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psnet.ahrq.gov/node/44839/psn-pdf
February 03, 2016 - Engaging frontline staff in performance improvement: the
American Organization of Nurse Executives
implementation of Transforming Care at the Bedside
collaborative.
February 3, 2016
Needleman J, Pearson ML, Upenieks V, et al. Engaging Frontline Staff in Performance Improvement: The
American Organization of Nurse …
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psnet.ahrq.gov/node/838930/psn-pdf
October 26, 2022 - Artificial Intelligence in Health Care: Benefits and
Challenges of Machine Learning Technologies for Medical
Diagnostics.
October 26, 2022
Washington DC: United States Government Accountability Office and National Academy of
Medicine; September 2022. Report no. GAO-22-104629.
https://psnet.ahrq.gov/issue/ar…
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psnet.ahrq.gov/node/841760/psn-pdf
December 21, 2022 - Pursuit of "endpoint diagnoses" as a cognitive forcing
strategy to avoid premature diagnostic closure.
December 21, 2022
Kaplan HM, Birnbaum JF, Kulkarni PA. Pursuit of “endpoint diagnoses” as a cognitive forcing strategy to
avoid premature diagnostic closure. Diagnosis (Berl). 2022;9(4):421-429. doi:10.1515/dx-202…
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psnet.ahrq.gov/node/34700/psn-pdf
January 04, 2017 - Reducing adverse drug events: lessons from a
breakthrough series collaborative.
January 4, 2017
Leape L, Kabcenell AI, Gandhi TK, et al. Reducing adverse drug events: lessons from a breakthrough
series collaborative. Jt Comm J Qual Improv. 2000;26(6):321-31.
https://psnet.ahrq.gov/issue/reducing-adverse-drug-event…
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psnet.ahrq.gov/node/47816/psn-pdf
June 26, 2019 - Clinical reasoning assessment methods: a scoping
review and practical guidance.
June 26, 2019
Daniel M, Rencic J, Durning SJ, et al. Clinical Reasoning Assessment Methods: A Scoping Review and
Practical Guidance. Acad Med. 2019;94(6):902-912. doi:10.1097/ACM.0000000000002618.
https://psnet.ahrq.gov/issue/clinical-…
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psnet.ahrq.gov/node/41305/psn-pdf
April 18, 2012 - Is computer-assisted telephone triage safe? A
prospective surveillance study in walk-in patients with
non-life-threatening medical conditions.
April 18, 2012
Meer A, Gwerder T, Duembgen L, et al. Is computer-assisted telephone triage safe? A prospective
surveillance study in walk-in patients with non-life-threaten…
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psnet.ahrq.gov/node/45819/psn-pdf
March 15, 2017 - How doctors think: common diagnostic errors in clinical
judgment--lessons from an undiagnosed and rare disease
program.
March 15, 2017
Kliegman RM, Bordini BJ, Basel D, et al. How Doctors Think: Common Diagnostic Errors in Clinical
Judgment-Lessons from an Undiagnosed and Rare Disease Program. Pediatr Clin North A…
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psnet.ahrq.gov/node/73568/psn-pdf
August 04, 2021 - Coping strategies in health care providers as second
victims: a systematic review.
August 4, 2021
Kappes M, Romero?García M, Delgado?Hito P. Coping strategies in health care providers as second
victims: a systematic review. Int Nurs Rev. 2021;68(4):471-481. doi:10.1111/inr.12694.
https://psnet.ahrq.gov/issue/copin…
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psnet.ahrq.gov/node/36496/psn-pdf
February 28, 2011 - Literacy and misunderstanding prescription drug labels.
February 28, 2011
Davis TC, Wolf MS, Bass PF, et al. Literacy and misunderstanding prescription drug labels. Ann Intern
Med. 2006;145(12):887-94.
https://psnet.ahrq.gov/issue/literacy-and-misunderstanding-prescription-drug-labels
Poor health literacy has been…
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psnet.ahrq.gov/node/47012/psn-pdf
August 01, 2018 - Trigger alerts associated with laboratory abnormalities on
identifying potentially preventable adverse drug events in
the intensive care unit and general ward.
August 1, 2018
Buckley MS, Rasmussen JR, Bikin DS, et al. Trigger alerts associated with laboratory abnormalities on
identifying potentially preventable ad…
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psnet.ahrq.gov/node/47638/psn-pdf
February 06, 2019 - Decreasing surgical site infections by developing a high
reliability culture.
