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psnet.ahrq.gov/node/838146/psn-pdf
September 21, 2022 - HSIB Maternity Investigation Programme Year in Review
2021/22. Summary of Highlights, Themes and Future
Work.
September 21, 2022
Farnborough, UK: Healthcare Safety Investigation Branch; 2022.
https://psnet.ahrq.gov/issue/hsib-maternity-investigation-programme-year-review-202122-summary-
highlights-themes-and
Thi…
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psnet.ahrq.gov/node/46496/psn-pdf
October 11, 2017 - Lessons learned for reducing the negative impact of
adverse events on patients, health professionals and
healthcare organizations.
October 11, 2017
Mira JJ, Lorenzo S, Carrillo I, et al. Lessons learned for reducing the negative impact of adverse events on
patients, health professionals and healthcare organization…
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psnet.ahrq.gov/node/837060/psn-pdf
May 11, 2022 - Clinician distress and inappropriate antibiotic prescribing
for acute respiratory tract infections: a retrospective
cohort study.
May 11, 2022
Brady KJS, Barlam TF, Trockel MT, et al. Clinician distress and inappropriate antibiotic prescribing for
acute respiratory tract infections: a retrospective cohort study. J…
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psnet.ahrq.gov/node/44156/psn-pdf
November 10, 2015 - Exploring the role of communications in quality
improvement: a case study of the 1000 Lives Campaign in
NHS Wales.
November 10, 2015
Cooper A, Gray J, Willson A, et al. Exploring the role of communications in quality improvement: A case
study of the 1000 Lives Campaign in NHS Wales. J Commun Healthc. 2015;8(1):76-…
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psnet.ahrq.gov/node/74169/psn-pdf
December 08, 2021 - Pointing fingers: verbosity of patient safety narratives is
associated with attribution of blame.
December 8, 2021
Ackerman RS, Patel SY, Costache M, et al. Anesthesiology News. November 21, 2021.
https://psnet.ahrq.gov/issue/pointing-fingers-verbosity-patient-safety-narratives-associated-attribution-
bl…
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psnet.ahrq.gov/node/47837/psn-pdf
May 11, 2019 - Association of hospital employee satisfaction with patient
safety and satisfaction within Veterans Affairs medical
centers.
May 11, 2019
Kang R, Kunkel ST, Columbo JA, et al. Association of Hospital Employee Satisfaction with Patient Safety
and Satisfaction within Veterans Affairs Medical Centers. Am J Med. 2019;1…
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psnet.ahrq.gov/node/37077/psn-pdf
October 03, 2011 - Sensemaking, safety, and cooperative work in the
intensive care unit.
October 3, 2011
Albolino S, Cook RI, O’Connor M. Sensemaking, safety, and cooperative work in the intensive care unit.
Cog Tech Work. 2006;9(3):131-137. doi:10.1007/s10111-006-0057-5.
https://psnet.ahrq.gov/issue/sensemaking-safety-and-cooperati…
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psnet.ahrq.gov/node/47924/psn-pdf
June 05, 2019 - Effect of a central call center on employee perceptions of
safety culture within community pharmacies in an
academic health system.
June 5, 2019
Bowden A, Mullin S, Tak C, et al. Effect of a central call center on employee perceptions of safety culture
within community pharmacies in an academic health system. Am J…
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psnet.ahrq.gov/node/48094/psn-pdf
June 19, 2019 - New persistent opioid use after postoperative intensive
care in US veterans.
June 19, 2019
Karamchandani K, Pyati S, Bryan W, et al. New Persistent Opioid Use After Postoperative Intensive Care
in US Veterans. JAMA Surg. 2019;154(8):778-780. doi:10.1001/jamasurg.2019.0899.
https://psnet.ahrq.gov/issue/new-persiste…
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psnet.ahrq.gov/node/837306/psn-pdf
June 01, 2022 - Mortality due to hospital-acquired infection after cardiac
surgery.
