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  1. Adoption of order entry with decision support for chronic care by physician organizations. | PSNet

    psnet.ahrq.gov/issue/adoption-order-entry-decision-support-chronic-care-physician-organizations
    October 06, 2011 - Study Adoption of order entry with decision support for chronic care by physician organizations. Citation Text: Simon JS, Rundall TG, Shortell SM. Adoption of order entry with decision support for chronic care by physician organizations. J Am Med Inform Assoc. 2007;14(4):432-9. Copy …

  2. Has the pendulum swung too far?; The impact of missed abdominal injuries in the era of nonoperative management. | PSNet

    psnet.ahrq.gov/issue/has-pendulum-swung-too-far-impact-missed-abdominal-injuries-era-nonoperative-management
    August 04, 2021 - Study Has the pendulum swung too far?; The impact of missed abdominal injuries in the era of nonoperative management. Citation Text: Fairfax LM, Christmas B, Deaugustinis M, et al. Has the pendulum swung too far? The impact of missed abdominal injuries in the era of nonoperative manage…

  3. Detection of potential look-alike/sound-alike medication errors using Veterans Affairs administrative databases. | PSNet

    psnet.ahrq.gov/issue/detection-potential-look-alikesound-alike-medication-errors-using-veterans-affairs
    October 04, 2011 - Study Detection of potential look-alike/sound-alike medication errors using Veterans Affairs administrative databases. Citation Text: Zacher JM, Cunningham FE, Zhao X, et al. Detection of potential look-alike/sound-alike medication errors using Veterans Affairs administrative databases. …

  4. Intraoperative communications between pathologists and surgeons: do we understand each other? | PSNet

    psnet.ahrq.gov/issue/intraoperative-communications-between-pathologists-and-surgeons-do-we-understand-each-other
    June 28, 2023 - Study Intraoperative communications between pathologists and surgeons: do we understand each other? Citation Text: Wiggett A, Fischer G. Intraoperative communications between pathologists and surgeons: do we understand each other? Arch Pathol Lab Med. 2023;147(8):933-939. doi:10.5858/arp…

  5. Pain as the neglected patient safety concern: five years on. | PSNet

    psnet.ahrq.gov/issue/pain-neglected-patient-safety-concern-five-years
    July 31, 2019 - Commentary Pain as the neglected patient safety concern: five years on. Citation Text: Twycross A, Forgeron P, Chorne J, et al. Pain as the neglected patient safety concern: Five years on. J Child Health Care. 2016;20(4):537-541. doi:10.1177/1367493516643422. Copy Citation Format: …

  6. Opioid medication discontinuation and risk of adverse opioid-related health care events. | PSNet

    psnet.ahrq.gov/issue/opioid-medication-discontinuation-and-risk-adverse-opioid-related-health-care-events
    November 16, 2022 - Study Classic Opioid medication discontinuation and risk of adverse opioid-related health care events. Citation Text: Mark TL, Parish W. Opioid medication discontinuation and risk of adverse opioid-related health care events. J Subst Abuse Treat. 2019;103:58-63.…

  7. Perceived value of ward-based pharmacists from the perspective of physicians and nurses. | PSNet

    psnet.ahrq.gov/issue/perceived-value-ward-based-pharmacists-perspective-physicians-and-nurses
    February 15, 2011 - Study Perceived value of ward-based pharmacists from the perspective of physicians and nurses. Citation Text: Gillespie U, Mörlin C, Hammarlund-Udenaes M, et al. Perceived value of ward-based pharmacists from the perspective of physicians and nurses. Int J Clin Pharm. 2012;34(1):127-35…

  8. How patients can improve the accuracy of their medical records. | PSNet

    psnet.ahrq.gov/issue/how-patients-can-improve-accuracy-their-medical-records
    July 20, 2022 - Study How patients can improve the accuracy of their medical records. Citation Text: Dullabh P, Sondheimer N, Katsh E, et al. How Patients Can Improve the Accuracy of their Medical Records. eGEMs (Generating Evidence & Methods to improve patient outcomes). 2014;2(3). doi:10.13063/2327-92…

  9. Perioperative patient safety recommendations: systematic review of clinical practice guidelines. | PSNet

    psnet.ahrq.gov/issue/perioperative-patient-safety-recommendations-systematic-review-clinical-practice-guidelines
    January 08, 2025 - Study Perioperative patient safety recommendations: systematic review of clinical practice guidelines. Citation Text: Martínez-Nicolas I, Arnal-Velasco D, Romero-García E, et al. Perioperative patient safety recommendations: systematic review of clinical practice guidelines. BJS Open. 20…

  10. Collaboration between pharmacists, physicians and nurse practitioners: a qualitative investigation of working relationships in the inpatient medical setting. | PSNet

    psnet.ahrq.gov/issue/collaboration-between-pharmacists-physicians-and-nurse-practitioners-qualitative
    November 16, 2022 - Study Collaboration between pharmacists, physicians and nurse practitioners: a qualitative investigation of working relationships in the inpatient medical setting. Citation Text: Makowsky MJ, Schindel TJ, Rosenthal M, et al. Collaboration between pharmacists, physicians and nurse pract…

