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  1. Psn-Pdf (pdf file)

    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…
  2. Psn-Pdf (pdf file)

    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…
  3. Psn-Pdf (pdf file)

    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…
  4. Psn-Pdf (pdf file)

    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…
  5. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/45564/psn-pdf
    October 03, 2017 - Fostering transparency in outcomes, quality, safety, and costs. October 3, 2017 Austin M, McGlynn EA, Pronovost P. Fostering Transparency in Outcomes, Quality, Safety, and Costs. JAMA. 2016;316(16):1661-1662. doi:10.1001/jama.2016.14039. https://psnet.ahrq.gov/issue/fostering-transparency-outcomes-quality-safety-a…
  6. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/34715/psn-pdf
    February 18, 2011 - Continuous improvement as an ideal in health care. February 18, 2011 Berwick D. Continuous improvement as an ideal in health care. New Engl J Med. 1989;320(1):53-56. https://psnet.ahrq.gov/issue/continuous-improvement-ideal-health-care Two approaches to improving quality in health care are illustrated in this artic…
  7. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/43945/psn-pdf
    September 09, 2015 - Hospital and procedure incidence of pediatric retained surgical items. September 9, 2015 Wang B, Tashiro J, Perez EA, et al. Hospital and procedure incidence of pediatric retained surgical items. J Surg Res. 2015;198(2):400-5. doi:10.1016/j.jss.2015.03.054. https://psnet.ahrq.gov/issue/hospital-and-procedure-incid…
  8. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/44682/psn-pdf
    March 15, 2016 - On resident duty hour restrictions and neurosurgical training: review of the literature. March 15, 2016 Bina RW, Lemole M, Dumont TM. On resident duty hour restrictions and neurosurgical training: review of the literature. J Neurosurg. 2016;124(3):842-8. doi:10.3171/2015.3.JNS142796. https://psnet.ahrq.gov/issue/r…
  9. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/45232/psn-pdf
    August 10, 2016 - Promoting patient safety with perioperative hand-off communication. August 10, 2016 Robinson NL. Promoting Patient Safety With Perioperative Hand-off Communication. J Perianesth Nurs. 2016;31(3):245-53. doi:10.1016/j.jopan.2014.08.144. https://psnet.ahrq.gov/issue/promoting-patient-safety-perioperative-hand-commun…
  10. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/47213/psn-pdf
    June 20, 2018 - Are second victims getting the help they need? June 20, 2018 Headley M. Patient Saf Qual Healthc. May/June 2018. https://psnet.ahrq.gov/issue/are-second-victims-getting-help-they-need Clinicians can experience emotional stress, guilt, and insecurity after making a mistake. Organizations are increasingly building p…
  11. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/46360/psn-pdf
    October 25, 2017 - Creating a culture of caregiver support. October 25, 2017 Gold KJ, Andrew LB, Goldman EB, et al. “I would never want to have a mental health diagnosis on my record”: A survey of female physicians on mental health diagnosis, treatment, and reporting. General Hospital Psychiatry. 2016;43. doi:10.1016/j.genhosppsych.2…
  12. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/40643/psn-pdf
    July 27, 2011 - Does the implementation of an electronic prescribing system create unintended medication errors? A study of the sociotechnical context through the analysis of reported medication incidents. July 27, 2011 Redwood S, Rajakumar A, Hodson J, et al. Does the implementation of an electronic prescribing system create un…
  13. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/43030/psn-pdf
    March 26, 2014 - Recommendations for practitioners and manufacturers to address system-based causes of vaccine errors. March 26, 2014 ISMP Medication Safety Alert! Acute care edition. March 13, 2014;19:1-2,4-5.   https://psnet.ahrq.gov/issue/recommendations-practitioners-and-manufacturers-address-system-based- causes-vaccine-…
  14. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/46457/psn-pdf
    December 20, 2017 - Simulation and the diagnostic process: a pilot study of trauma and rapid response teams. December 20, 2017 Juriga LL, Murray DJ, Boulet JR, et al. Simulation and the diagnostic process: a pilot study of trauma and rapid response teams. Diagnosis (Berl). 2017;4(4):241-249. doi:10.1515/dx-2017-0010. https://psnet.ah…
  15. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/39972/psn-pdf
    January 22, 2017 - Executive/senior leader checklist to improve culture and reduce central line–associated bloodstream infections. January 22, 2017 Goeschel CA, Holzmueller CG, Berenholtz SM, et al. Executive/Senior Leader Checklist to improve culture and reduce central line-associated bloodstream infections. Jt Comm J Qual Patient S…
  16. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/46895/psn-pdf
    March 14, 2018 - Rapid response teams: what's the latest? March 14, 2018 Jackson SA. Rapid response teams: What's the latest? Nursing (Brux). 2017;47(12):34-41. doi:10.1097/01.NURSE.0000526885.10306.21. https://psnet.ahrq.gov/issue/rapid-response-teams-whats-latest Rapid response systems are an established strategy to prevent in-h…
  17. psnet.ahrq.gov/web-mm/stroke-error
    February 01, 2016 - SPOTLIGHT CASE A Stroke of Error Citation Text: Barrett KM. A Stroke of Error. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2014. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML EndNote 7 XML End…
  18. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/39309/psn-pdf
    December 09, 2014 - Patient Safety in Emergency Medicine. December 9, 2014 Croskerry P, Cosby KS, Schenkel SM, Wears RL, eds. Philadelphia, PA: Lippincott Williams & Wilkins; 2009. ISBN: 9780781777278. https://psnet.ahrq.gov/issue/patient-safety-emergency-medicine The pace, diversity, and scope of an emergency department (ED) cre…
  19. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/43645/psn-pdf
    November 12, 2014 - Health IT and Clinical Decision Support Systems. November 12, 2014 Ohno-Machado L, ed. J Am Med Inform Assoc. 2014;21:e180-e375. https://psnet.ahrq.gov/issue/health-it-and-clinical-decision-support-systems A universal agreement on how to calculate the return on investment for health information technology (IT) and…
  20. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/44691/psn-pdf
    December 02, 2015 - Quality and safety in orthopaedics: learning and teaching at the same time: AOA critical issues. December 2, 2015 Black KP, Armstrong AD, Hutzler L, et al. Quality and Safety in Orthopaedics: Learning and Teaching at the Same Time: AOA Critical Issues. J Bone Joint Surg Am. 2015;97(21):1809-15. doi:10.2106/JBJS.O.0…

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