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psnet.ahrq.gov/node/35339/psn-pdf
April 23, 2014 - Disclosing harmful medical errors to patients: a time for
professional action.
April 23, 2014
Gallagher TH, Levinson W. Disclosing Harmful Medical Errors to Patients. Arch Intern Med. 2005;165(16).
doi:10.1001/archinte.165.16.1819.
https://psnet.ahrq.gov/issue/disclosing-harmful-medical-errors-patients-time-profes…
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psnet.ahrq.gov/node/42976/psn-pdf
May 29, 2014 - Quality and safety in pediatric hematology/oncology.
May 29, 2014
Mueller BU. Quality and safety in pediatric hematology/oncology. Pediatr Blood Cancer. 2014;61(6):966-9.
doi:10.1002/pbc.24946.
https://psnet.ahrq.gov/issue/quality-and-safety-pediatric-hematologyoncology
Children with cancer are particularly vulner…
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psnet.ahrq.gov/node/34659/psn-pdf
April 07, 2010 - Leading change: why transformation efforts fail.
April 7, 2010
Kotter JP. Harvard Bus Rev 1995;73(2);59-67.
https://psnet.ahrq.gov/issue/leading-change-why-transformation-efforts-fail
Kotter, a professor at Harvard Business School, outlines the eight stages of a successful change process,
as well a…
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psnet.ahrq.gov/node/43699/psn-pdf
November 26, 2014 - Diagnosing overdiagnosis: conceptual challenges and
suggested solutions.
November 26, 2014
Hofmann B. Diagnosing overdiagnosis: conceptual challenges and suggested solutions. Eur J Epidemiol.
2014;29(9):599-604. doi:10.1007/s10654-014-9920-5.
https://psnet.ahrq.gov/issue/diagnosing-overdiagnosis-conceptual-challen…
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psnet.ahrq.gov/node/47289/psn-pdf
October 24, 2018 - ASHP guidelines on managing drug product shortages.
October 24, 2018
Fox ER, McLaughlin MM. ASHP guidelines on managing drug product shortages. Am J Health Syst Pharm.
2018;75(21):1742-1750. doi:10.2146/ajhp180441.
https://psnet.ahrq.gov/issue/ashp-guidelines-managing-drug-product-shortages
Drug shortages are a pe…
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psnet.ahrq.gov/node/40769/psn-pdf
March 21, 2012 - Identification of adverse events in ground transport
emergency medical services.
March 21, 2012
Patterson PD, Weaver MD, Abebe K, et al. Identification of adverse events in ground transport emergency
medical services. Am J Med Qual. 2011;27(2):139-146. doi:10.1177/1062860611415515.
https://psnet.ahrq.gov/issue/ide…
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psnet.ahrq.gov/node/39072/psn-pdf
November 04, 2009 - Variations in nursing care quality across hospitals.
November 4, 2009
Lucero RJ, Lake ET, Aiken LH. Variations in nursing care quality across hospitals. J Adv Nurs.
2009;65(11):2299-310. doi:10.1111/j.1365-2648.2009.05090.x.
https://psnet.ahrq.gov/issue/variations-nursing-care-quality-across-hospitals
This seconda…
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psnet.ahrq.gov/node/46336/psn-pdf
August 23, 2017 - Improving the Working Environment for Safe Surgical
Care.
August 23, 2017
Short-Life Working Group on Hospital Reports. Edinburgh, Scotland: Royal College of Surgeons of
Edinburgh; July 31, 2017.
https://psnet.ahrq.gov/issue/improving-working-environment-safe-surgical-care
Surgical training is demanding and can r…
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psnet.ahrq.gov/node/45257/psn-pdf
July 27, 2016 - Exploring approaches to patient safety: the case of spinal
manipulation therapy.
July 27, 2016
Rozmovits L, Mior S, Boon H. Exploring approaches to patient safety: the case of spinal manipulation
therapy. BMC Complement Altern Med. 2016;16:164. doi:10.1186/s12906-016-1149-2.
https://psnet.ahrq.gov/issue/exploring-…
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psnet.ahrq.gov/node/41388/psn-pdf
May 30, 2012 - Observational teamwork assessment for surgery:
feasibility of clinical and nonclinical assessor calibration
with short-term training.
