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psnet.ahrq.gov/node/39236/psn-pdf
May 25, 2010 - Do emergency physicians attribute drug-related
emergency department visits to medication-related
problems?
May 25, 2010
Hohl CM, Zed PJ, Brubacher JR, et al. Do emergency physicians attribute drug-related emergency
department visits to medication-related problems? Ann Emerg Med. 2010;55(6):493-502.e4.
doi:10.1016…
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psnet.ahrq.gov/node/837761/psn-pdf
August 03, 2022 - The effectiveness of improving healthcare teams' human
factor skills using simulation-based training: a systematic
review.
August 3, 2022
Abildgren L, Lebahn-Hadidi M, Mogensen CB, et al. The effectiveness of improving healthcare teams’
human factor skills using simulation-based training: a systematic review. Adv …
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psnet.ahrq.gov/node/866817/psn-pdf
January 01, 2025 - Longitudinal study of the manifestations and mechanisms
of technology-related prescribing errors in pediatrics.
September 25, 2024
Raban MZ, Fitzpatrick E, Merchant A, et al. Longitudinal study of the manifestations and mechanisms of
technology-related prescribing errors in pediatrics. J Am Med Inform Assoc. 2025;3…
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psnet.ahrq.gov/node/44866/psn-pdf
March 15, 2016 - Associations between attending physician workload,
teaching effectiveness, and patient safety.
March 15, 2016
Wingo MT, Halvorsen AJ, Beckman T, et al. Associations between attending physician workload, teaching
effectiveness, and patient safety. J Hosp Med. 2016;11(3):169-73. doi:10.1002/jhm.2540.
https://psnet.a…
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psnet.ahrq.gov/node/73983/psn-pdf
October 20, 2021 - Factors associated with potentially missed acute
deterioration in primary care: cohort study of UK general
practices.
October 20, 2021
Cecil E, Bottle A, Majeed A, et al. Factors associated with potentially missed acute deterioration in primary
care: cohort study of UK general practices. Br J Gen Pract. 2021;71(70…
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psnet.ahrq.gov/node/41586/psn-pdf
January 01, 2013 - Strategies for improving patient safety culture in
hospitals: a systematic review.
December 31, 2012
Morello RT, Lowthian JA, Barker AL, et al. Strategies for improving patient safety culture in hospitals: a
systematic review. BMJ Qual Saf. 2013;22(1):11-8. doi:10.1136/bmjqs-2011-000582.
https://psnet.ahrq.gov/iss…
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psnet.ahrq.gov/node/854991/psn-pdf
November 01, 2023 - Assessing biases in medical decisions via clinician and
AI chatbot responses to patient vignettes.
November 1, 2023
Kim J, Cai ZR, Chen ML, et al. Assessing biases in medical decisions via clinician and AI chatbot
responses to patient vignettes. JAMA Netw Open. 2023;6(10):e2338050.
doi:10.1001/jamanetworkopen.2023…
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psnet.ahrq.gov/node/837799/psn-pdf
August 10, 2022 - Effect of a pharmacy-based centralized intravenous
admixture service on the prevalence of medication errors:
a before-and-after study.
August 10, 2022
Jessurun JG, Hunfeld NGM, Van Rosmalen J, et al. Effect of a pharmacy-based centralized intravenous
admixture service on the prevalence of medication errors: a befo…
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psnet.ahrq.gov/node/36407/psn-pdf
April 19, 2011 - Adverse events experienced while transferring the
critically ill patient from the emergency department to the
intensive care unit.
April 19, 2011
Gillman L, Leslie G, Williams T, et al. Adverse events experienced while transferring the critically ill patient
from the emergency department to the intensive care unit…
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psnet.ahrq.gov/node/866517/psn-pdf
August 14, 2024 - Feedback loop failure modes in medical diagnosis: how
biases can emerge and be reinforced.