February 6, 2019
Pettis AM. Decreasing Surgical Site Infections by Developing a High Reliability Culture. AORN J.
2018;108(6):644-650. doi:10.1002/aorn.12416.
https://psnet.ahrq.gov/issue/decreasing-surgical-site-infections-developing-hi…
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psnet.ahrq.gov/node/73611/psn-pdf
August 18, 2021 - Racial disparities in diagnostic delay among women with
breast cancer.
August 18, 2021
Miller-Kleinhenz JM, Collin LJ, Seidel R, et al. Racial disparities in diagnostic delay among women with
breast cancer. J Am Coll Radiol. 2021;18(10):1384-1393. doi:10.1016/j.jacr.2021.06.019.
https://psnet.ahrq.gov/issue/racial…
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psnet.ahrq.gov/node/44130/psn-pdf
May 13, 2015 - Recent Evidence That Health IT Improves Patient Safety:
Issue Brief.
May 13, 2015
Banger A, Graber ML. Washington, DC: Office of the National Coordinator for Health Information
Technology; February 2015.
https://psnet.ahrq.gov/issue/recent-evidence-health-it-improves-patient-safety-issue-brief
Rapid implementatio…
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psnet.ahrq.gov/node/39298/psn-pdf
June 11, 2010 - Medication error reporting in nursing homes: identifying
targets for patient safety improvement.
June 11, 2010
Greene SB, Williams CE, Pierson S, et al. Medication error reporting in nursing homes: identifying targets
for patient safety improvement. Qual Saf Health Care. 2010;19(3):218-22. doi:10.1136/qshc.2008.031…
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psnet.ahrq.gov/node/73164/psn-pdf
April 21, 2021 - Effectiveness of communication interventions in
obstetrics--a systematic review.
April 21, 2021
Lippke S, Derksen C, Keller FM, et al. Effectiveness of communication interventions in obstetrics--a
systematic review. Int J Environ Res Public Health. 2021;18(5):2616. doi:10.3390/ijerph18052616.
https://psnet.ahrq.go…
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psnet.ahrq.gov/node/73345/psn-pdf
June 02, 2021 - An estimate of missed pediatric sepsis in the emergency
department.
June 2, 2021
Cifra CL, Westlund E, Ten Eyck P, et al. An estimate of missed pediatric sepsis in the emergency
department. Diagnosis (Berl). 2020;8(2):193-198. doi:10.1515/dx-2020-0023.
https://psnet.ahrq.gov/issue/estimate-missed-pediatric-sepsis-…
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psnet.ahrq.gov/node/867046/psn-pdf
October 30, 2024 - The future of safety and quality in radiation oncology.
October 30, 2024
Talcott W, Covington E, Bazan J, et al. The future of safety and quality in radiation oncology. Semin Radiat
Oncol. 2024;34(4):433-440. doi:10.1016/j.semradonc.2024.07.008.
https://psnet.ahrq.gov/issue/future-safety-and-quality-radiation-oncol…
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psnet.ahrq.gov/node/42362/psn-pdf
July 10, 2013 - How to improve change of shift handovers and
collaborative grounding and what role does the electronic
patient record system play? Results of a systematic
literature review.
July 10, 2013
Flemming D, Hübner U. How to improve change of shift handovers and collaborative grounding and what
role does the electronic p…
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psnet.ahrq.gov/node/74097/psn-pdf
November 24, 2021 - Inattentional blindness in anesthesiology: a gorilla is
worth one thousand words.
November 24, 2021
De Cassai A, Negro S, Geraldini F, et al. Inattentional blindness in anesthesiology: a gorilla is worth one
thousand words. PLoS One. 2021;16(9):e0257508. doi:10.1371/journal.pone.0257508.
https://psnet.ahrq.gov/iss…
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psnet.ahrq.gov/node/847051/psn-pdf
April 05, 2023 - Distractions in the operating room: a survey of the
healthcare team.
April 5, 2023
Nasri B-N, Mitchell JD, Jackson C, et al. Distractions in the operating room: a survey of the healthcare
team. Surg Endosc. 2023;37(3):2316-2325. doi:10.1007/s00464-022-09553-8.
https://psnet.ahrq.gov/issue/distractions-operating-ro…