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psnet.ahrq.gov/issue/incidence-and-nature-adverse-events-during-pediatric-sedationanesthesia-propofol-procedures
April 11, 2011 - Study
The incidence and nature of adverse events during pediatric sedation/anesthesia with propofol for procedures outside the operating room: a report from the Pediatric Sedation Research Consortium.
Citation Text:
Cravero JP, Beach ML, Blike G, et al. The incidence and nature of adve…
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psnet.ahrq.gov/issue/association-between-day-delivery-and-obstetric-outcomes-observational-study
January 07, 2015 - Study
Association between day of delivery and obstetric outcomes: observational study.
Citation Text:
Palmer WL, Bottle A, Aylin P. Association between day of delivery and obstetric outcomes: observational study. BMJ. 2015;351:h5774. doi:10.1136/bmj.h5774.
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psnet.ahrq.gov/issue/hospital-credentialing-and-privileging-surgeons-potential-safety-blind-spot
September 24, 2017 - Commentary
Hospital credentialing and privileging of surgeons: a potential safety blind spot.
Citation Text:
Pradarelli J, Campbell D, Dimick JB. Hospital credentialing and privileging of surgeons: a potential safety blind spot. JAMA. 2015;313(13):1313-4. doi:10.1001/jama.2015.1943.
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psnet.ahrq.gov/issue/how-do-we-learn-about-error-cross-sectional-study-urology-trainees
October 21, 2010 - Study
How do we learn about error? A cross-sectional study of urology trainees.
Citation Text:
Browne C, Crone L, O'Connor E. How do we learn about error? A cross-sectional study of urology trainees. J Surg Educ. 2023;80(6):864-872. doi:10.1016/j.jsurg.2023.03.007.
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psnet.ahrq.gov/issue/learning-collaboratives-insights-and-new-taxonomy-ahrqs-two-decades-experience
April 27, 2019 - Commentary
Emerging Classic
Learning collaboratives: insights and a new taxonomy from AHRQ's two decades of experience.
Citation Text:
Nix M, McNamara P, Genevro J, et al. Learning Collaboratives: Insights And A New Taxonomy From AHRQ's Two Decades Of Experience…
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psnet.ahrq.gov/issue/prescribing-2019-what-are-safety-concerns
December 21, 2022 - Review
Prescribing in 2019: what are the safety concerns?
Citation Text:
Coleman JJ. Prescribing in 2019: what are the safety concerns? Expert Opin Drug Saf. 2019;18(2):69-74. doi:10.1080/14740338.2019.1571038.
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psnet.ahrq.gov/issue/association-between-frequency-self-reported-medical-errors-and-anesthesia-trainee-supervision
July 19, 2017 - Study
The association between frequency of self-reported medical errors and anesthesia trainee supervision: a survey of United States anesthesiology residents-in-training.
Citation Text:
De Oliveira GS, Rahmani R, Fitzgerald PC, et al. The association between frequency of self-reported m…
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psnet.ahrq.gov/issue/improving-medication-management-through-redesign-hospital-code-cart-medication-drawer
October 31, 2018 - Study
Improving medication management through the redesign of the hospital code cart medication drawer.
Citation Text:
Rousek JB, Hallbeck MS. Improving Medication Management Through the Redesign of the Hospital Code Cart Medication Drawer. Human Factors: The Journal of the Human Facto…
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psnet.ahrq.gov/issue/errors-and-omissions-hospital-prescriptions-survey-prescription-writing-hospital
April 13, 2022 - Study
Errors and omissions in hospital prescriptions: a survey of prescription writing in a hospital.
Citation Text:
Calligaris L, Panzera A, Arnoldo L, et al. Errors and omissions in hospital prescriptions: a survey of prescription writing in a hospital. BMC Clin Pharmacol. 2009;9:9. d…
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psnet.ahrq.gov/issue/miscoding-misclassification-and-misdiagnosis-diabetes-primary-care
September 23, 2020 - Study
Miscoding, misclassification and misdiagnosis of diabetes in primary care.
Citation Text:
de Lusignan S, Sadek N, Mulnier H, et al. Miscoding, misclassification and misdiagnosis of diabetes in primary care. Diabet Med. 2012;29(2):181-9. doi:10.1111/j.1464-5491.2011.03419.x.