June 1, 2022
Massart N, Mansour A, Ross JT, et al. Mortality due to hospital-acquired infection after cardiac surgery. J
Thorac Cardiovasc Surg. 2022;163(6):2131-2140.e3. doi:10.1016/j.jtcvs.2020.08.094.
https://psnet.ahrq.gov/issue/mortality-due-…
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psnet.ahrq.gov/node/44536/psn-pdf
November 11, 2015 - Healthcare system intervention for safer use of medicines
in elderly patients in primary care—a qualitative study of
the participants' perceptions of self-assessment, peer
review, feedback and agreement for change.
November 11, 2015
Lenander C, Bondesson Å, Midlöv P, et al. Healthcare system intervention for safer…
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psnet.ahrq.gov/node/49729/psn-pdf
April 01, 2015 - Dissecting the Presentation
April 1, 2015
Suat-Ooi SB. Dissecting the Presentation. PSNet [internet]. 2015.
https://psnet.ahrq.gov/web-mm/dissecting-presentation
Case Objectives
Define aortic dissection.
Describe the epidemiology of acute aortic dissection.
State the common and uncommon presentation of acute aor…
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psnet.ahrq.gov/curated-library/organizational-learning
August 11, 2025 - Breadcrumb
Home
The PSNet Collection
Curated Libraries
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Organizational Learning
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Created By: Lorri Zipperer, Cybrarian, AHRQ PSNet Team…
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psnet.ahrq.gov/primer/simulation-training
September 15, 2024 - Simulation Training
Citation Text:
Edward JJ, Nichols A, Bakerjian D. Simulation Training. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2023.
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Format:
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psnet.ahrq.gov/web-mm/abdominal-pain-early-pregnancy
November 13, 2024 - SPOTLIGHT CASE
Abdominal Pain in Early Pregnancy
Citation Text:
Kilpatrick CC. Abdominal Pain in Early Pregnancy. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2015.
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psnet.ahrq.gov/node/44902/psn-pdf
February 24, 2016 - Barriers to incident-reporting behavior among nursing
staff: a study based on the theory of planned behavior.
February 24, 2016
Lee Y-H, Yang C-C, Chen T-T. Barriers to incident-reporting behavior among nursing staff: A study based
on the theory of planned behavior. J Manag Organ. 2015;22(1):1-18. doi:10.1017/jmo.2…
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psnet.ahrq.gov/node/45678/psn-pdf
October 11, 2017 - Is there a role for patients and their relatives in escalating
clinical deterioration in hospital? A systematic review.
October 11, 2017
Albutt AK, O'Hara JK, Conner MT, et al. Is there a role for patients and their relatives in escalating clinical
deterioration in hospital? A systematic review. Health Expect. 2017…
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psnet.ahrq.gov/node/867397/psn-pdf
December 18, 2024 - Overview of Methicillin-Resistant Staphylococcus aureus
(MRSA)-Related Adult Inpatient Stays, 2016–2021. HCUP
Statistical Brief #315.
December 18, 2024
Miller MA, Owens P, Kim J, et al. Overview Of Methicillin-Resistant Staphylococcus Aureus (Mrsa)-Related
Adult Inpatient Stays, 2016–2021. Agency for Healthcare Re…
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psnet.ahrq.gov/node/60846/psn-pdf
January 01, 2021 - Safety climate associated with adverse events in nursing
homes: a national VA study.
August 26, 2020
Quach ED, Kazis LE, Zhao S, et al. Safety climate associated with adverse events in nursing homes: a
national VA study. J Am Med Dir Assoc. 2021;22(2):388-392. doi:10.1016/j.jamda.2020.05.028.
https://psnet.ahrq.go…
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psnet.ahrq.gov/node/837758/psn-pdf
August 03, 2022 - Association of anesthesiologist staffing ratio with
surgical patient morbidity and mortality.
August 3, 2022
Burns ML, Saager L, Cassidy RB, et al. Association of anesthesiologist staffing ratio with surgical patient
morbidity and mortality. JAMA Surg. 2022;157(9):807-815. doi:10.1001/jamasurg.2022.2804.
https://p…