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psnet.ahrq.gov/node/837797/psn-pdf
August 10, 2022 - Toward constructive change after making a medical error:
recovery from situations of error theory as a psychosocial
model for clinician recovery.
August 10, 2022
Harrison R, Johnson J, Mcmullan RD, et al. Toward constructive change after making a medical error:
recovery from situations of error theory as a psychos…
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psnet.ahrq.gov/node/853238/psn-pdf
September 06, 2023 - Potentially inappropriate medication use is associated
with increased risk of incident disability in healthy older
adults.
September 6, 2023
Lockery JE, Collyer TA, Woods RL, et al. Potentially inappropriate medication use is associated with
increased risk of incident disability in healthy older adults. J Am Geria…
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psnet.ahrq.gov/issue/health-courts-offer-cure
January 09, 2024 - Newspaper/Magazine Article
'Health courts' offer cure.
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July 20, 2005
This editorial supports legislation such as the Fair and Re…
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psnet.ahrq.gov/node/46309/psn-pdf
December 22, 2018 - Effects of the I-PASS nursing handoff bundle on
communication quality and workflow.
December 22, 2018
Starmer AJ, Schnock KO, Lyons A, et al. Effects of the I-PASS Nursing Handoff Bundle on communication
quality and workflow. BMJ Qual Saf. 2017;26(12):949-957. doi:10.1136/bmjqs-2016-006224.
https://psnet.ahrq.gov/…
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psnet.ahrq.gov/node/36409/psn-pdf
September 28, 2016 - The multitasking clinician: decision-making and cognitive
demand during and after team handoffs in emergency
care.
September 28, 2016
Laxmisan A, Hakimzada F, Sayan OR, et al. The multitasking clinician: decision-making and cognitive
demand during and after team handoffs in emergency care. IntJ Med Inform. 2007;76…
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psnet.ahrq.gov/node/866687/psn-pdf
September 11, 2024 - An exploratory analysis of the association between
healthcare associated infections & hospital financial
performance.
September 11, 2024
Beauvais B, Dolezel D, Shanmugam R, et al. An exploratory analysis of the association between
healthcare associated infections & hospital financial performance. Healthcare (Basel…
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psnet.ahrq.gov/node/37062/psn-pdf
January 02, 2017 - The emotional impact of medical errors on practicing
physicians in the United States and Canada.
January 2, 2017
Waterman AD, Garbutt J, Hazel E, et al. The emotional impact of medical errors on practicing physicians in
the United States and Canada. Jt Comm J Qual Saf. 2007;33(8):467-476.
https://psnet.ahrq.gov/is…
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psnet.ahrq.gov/node/37207/psn-pdf
September 09, 2008 - Publicly available hospital comparison web sites:
determination of useful, valid, and appropriate
information for comparing surgical quality.
September 9, 2008
Leonardi MJ, McGory ML, Ko CY. Publicly available hospital comparison web sites: determination of useful,
valid, and appropriate information for comparing …
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psnet.ahrq.gov/node/42944/psn-pdf
March 03, 2024 - Clinical Learning Environment Review (CLER) Program.
March 3, 2024
Accreditation Council for Graduate Medical Education.
https://psnet.ahrq.gov/issue/clinical-learning-environment-review-cler-program
Many graduate medical education programs have instituted patient safety didactics or online courses to
meet accredi…
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psnet.ahrq.gov/node/866564/psn-pdf
August 21, 2024 - Care quality and safety in long-term aged care settings: a
systematic review and narrative analysis of missed care
measurements.
August 21, 2024
Wang X, Rihari?Thomas J, Bail K, et al. Care quality and safety in long?term aged care settings: a
systematic review and narrative analysis of missed care measurements. J…
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psnet.ahrq.gov/node/44577/psn-pdf
October 21, 2015 - Improving patient safety in clinical oncology: applying
lessons from Normal Accident Theory.
