-
psnet.ahrq.gov/node/40946/psn-pdf
January 19, 2012 - Effects of a multicentre teamwork and communication
programme on patient outcomes: results from the Triad
for Optimal Patient Safety (TOPS) project.
January 19, 2012
Auerbach AD, Sehgal NL, Blegen MA, et al. Effects of a multicentre teamwork and communication
programme on patient outcomes: results from the Triad f…
-
psnet.ahrq.gov/node/44958/psn-pdf
March 09, 2016 - The Sepsis Early Recognition and Response Initiative
(SERRI).
March 9, 2016
Jones SL, Ashton CM, Kiehne L, et al. The Sepsis Early Recognition and Response Initiative (SERRI). Jt
Comm J Qual Patient Saf. 2016;42(3):122-138.
https://psnet.ahrq.gov/issue/sepsis-early-recognition-and-response-initiative-serri
Early …
-
psnet.ahrq.gov/node/38399/psn-pdf
February 11, 2009 - Effect of computerized provider order entry with clinical
decision support on adverse drug events in the long-term
care setting.
February 11, 2009
Gurwitz JH, Field T, Rochon P, et al. Effect of computerized provider order entry with clinical decision
support on adverse drug events in the long-term care setting. J…
-
psnet.ahrq.gov/node/47875/psn-pdf
July 19, 2019 - Observer-based tools for non-technical skills assessment
in simulated and real clinical environments in healthcare:
a systematic review.
July 19, 2019
Higham H, Greig PR, Rutherford J, et al. Observer-based tools for non-technical skills assessment in
simulated and real clinical environments in healthcare: a syste…
-
psnet.ahrq.gov/node/41557/psn-pdf
August 01, 2012 - Signal and noise: applying a laboratory trigger tool to
identify adverse drug events among primary care
patients.
August 1, 2012
Brenner S, Detz A, Lopez A, et al. Signal and noise: applying a laboratory trigger tool to identify adverse
drug events among primary care patients. BMJ Qual Saf. 2012;21(8):670-5. doi:1…
-
psnet.ahrq.gov/node/40904/psn-pdf
January 04, 2012 - Effect of illness severity and comorbidity on patient
safety and adverse events.
January 4, 2012
Naessens JM, Campbell CR, Shah ND, et al. Effect of illness severity and comorbidity on patient safety
and adverse events. Am J Med Qual. 2012;27(1):48-57. doi:10.1177/1062860611413456.
https://psnet.ahrq.gov/issue/eff…
-
psnet.ahrq.gov/node/45310/psn-pdf
January 03, 2017 - Minding the gaps: assessing communication outcomes of
electronic preconsultation exchange.
January 3, 2017
Price EL, Sewell JL, Chen AH, et al. Minding the Gaps: Assessing Communication Outcomes of Electronic
Preconsultation Exchange. Jt Comm J Qual Patient Saf. 2016;42(8):341-54.
https://psnet.ahrq.gov/issue/mind…
-
psnet.ahrq.gov/node/39104/psn-pdf
February 16, 2011 - Is there a relationship between high-quality performance
in major teaching hospitals and residents' knowledge of
quality and patient safety?
February 16, 2011
Pingleton SK, Horak BJ, Davis DA, et al. Is there a relationship between high-quality performance in major
teaching hospitals and residents' knowledge of qu…
-
psnet.ahrq.gov/node/40995/psn-pdf
January 04, 2012 - Effects of the introduction of the WHO "Surgical Safety
Checklist" on in-hospital mortality: a cohort study.
January 4, 2012
van Klei WA, Hoff RG, van Aarnhem EEHL, et al. Effects of the introduction of the WHO "Surgical Safety
Checklist" on in-hospital mortality: a cohort study. Ann Surg. 2012;255(1):44-9.
doi:10…
-
psnet.ahrq.gov/node/50368/psn-pdf
September 25, 2019 - A patient and family reporting system for perceived
ambulatory note mistakes: experience at 3 U.S. healthcare
centers.