  11. Grand rounds in methodology: key considerations for implementing machine learning solutions in quality improvement initiatives. | PSNet

    psnet.ahrq.gov/issue/grand-rounds-methodology-key-considerations-implementing-machine-learning-solutions-quality
    July 26, 2023 - Commentary Grand rounds in methodology: key considerations for implementing machine learning solutions in quality improvement initiatives. Citation Text: Verma AA, Trbovich PL, Mamdani MM, et al. Grand rounds in methodology: key considerations for implementing machine learning solutions …

  12. Balancing patient-centered and safe pain care for nonsurgical inpatients: clinical and managerial perspectives. | PSNet

    psnet.ahrq.gov/issue/balancing-patient-centered-and-safe-pain-care-nonsurgical-inpatients-clinical-and-managerial
    March 12, 2025 - Study Balancing patient-centered and safe pain care for nonsurgical inpatients: clinical and managerial perspectives. Citation Text: Mazurenko O, Andraka-Christou BT, Bair MJ, et al. Balancing Patient-Centered and Safe Pain Care for Nonsurgical Inpatients: Clinical and Managerial Perspec…

  13. Safety culture, safety climate, and safety performance in healthcare facilities: a systematic review. | PSNet

    psnet.ahrq.gov/issue/safety-culture-safety-climate-and-safety-performance-healthcare-facilities-systematic-review
    October 20, 2021 - Review Safety culture, safety climate, and safety performance in healthcare facilities: a systematic review. Citation Text: Noor Arzahan IS, Ismail Z, Yasin SM. Safety culture, safety climate, and safety performance in healthcare facilities: A systematic review. Safety Sci. 2022;147:1056…

  14. Controlled substance drug diversion by healthcare workers as a threat to patient safety. | PSNet

    psnet.ahrq.gov/issue/controlled-substance-drug-diversion-healthcare-workers-threat-patient-safety
    April 05, 2023 - Special or Theme Issue Controlled substance drug diversion by healthcare workers as a threat to patient safety. Citation Text: Controlled substance drug diversion by healthcare workers as a threat to patient safety. ISMP Medication Safety Alert! Acute care edition. February 23, 2023;28(4…

  15. An improvement approach to integrate teaching teams in the reporting of safety events. | PSNet

    psnet.ahrq.gov/issue/improvement-approach-integrate-teaching-teams-reporting-safety-events
    September 23, 2020 - Study An improvement approach to integrate teaching teams in the reporting of safety events. Citation Text: Dunbar AE, Cupit M, Vath RJ, et al. An Improvement Approach to Integrate Teaching Teams in the Reporting of Safety Events. Pediatrics. 2017;139(2). doi:10.1542/peds.2015-3807. Co…

  16. Variations by state in physician disciplinary actions by US medical licensure boards. | PSNet

    psnet.ahrq.gov/issue/variations-state-physician-disciplinary-actions-us-medical-licensure-boards
    March 12, 2025 - Study Variations by state in physician disciplinary actions by US medical licensure boards. Citation Text: Harris JA, Byhoff E. Variations by state in physician disciplinary actions by US medical licensure boards. BMJ Qual Saf. 2017;26(3):200-208. doi:10.1136/bmjqs-2015-004974. Copy Ci…

  17. Healthcare staff wellbeing, burnout, and patient safety: a systematic review. | PSNet

    psnet.ahrq.gov/issue/healthcare-staff-wellbeing-burnout-and-patient-safety-systematic-review
    November 13, 2024 - Review Healthcare staff wellbeing, burnout, and patient safety: a systematic review. Citation Text: Hall LH, Johnson J, Watt I, et al. Healthcare Staff Wellbeing, Burnout, and Patient Safety: A Systematic Review. PLoS One. 2016;11(7):e0159015. doi:10.1371/journal.pone.0159015. Copy Cit…

  18. A practical guide to Failure Mode and Effects Analysis in health care: making the most of the team and its meetings. | PSNet

    psnet.ahrq.gov/issue/practical-guide-failure-mode-and-effects-analysis-health-care-making-most-team-and-its
    March 04, 2015 - Commentary A practical guide to Failure Mode and Effects Analysis in health care: making the most of the team and its meetings. Citation Text: Ashley L, Armitage G, Neary M, et al. A practical guide to Failure Mode and Effects Analysis in health care: making the most of the team and its …

  19. Case 34-2010: a 65-year-old woman with an incorrect operation on the left hand. | PSNet

    psnet.ahrq.gov/issue/case-34-2010-65-year-old-woman-incorrect-operation-left-hand
    March 13, 2013 - Commentary Case 34-2010: a 65-year-old woman with an incorrect operation on the left hand. Citation Text: Ring DC, Herndon JH, Meyer GS. Case records of The Massachusetts General Hospital: Case 34-2010: a 65-year-old woman with an incorrect operation on the left hand. N Engl J Med. 201…

  20. Toward the translation of systems thinking methods in patient safety practice: assessing the validity of Net-HARMS and AcciMap. | PSNet

    psnet.ahrq.gov/issue/toward-translation-systems-thinking-methods-patient-safety-practice-assessing-validity-net
    April 21, 2021 - Study Toward the translation of systems thinking methods in patient safety practice: assessing the validity of Net-HARMS and AcciMap. Citation Text: Salmon PM, King B, Hulme A, et al. Toward the translation of systems thinking methods in patient safety practice: assessing the validity of…
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