et al. Medication-related clinical decision support in computerized provider order entry systems: a review. J Am Med Inform Assoc. 2…
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psnet.ahrq.gov/issue/first-know-thyself-cognition-and-error-medicine
March 09, 2022 - Review
"First, know thyself": cognition and error in medicine.
Citation Text:
Elia F, Aprà F, Verhovez A, et al. "First, know thyself": cognition and error in medicine. Acta Diabetol. 2016;53(2):169-175. doi:10.1007/s00592-015-0762-8.
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psnet.ahrq.gov/issue/beyond-communication-role-standardized-protocols-changing-health-care-environment
October 12, 2011 - Study
Beyond communication: the role of standardized protocols in a changing health care environment.
Citation Text:
Vardaman JM, Cornell P, Gondo MB, et al. Beyond communication: the role of standardized protocols in a changing health care environment. Health Care Manage Rev. 2012;37…
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psnet.ahrq.gov/issue/safety-performance-and-satisfaction-outcomes-operating-room-literature-review
April 03, 2019 - Review
Emerging Classic
Safety, performance, and satisfaction outcomes in the operating room: a literature review.
Citation Text:
Joseph A, Bayramzadeh S, Zamani Z, et al. Safety, Performance, and Satisfaction Outcomes in the Operating Room: A Literature Review.…
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psnet.ahrq.gov/issue/use-beers-criteria-predict-adverse-drug-reactions-among-first-visit-elderly-outpatients
October 27, 2016 - Study
Use of the Beers criteria to predict adverse drug reactions among first-visit elderly outpatients.
Citation Text:
Chang C-M, Liu P-YY, Yang Y-HK, et al. Use of the Beers criteria to predict adverse drug reactions among first-visit elderly outpatients. Pharmacotherapy. 2005;25(6):…