May 30, 2012
Russ S, Hull L, Rout S, et al. Observational teamwork assessment for surgery: feasibility of clinical and
nonclinical assessor calibration with short-term training. Ann…
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psnet.ahrq.gov/node/46244/psn-pdf
June 28, 2017 - Changing the narratives for patient safety.
June 28, 2017
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.
https://psnet.ahrq.gov/issue/changing-narratives-patient-safety
Mental models represent established …
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psnet.ahrq.gov/node/46076/psn-pdf
September 24, 2017 - The evolving story of overlapping surgery.
September 24, 2017
Mello MM, Livingston EH. The Evolving Story of Overlapping Surgery. JAMA. 2017;318(3):233-234.
doi:10.1001/jama.2017.8061.
https://psnet.ahrq.gov/issue/evolving-story-overlapping-surgery
Scheduling overlapping procedures is perceived as risky, despite l…
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psnet.ahrq.gov/node/44729/psn-pdf
January 07, 2016 - The morbidity and mortality meeting: time for a different
approach?
January 7, 2016
Fraser J. The morbidity and mortality meeting: time for a different approach? Arch Dis Child. 2016;101(1):4-
8. doi:10.1136/archdischild-2015-309536.
https://psnet.ahrq.gov/issue/morbidity-and-mortality-meeting-time-different-appro…
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psnet.ahrq.gov/node/41971/psn-pdf
January 23, 2013 - Behavioral integrity for safety, priority of safety,
psychological safety, and patient safety: a team-level
study.
January 23, 2013
Leroy H, Dierynck B, Anseel F, et al. Behavioral integrity for safety, priority of safety, psychological safety,
and patient safety: A team-level study. Journal of Applied Psychology.…
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psnet.ahrq.gov/node/45150/psn-pdf
October 13, 2018 - Pain as the neglected patient safety concern: five years
on.
October 13, 2018
Twycross A, Forgeron P, Chorne J, et al. Pain as the neglected patient safety concern: Five years on. J
Child Health Care. 2016;20(4):537-541. doi:10.1177/1367493516643422.
https://psnet.ahrq.gov/issue/pain-neglected-patient-safety-conce…
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psnet.ahrq.gov/node/45689/psn-pdf
January 25, 2018 - How to prevent burnout (maybe).
January 25, 2018
Dissanaike S. How to prevent burnout (maybe). Am J Surg. 2016;212(6):1251-1255.
doi:10.1016/j.amjsurg.2016.08.022.
https://psnet.ahrq.gov/issue/how-prevent-burnout-maybe
Burnout can affect the ability of individuals and teams to act safely. Originally delivered as a…
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psnet.ahrq.gov/node/46080/psn-pdf
August 28, 2017 - A growth mindset approach to preparing trainees for
medical error.
August 28, 2017
Klein J, Delany C, Fischer MD, et al. A growth mindset approach to preparing trainees for medical error.
BMJ Qual Saf. 2017;26(9):771-774. doi:10.1136/bmjqs-2016-006416.
https://psnet.ahrq.gov/issue/growth-mindset-approach-preparing…
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psnet.ahrq.gov/node/40237/psn-pdf
February 23, 2011 - The impact of the medical emergency team on the
resuscitation practice of critical care nurses.
February 23, 2011
Santiano N, Young L, Baramy LS, et al. The impact of the medical emergency team on the resuscitation
practice of critical care nurses. BMJ Qual Saf. 2011;20(2):115-20. doi:10.1136/bmjqs.2008.029876.
ht…
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psnet.ahrq.gov/node/40875/psn-pdf
November 21, 2016 - Implementation of Condition Help: family teaching and
evaluation of family understanding.
November 21, 2016
Hueckel RM, Mericle JM, Frush K, et al. Implementation of condition help: family teaching and evaluation of
family understanding. J Nurs Care Qual. 2012;27(2):176-81. doi:10.1097/NCQ.0b013e318235bdec.
https:…
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psnet.ahrq.gov/node/45321/psn-pdf
August 01, 2017 - Peer support for clinicians: a programmatic approach.
August 1, 2017
Shapiro J, Galowitz P. Peer Support for Clinicians: A Programmatic Approach. Acad Med.
2016;91(9):1200-4. doi:10.1097/ACM.0000000000001297.
https://psnet.ahrq.gov/issue/peer-support-clinicians-programmatic-approach
Peer support programs can help …