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  1. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/36816/psn-pdf
    August 26, 2011 - Embedding quality improvement and patient safety - the UCLA value analysis experience. August 26, 2011 Gambone JC, Broder MS. Embedding quality improvement and patient safety: the UCLA value analysis experience. Best Pract Res Clin Obstet Gynaecol. 2007;21(4):581-92. https://psnet.ahrq.gov/issue/embedding-quality-…
  2. psnet.ahrq.gov/web-mm/errors-managing-open-wound-elbow-leading-multiple-complications-and-operations
    September 27, 2023 - SPOTLIGHT CASE Errors in Managing an Open Wound of the Elbow Leading to Multiple Complications and Operations Citation Text: Barnes DK, Utter GH. Errors in Managing an Open Wound of the Elbow Leading to Multiple Complications and Operations. PSNet [internet]. Agency for Healthcare Research and Qu…
  3. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/42216/psn-pdf
    June 28, 2013 - Simulation for ward processes of surgical care. June 28, 2013 Pucher PH, Darzi A, Aggarwal R. Simulation for ward processes of surgical care. Am J Surg. 2013;206(1):96-102. doi:10.1016/j.amjsurg.2012.08.013. https://psnet.ahrq.gov/issue/simulation-ward-processes-surgical-care This commentary describes one hospital…
  4. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/37242/psn-pdf
    September 12, 2016 - Failure-to-rescue: comparing definitions to measure quality of care. September 12, 2016 Silber JH, Romano PS, Rosen AK, et al. Failure-to-rescue: comparing definitions to measure quality of care. Med Care. 2007;45(10):918-25. https://psnet.ahrq.gov/issue/failure-rescue-comparing-definitions-measure-quality-care T…
  5. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/44198/psn-pdf
    July 01, 2016 - Safety and diagnostic accuracy of tumor biopsies in children with cancer. July 1, 2016 Interiano RB, Loh AHP, Hinkle N, et al. Safety and diagnostic accuracy of tumor biopsies in children with cancer. Cancer. 2015;121(7):1098-107. doi:10.1002/cncr.29167. https://psnet.ahrq.gov/issue/safety-and-diagnostic-accuracy-…
  6. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/37350/psn-pdf
    January 05, 2012 - How safe is my intensive care unit? Methods for monitoring and measurement. January 5, 2012 Berenholtz SM, Pustavoitau A, Schwartz SJ, et al. How safe is my intensive care unit? Methods for monitoring and measurement. Curr Opin Crit Care. 2007;13(6):703-8. https://psnet.ahrq.gov/issue/how-safe-my-intensive-care-un…
  7. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/36157/psn-pdf
    September 29, 2010 - Adverse drug event reporting in intensive care units: a survey of current practices. September 29, 2010 Kane-Gill SL, Devlin JW. Adverse drug event reporting in intensive care units: a survey of current practices. Ann Pharmacother. 2006;40(7-8):1267-73. https://psnet.ahrq.gov/issue/adverse-drug-event-reporting-int…
  8. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/35047/psn-pdf
    November 04, 2015 - Managing patients with identical names in the same ward. November 4, 2015 Lee ACW, Leung M, So KT. Managing patients with identical names in the same ward. Int J Health Care Qual Assur Inc Leadersh Health Serv. 2005;18(1):15-23. https://psnet.ahrq.gov/issue/managing-patients-identical-names-same-ward This case rep…
  9. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/33715/psn-pdf
    July 01, 2011 - Becoming a Patient Safety Organization July 1, 2011 Jaffe R. Becoming a Patient Safety Organization. PSNet [internet]. 2011. https://psnet.ahrq.gov/perspective/becoming-patient-safety-organization Perspective While I was the first employee of the California Hospital Patient Safety Organization (CHPSO), its story …
  10. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/60548/psn-pdf
    May 28, 2020 - In Conversation With... Jeffrey Shuren, MD, JD May 28, 2020 In Conversation With.. Jeffrey Shuren, MD, JD. PSNet [internet]. 2020. https://psnet.ahrq.gov/perspective/conversation-jeffrey-shuren-md-jd Editor’s note: Jeffrey Shuren, MD, JD is the Director of the Center for Devices and Radiological Health at the Food…
  11. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/866621/psn-pdf
    August 28, 2024 - Application of Safety-II Principles August 28, 2024 Venkatesan C, Helak K, Sousane Z, et al. Application of Safety-II Principles. PSNet [internet]. 2024. https://psnet.ahrq.gov/perspective/application-safety-ii-principles Traditional approaches to patient safety have often been reactive rather than proactive, seeki…
  12. psnet.ahrq.gov/issue/breast-cancer-missed-screening-hindsight-or-mistakes
    November 15, 2023 - January 29, 2020 Why Current Breast Pathology Practices Must Be Evaluated.
  13. psnet.ahrq.gov/issue/discrepancies-between-clinical-and-autopsy-diagnosis-and-value-post-mortem-histology-meta
    September 22, 2021 - March 23, 2012 Why Current Breast Pathology Practices Must Be Evaluated.
  14. psnet.ahrq.gov/issue/missed-lesions-abdominal-oncologic-ct-lessons-learned-quality-assurance
    April 21, 2011 - October 4, 2011 Why Current Breast Pathology Practices Must Be Evaluated.
  15. psnet.ahrq.gov/issue/evaluation-12-strategies-obtaining-second-opinions-improve-interpretation-breast
    November 03, 2015 - April 9, 2013 Why Current Breast Pathology Practices Must Be Evaluated.
  16. psnet.ahrq.gov/issue/characteristics-and-predictors-missed-opportunities-lung-cancer-diagnosis-electronic-health
    January 19, 2012 - October 31, 2014 Why Current Breast Pathology Practices Must Be Evaluated.
  17. psnet.ahrq.gov/issue/diagnostic-errors-musculoskeletal-oncology-and-possible-mitigation-strategies
    May 01, 2013 - December 27, 2014 Why Current Breast Pathology Practices Must Be Evaluated.
  18. psnet.ahrq.gov/issue/big-dog-effect-variability-assessing-causes-error-diagnoses-patients-lung-cancer
    March 28, 2012 - April 9, 2013 Why Current Breast Pathology Practices Must Be Evaluated.
  19. psnet.ahrq.gov/issue/delayed-or-missed-diagnosis-cervical-spine-injuries
    May 05, 2010 - October 31, 2014 Why Current Breast Pathology Practices Must Be Evaluated.
  20. psnet.ahrq.gov/issue/patient-safety-leadership-academy-university-pennsylvania-first-cohorts-learning-experience
    October 04, 2011 - June 18, 2013 Why Current Breast Pathology Practices Must Be Evaluated.

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