August 14, 2024
Aikens RC, Chen JH, Baiocchi M, et al. Feedback loop failure modes in medical diagnosis: how biases can
emerge and be reinforced. Med Decis Making. 2024;44(5):481-496. doi:10.1177/0272989x241248612.
https://p…
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psnet.ahrq.gov/node/60326/psn-pdf
May 13, 2020 - Preventing diagnostic errors in ambulatory care: an
electronic notification tool for incomplete radiology tests.
May 13, 2020
Weingart SN, Yaghi O, Barnhart L, et al. Preventing diagnostic errors in ambulatory care: an electronic
notification tool for incomplete radiology tests. Appl Clin Inform. 2020;11(02). doi:1…
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psnet.ahrq.gov/node/841151/psn-pdf
December 07, 2022 - Discontinuation of outpatient medications: implications
for electronic messaging to pharmacies using CancelRx.
December 7, 2022
Pitts S, Yang Y, Thomas BA, et al. Discontinuation of outpatient medications: implications for electronic
messaging to pharmacies using CancelRx. J Am Med Inform Assoc. 2022;29(12):2101-21…
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psnet.ahrq.gov/node/47059/psn-pdf
May 16, 2018 - Participating in a multisite study exploring operational
failures encountered by frontline nurses: lessons learned.
May 16, 2018
Melnyk H, Rosenfeld P, Glassman KS. Participating in a Multisite Study Exploring Operational Failures
Encountered by Frontline Nurses: Lessons Learned. J Nurs Adm. 2018;48(4):203-208.
do…
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psnet.ahrq.gov/node/50573/psn-pdf
October 23, 2019 - Preventing patient harm via adverse event review: An
APSA survey regarding the role of morbidity and mortality
(M&M) conference.
October 23, 2019
Berman L, Ottosen M, Renaud E, et al. Preventing patient harm via adverse event review: An APSA survey
regarding the role of morbidity and mortality (M&M) conference. J …
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psnet.ahrq.gov/node/35886/psn-pdf
July 23, 2010 - In-house, overnight physician staffing: a cross-sectional
survey of Canadian adult and pediatric intensive care
units.
July 23, 2010
Parshuram CS, Kirpalani H, Mehta S, et al. In-house, overnight physician staffing: a cross-sectional survey
of Canadian adult and pediatric intensive care units. Crit Care Med. 2006;…
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psnet.ahrq.gov/node/47849/psn-pdf
August 14, 2019 - The effect of external inspections on safety in acute
hospitals in the National Health Service in England: a
controlled interrupted time-series analysis.
August 14, 2019
Castro-Avila A, Bloor K, Thompson C. The effect of external inspections on safety in acute hospitals in the
National Health Service in England: A…
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psnet.ahrq.gov/node/37153/psn-pdf
October 06, 2011 - The effect of a rapid response team on major clinical
outcome measures in a community hospital.
October 6, 2011
Dacey MJ, Mirza ER, Wilcox V, et al. The effect of a rapid response team on major clinical outcome
measures in a community hospital. Crit Care Med. 2007;35(9):2076-82.
https://psnet.ahrq.gov/issue/effect…
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psnet.ahrq.gov/issue/hospital-board-and-management-practices-are-strongly-related-hospital-performance-clinical
October 27, 2021 - Study
Classic
Hospital board and management practices are strongly related to hospital performance on clinical quality metrics.
Citation Text:
Tsai TC, Jha AK, Gawande AA, et al. Hospital board and management practices are strongly related to hospital performanc…
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psnet.ahrq.gov/innovation/esimpler-dynamic-electronic-health-record-integrated-checklist-clinical-decision-support
June 16, 2021 - EMERGING INNOVATIONS
eSIMPLER: a dynamic, electronic health record-integrated checklist for clinical decision support during PICU daily rounds.
Citation Text:
Geva A, Albert BD, Hamilton S, et al. eSIMPLER: a dynamic, electronic health record-integrated checklist for clinical decision support duri…
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psnet.ahrq.gov/primer/responding-patient-safety-events
October 18, 2023 - Responding to Patient Safety Events
Citation Text:
Shaikh U. Responding to Patient Safety Events. PSNet [internet]. Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2025.
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