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psnet.ahrq.gov/issue/quality-journey-ascension-health-how-weve-prevented-least-1500-avoidable-deaths-year-and-aim
June 06, 2018 - Commentary
The quality 'journey' at Ascension Health: how we've prevented at least 1,500 avoidable deaths a year—and aim to do even better.
Citation Text:
Pryor D, Hendrich A, Henkel RJ, et al. The quality 'journey' at Ascension Health: how we've prevented at least 1,500 avoidable deaths…
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psnet.ahrq.gov/issue/utilizing-information-technology-mitigate-handoff-risks-caused-resident-work-hour
March 17, 2010 - Commentary
Utilizing information technology to mitigate the handoff risks caused by resident work hour restrictions.
Citation Text:
Bernstein J, MacCourt DC, Jacob DM, et al. Utilizing information technology to mitigate the handoff risks caused by resident work hour restrictions. Clin …
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psnet.ahrq.gov/issue/theoretical-framework-and-competency-based-approach-improving-handoffs
March 28, 2011 - Commentary
A theoretical framework and competency-based approach to improving handoffs.
Citation Text:
Arora VM, Johnson JK, Meltzer DO, et al. A theoretical framework and competency-based approach to improving handoffs. Qual Saf Health Care. 2008;17(1):11-4. doi:10.1136/qshc.2006.0189…
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psnet.ahrq.gov/issue/medication-complexity-medication-number-and-their-relationships-medication-discrepancies
November 16, 2022 - Study
Medication complexity, medication number, and their relationships to medication discrepancies.
Citation Text:
Patel CH, Zimmerman KM, Fonda JR, et al. Medication Complexity, Medication Number, and Their Relationships to Medication Discrepancies. Ann Pharmacother. 2016;50(7):534-40.…
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psnet.ahrq.gov/issue/feasibility-centre-based-incident-reporting-primary-healthcare-spiegel-study
October 05, 2011 - Study
Feasibility of centre-based incident reporting in primary healthcare: the SPIEGEL study.
Citation Text:
Zwart DLM, Steerneman AHM, van Rensen ELJ, et al. Feasibility of centre-based incident reporting in primary healthcare: the SPIEGEL study. BMJ Qual Saf. 2011;20(2):121-7. doi:1…
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psnet.ahrq.gov/issue/blending-evidence-and-innovation-improving-intershift-handoffs-multihospital-setting
September 23, 2017 - Commentary
Blending evidence and innovation: improving intershift handoffs in a multihospital setting.
Citation Text:
Thomas L, Donohue-Porter P. Blending evidence and innovation: improving intershift handoffs in a multihospital setting. J Nurs Care Qual. 2012;27(2):116-24. doi:10.1097…
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psnet.ahrq.gov/issue/management-arterial-lines-and-blood-sampling-intensive-care-threat-patient-safety
November 12, 2014 - Study
Management of arterial lines and blood sampling in intensive care: a threat to patient safety.
Citation Text:
Leslie RA, Gouldson S, Habib N, et al. Management of arterial lines and blood sampling in intensive care: a threat to patient safety. Anaesthesia. 2013;68(11). doi:10.1111…
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psnet.ahrq.gov/issue/prospective-memory-icu-effect-visual-cues-task-execution-representative-simulation
April 24, 2018 - Study
Prospective memory in the ICU: the effect of visual cues on task execution in a representative simulation.
Citation Text:
Grundgeiger T, Sanderson PM, Orihuela B, et al. Prospective memory in the ICU: the effect of visual cues on task execution in a representative simulation. Ergo…
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psnet.ahrq.gov/issue/developing-framework-nursing-handover-emergency-department-individualised-and-systematic
October 06, 2016 - Study
Developing a framework for nursing handover in the emergency department: an individualised and systematic approach.
Citation Text:
Klim S, Kelly A-M, Kerr D, et al. Developing a framework for nursing handover in the emergency department: an individualised and systematic approach. …
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psnet.ahrq.gov/issue/evidence-guiding-practice-reported-versus-observed-adherence-contact-precautions-pilot-study
June 28, 2017 - Study
Is evidence guiding practice? Reported versus observed adherence to contact precautions: a pilot study.
Citation Text:
Jessee MA, Mion LC. Is evidence guiding practice? Reported versus observed adherence to contact precautions: a pilot study. Am J Infect Control. 2013;41(11):965-…