September 25, 2019
Bourgeois FC, Fossa A, Gerard M, et al. A patient and family reporting system for perceived ambulatory
note mistakes: experience at 3 U.S. healthcare centers. J Am Med Inform As…
-
psnet.ahrq.gov/node/46507/psn-pdf
October 11, 2017 - Outcomes in two Massachusetts hospital systems give
reason for optimism about communication-and-resolution
programs.
October 11, 2017
Mello MM, Kachalia A, Roche S, et al. Outcomes In Two Massachusetts Hospital Systems Give Reason
For Optimism About Communication-And-Resolution Programs. Health Aff (Millwood). 201…
-
psnet.ahrq.gov/node/39947/psn-pdf
July 03, 2014 - Association between implementation of a medical team
training program and surgical mortality.
July 3, 2014
Neily J, Mills PD, Young-Xu Y, et al. Association between implementation of a medical team training
program and surgical mortality. JAMA. 2010;304(15):1693-1700. doi:10.1001/jama.2010.1506.
https://psnet.ahrq…
-
psnet.ahrq.gov/perspective/lesson-vas-team-training-program
November 01, 2011 - Lesson from the VA's Team Training Program
Julia Neily, RN, MS, MPH; Peter D. Mills, PhD, MS; Lisa M. Mazzia, MD; and Douglas E. Paull,MD | November 1, 2011
Also Read a Conversation
View more articles from the same authors.
Citation Text:
Neily J, Mills PD, Pa…
-
psnet.ahrq.gov/perspective/conversation-eduardo-salas-phd
November 01, 2011 - In Conversation With… Eduardo Salas, PhD
November 1, 2011
Also Read an Essay
Citation Text:
In Conversation With… Eduardo Salas, PhD . PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2011.…
-
psnet.ahrq.gov/perspective/conversation-withwilliam-b-munier-md-mba
July 01, 2011 - We are evaluating how to handle our data needs not satisfied by the Common Formats.
-
psnet.ahrq.gov/web-mm/mobility-lost-icu
August 01, 2018 - SPOTLIGHT CASE
Mobility Lost in the ICU
Citation Text:
Smith J. Mobility Lost in the ICU. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2011.
Copy Citation
Format:
Google Scholar BibTeX EndNote X3 XML EndNot…
-
psnet.ahrq.gov/sites/default/files/2023-09/a_missed_bowel_perforation_-_the_importance_of_diagnostic_reasoning.pdf
January 01, 2023 - Microsoft PowerPoint - Spotlight Case_A Missed Bowel Perforation - SLIDES_FINAL.pptx
Spotlight
A Missed Bowel Perforation – the Importance of
Diagnostic Reasoning
Source and Credits
• This presentation is based on the September 2023 AHRQ WebM&M
Spotlight Case
o See the full article at https://psnet.ahrq.gov/web…
-
psnet.ahrq.gov/web-mm/despite-clues-failed-rescue
August 02, 2015 - SPOTLIGHT CASE
Despite Clues, Failed to Rescue
Citation Text:
Ghaferi AA. Despite Clues, Failed to Rescue. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2017.
Copy Citation
Format:
Google Scholar BibTeX EndN…
-
psnet.ahrq.gov/web-mm/not-miscarriage
June 01, 2005 - Not a Miscarriage
Citation Text:
Learman LA. Not a Miscarriage. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2003.
Copy Citation
Format:
Google Scholar BibTeX EndNote X3 XML EndNote 7 XML Endnote tagged PubMedId RIS
…
-
psnet.ahrq.gov/sites/default/files/2021-06/final_spotlight_miscommunication_possible_artifact_06.21.2021.pdf
January 01, 2021 - Spotlight
Spotlight
The Consequences of Miscommunication
Regarding a Possible Artifact
Source and Credits
• This presentation is based on the June 2021 AHRQ WebM&M
Spotlight Case
o See the full article at https://psnet.ahrq.gov/webmm
o CME credit is available
o Commentary by: Kriti Gwal, MD
o AHRQ WebM&M Edit…