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psnet.ahrq.gov/node/42256/psn-pdf
May 10, 2013 - Rapid response systems: should we still question their
implementation?
May 10, 2013
Winters BD, Pronovost P. Rapid response systems: should we still question their implementation? J Hosp
Med. 2013;8(5):278-81. doi:10.1002/jhm.2050.
https://psnet.ahrq.gov/issue/rapid-response-systems-should-we-still-question-their-…
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psnet.ahrq.gov/node/38773/psn-pdf
July 08, 2009 - Complexity, bullying, and stress: analyzing and mitigating
a challenging work environment for nurses.
July 8, 2009
Hughes RG, Clancy CM. Complexity, bullying, and stress: analyzing and mitigating a challenging work
environment for nurses. J Nurs Care Qual. 2009;24(3):180-183. doi:10.1097/NCQ.0b013e3181a6350a.
http…
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psnet.ahrq.gov/node/39412/psn-pdf
January 03, 2017 - Health care serial murder: a patient safety orphan.
January 3, 2017
Kizer KW, Yorker BC. Health care serial murder: a patient safety orphan. Jt Comm J Qual Saf.
2010;36(4):186-191.
https://psnet.ahrq.gov/issue/health-care-serial-murder-patient-safety-orphan
This article defines health care serial murder, examines …
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psnet.ahrq.gov/node/39956/psn-pdf
June 20, 2011 - Validity of selected patient safety indicators:
opportunities and concerns.
June 20, 2011
Kaafarani HMA, Borzecki AM, Itani KMF, et al. Validity of Selected Patient Safety Indicators: Opportunities
and Concerns. J Am Coll Surg. 2010;212(6):924-934. doi:10.1016/j.jamcollsurg.2010.07.007.
https://psnet.ahrq.gov/issu…
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psnet.ahrq.gov/node/34012/psn-pdf
December 22, 2008 - Always having to say you're sorry: an ethical response to
making mistakes in professional practice.
December 22, 2008
Crigger NJ. Always having to say you're sorry: an ethical response to making mistakes in professional
practice. Nurs Ethics. 2004;11(6):568-76.
https://psnet.ahrq.gov/issue/always-having-say-youre-…
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psnet.ahrq.gov/node/36828/psn-pdf
August 29, 2011 - Pediatric medication errors in the postanesthesia care
unit: analysis of MEDMARX data.
August 29, 2011
Payne CH, Smith CR, Newkirk LE, et al. Pediatric medication errors in the postanesthesia care unit:
analysis of MEDMARX data. AORN J. 2007;85(4):731-40; quiz 741-4.
https://psnet.ahrq.gov/issue/pediatric-medicati…
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psnet.ahrq.gov/node/42762/psn-pdf
November 27, 2013 - Motivational antecedents of incident reporting: evidence
from a survey of nurses and physicians.
November 27, 2013
Pfeiffer Y, Briner M, Wehner T, et al. Motivational antecedents of incident reporting: evidence from a survey
of nurses and physicians. Swiss Med Wkly. 2013;143:w13881. doi:10.4414/smw.2013.13881.
htt…
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psnet.ahrq.gov/node/37731/psn-pdf
July 15, 2013 - The relationship between nurse education level and
patient safety: an integrative review.
July 15, 2013
Ridley RT. The relationship between nurse education level and patient safety: an integrative review. J Nurs
Educ. 2008;47(4):149-56.
https://psnet.ahrq.gov/issue/relationship-between-nurse-education-level-and-pa…
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psnet.ahrq.gov/node/72809/psn-pdf
March 03, 2021 - Dying on the waitlist.
March 3, 2021
Armstrong D. Allen M. ProPublica. February 18, 2021.
https://psnet.ahrq.gov/issue/dying-waitlist
The COVID-19 pandemic has revealed systemic weaknesses in health care access and delivery. This story
examines how equipment shortages affected treatment decisions to culminate in r…
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psnet.ahrq.gov/node/44535/psn-pdf
September 30, 2015 - Diagnostic experiences of children with attention-
deficit/hyperactivity disorder.