October 21, 2015
Chera BS, Mazur L, Buchanan I, et al. Improving Patient Safety in Clinical Oncology: Applying Lessons
From Normal Accident Theory. JAMA Oncol. 2015;1(7):958-64. doi:10.1001/jamaoncol.2015.0891.
https://psn…
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psnet.ahrq.gov/node/37091/psn-pdf
March 02, 2016 - The tension between needing to improve care and
knowing how to do it.
March 2, 2016
Auerbach AD, Landefeld S, Shojania KG. The tension between needing to improve care and knowing how
to do it. N Engl J Med. 2007;357(6):608-13.
https://psnet.ahrq.gov/issue/tension-between-needing-improve-care-and-knowing-how-do-it
…
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psnet.ahrq.gov/node/74201/psn-pdf
December 22, 2021 - Next of kin involvement in regulatory investigations of
adverse events that caused patient death: a process
evaluation.
December 22, 2021
Wiig S, Haraldseid-Driftland C, Tvete Zachrisen R, et al. J Patient Saf. 2021;17(8):e1707-
e1718.
https://psnet.ahrq.gov/issue/next-kin-involvement-regulatory-inves…
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psnet.ahrq.gov/node/38935/psn-pdf
March 01, 2017 - Leadership committed to safety.
December 23, 2016
Sentinel Event Alert. August 27, 2009;(43):1-3.
https://psnet.ahrq.gov/issue/leadership-committed-safety
Despite the past decade's focus on improving patient safety, most health care organizations are still striving
to achieve high reliability status—consistently p…
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psnet.ahrq.gov/node/60047/psn-pdf
March 18, 2020 - A systematic review exploring the content and outcomes
of interventions to improve psychological safety,
speaking up and voice behaviour.
March 18, 2020
O’Donovan R, McAuliffe E. A systematic review exploring the content and outcomes of interventions to
improve psychological safety, speaking up and voice behaviour…
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psnet.ahrq.gov/node/866689/psn-pdf
September 11, 2024 - Human-AI teaming in critical care: a comparative analysis
of data scientists' and clinicians' perspectives on AI
augmentation and automation.
September 11, 2024
Bienefeld N, Keller E, Grote G. Human-AI teaming in critical care: a comparative analysis of data scientists'
and clinicians' perspectives on AI augmentat…
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psnet.ahrq.gov/node/43764/psn-pdf
July 03, 2016 - Redesigning rounds: towards a more purposeful
approach to inpatient teaching and learning.
July 3, 2016
Reilly JB, Bennett N, Fosnocht K, et al. Redesigning rounds: towards a more purposeful approach to
inpatient teaching and learning. Acad Med. 2015;90(4):450-3. doi:10.1097/ACM.0000000000000579.
https://psnet.ahr…
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psnet.ahrq.gov/node/843414/psn-pdf
February 01, 2023 - Leadership behavior associations with domains of safety
culture, engagement, and healthcare worker well-being.
February 1, 2023
Tawfik DS, Adair KC, Palassof S, et al. Leadership behavior associations with domains of safety culture,
engagement, and healthcare worker well-being. Jt Comm J Qual Patient Saf. 2023;49(3…
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psnet.ahrq.gov/node/851200/psn-pdf
July 05, 2023 - Deficient Care of a Patient Who Died by Suicide and
Facility Leaders' Response at the Charlie Norwood VA
Medical Center in Augusta, Georgia.
July 5, 2023
Washington DC: Department of Veterans Affairs, Office of Inspector General; May 10, 2023.
Report no. 22-01116-110.
https://psnet.ahrq.gov/issue/defi…
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psnet.ahrq.gov/node/840148/psn-pdf
November 16, 2022 - Safety culture and the positive association of being a
primary care training practice during COVID-19: the
results of the multi-country European PRICOV-19 Study.
November 16, 2022
Silva B, Ožva?i? Adži? Z, Vanden Bussche P, et al. Safety culture and the positive association of being a
primary care training practic…