September 30, 2015
Visser SN, Zablotsky B, Holbrook JR, Danielson ML, Bitsko RH. Natl Health Stat Report. 2015;(81):1-8.
https://psnet.ahrq.gov/issue/diagnostic-experiences-children-attention-deficithyperactivity-disorder
This surve…
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psnet.ahrq.gov/node/837985/psn-pdf
August 31, 2022 - Inequity and Iatrogenic Harm.
August 31, 2022
AMA J Ethics. 2022;24(8):e715-e816.
https://psnet.ahrq.gov/issue/inequity-and-iatrogenic-harm
Health inequity is recent expansion in the patient safety canon. This special issue examines poor access,
quality of care, and health status as contributors to patient harm. A…
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psnet.ahrq.gov/node/39078/psn-pdf
May 21, 2014 - Assessing Patient Safety Practices and Outcomes in the
U.S. Health Care System.
May 21, 2014
Farley DO, Ridgely MS, Mendel P, et al. Santa Monica, CA: RAND Corporation; 2009. ISBN:
9780833047748.
https://psnet.ahrq.gov/issue/assessing-patient-safety-practices-and-outcomes-us-health-care-system
This publication re…
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psnet.ahrq.gov/node/42814/psn-pdf
February 06, 2014 - Twelve tips on engaging learners in checking health care
decisions.
February 6, 2014
Sibbald M, de Bruin A, van Merrienboer JJG. Twelve tips on engaging learners in checking health care
decisions. Med Teach. 2014;36(2):111-5. doi:10.3109/0142159X.2013.847910.
https://psnet.ahrq.gov/issue/twelve-tips-engaging-learn…
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psnet.ahrq.gov/node/72512/psn-pdf
November 25, 2020 - The untold story of a cyberattack, a hospital and a dying
woman.
November 25, 2020
Ralston W. Wired Magazine. November 11, 2020.
https://psnet.ahrq.gov/issue/untold-story-cyberattack-hospital-and-dying-woman
Health information system downtime can affect patient safety. This story discusses a ransomware incide…
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psnet.ahrq.gov/node/74766/psn-pdf
June 24, 2024 - Patient handoffs.
June 24, 2024
Arora V, Farnan J. UpToDate. June 24, 2024.
https://psnet.ahrq.gov/issue/patient-handoffs-0
The change of an inpatient’s location or handoffs between teams can fragment care due to communication,
information, and knowledge gaps. This review examines in-patient transition safety issu…
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psnet.ahrq.gov/node/37242/psn-pdf
September 12, 2016 - Failure-to-rescue: comparing definitions to measure
quality of care.
September 12, 2016
Silber JH, Romano PS, Rosen AK, et al. Failure-to-rescue: comparing definitions to measure quality of
care. Med Care. 2007;45(10):918-25.
https://psnet.ahrq.gov/issue/failure-rescue-comparing-definitions-measure-quality-care
T…
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psnet.ahrq.gov/node/837813/psn-pdf
January 21, 2021 - Recognizing Excellence in Diagnosis.
January 21, 2021
The Leapfrog Group.
https://psnet.ahrq.gov/issue/recognizing-excellence-diagnosis
Examination of diagnostic failure and identification of reduction strategies require multidisciplinary expertise
to be successful. This collaborative initiative will initially dev…
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psnet.ahrq.gov/web-mm/delirium-or-dementia
September 27, 2023 - SPOTLIGHT CASE
Delirium or Dementia?
Citation Text:
Rudolph JL. Delirium or Dementia?. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2009.
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psnet.ahrq.gov/issue/pathology-and-patient-safety-critical-role-pathology-informatics-error-reduction-and-quality
July 20, 2009 - Resources From the Same Author(s)
Database construction for improving patient safety by examining
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psnet.ahrq.gov/issue/does-your-knee-make-more-click-or-clack-teaching-car-talk-new-docs
April 17, 2019 - November 4, 2014
Examining the diagnostic justification abilities of fourth-year medical