-
psnet.ahrq.gov/node/47397/psn-pdf
January 09, 2019 - Using patient safety reporting systems to understand the
clinical learning environment: a content analysis.
January 9, 2019
Sellers MM, Berger I, Myers JS, et al. Using Patient Safety Reporting Systems to Understand the Clinical
Learning Environment: A Content Analysis. J Surg Educ. 2018;75(6):e168-e177.
doi:10.10…
-
psnet.ahrq.gov/node/838325/psn-pdf
October 12, 2022 - Comprehensive Healthcare Inspection Summary Report:
Evaluation of Care Coordination in Veterans Health
Administration Facilities, Fiscal Year 2021.
October 12, 2022
Washington, DC: VA Office of the Inspector General; September 15, 2022. Report no. 22-00815-232.
https://psnet.ahrq.gov/issue/comprehensive-healthcare…
-
psnet.ahrq.gov/node/50884/psn-pdf
February 12, 2020 - Prescribing patterns of heart failure-exacerbating
medications following a heart failure hospitalization.
February 12, 2020
Goyal P, Kneifati-Hayek J, Archambault A, et al. Prescribing patterns of heart failure-exacerbating
medications following a heart failure hospitalization. JACC Heart Fail. 2019;8(1):25-34.
do…
-
psnet.ahrq.gov/node/861778/psn-pdf
January 31, 2024 - Care Deficiencies and Leaders' Inadequate Reviews of a
Patient Who Died at the Lt. Col. Luke Weathers, Jr. VA
Medical Center in Memphis, Tennessee.
January 31, 2024
Washington, DC: The Veterans Affairs Inspector General; January 10, 2024. Report No. 23-00777-52.
https://psnet.ahrq.gov/issue/care-deficiencies-and-l…
-
psnet.ahrq.gov/node/845073/psn-pdf
February 22, 2023 - Nursing student errors and near misses: three years of
data.
February 22, 2023
Silvestre JH, Spector ND. Nursing student errors and near misses: three years of data. J Nurs Educ.
2023;62(1):12-19. doi:10.3928/01484834-20221109-05.
https://psnet.ahrq.gov/issue/nursing-student-errors-and-near-misses-three-years-data…
-
psnet.ahrq.gov/node/34921/psn-pdf
February 27, 2009 - A controlled trial of smart infusion pumps to improve
medication safety in critically ill patients.
February 27, 2009
Rothschild JM, Keohane C, Cook F, et al. A controlled trial of smart infusion pumps to improve medication
safety in critically ill patients. Crit Care Med. 2005;33(3):533-540.
https://psnet.ahrq.go…
-
psnet.ahrq.gov/node/47215/psn-pdf
September 19, 2018 - The application of system dynamics modelling to system
safety improvement: present use and future potential.
September 19, 2018
Ibrahim M; Gyuchan S; Jun GT; Robinson S. Safety Sci. 2018;106:104-120.
https://psnet.ahrq.gov/issue/application-system-dynamics-modelling-system-safety-improvement-present-
use-and-futur…
-
psnet.ahrq.gov/node/44742/psn-pdf
January 06, 2016 - A piece of my mind. From shame to guilt to love.
January 6, 2016
Pronovost P, Bienvenu J. A piece of my mind. From shame to guilt to love. JAMA. 2015;314(23):2507-
2508. doi:10.1001/jama.2015.11521.
https://psnet.ahrq.gov/issue/piece-my-mind-shame-guilt-love
While numerous studies have examined the psychological i…
-
psnet.ahrq.gov/node/42662/psn-pdf
October 16, 2013 - Informal learning from error in hospitals: what do we
learn, how do we learn and how can informal learning be
enhanced? A narrative review.
October 16, 2013
de Feijter JM, de Grave WS, Koopmans RP, et al. Informal learning from error in hospitals: what do we
learn, how do we learn and how can informal learning be …
-
psnet.ahrq.gov/node/35210/psn-pdf
June 24, 2009 - Hospitalwide adverse drug events before and after
limiting weekly work hours of medical residents to 80.
June 24, 2009
Mycyk MB, McDaniel MR, Fotis MA, et al. Hospitalwide adverse drug events before and after limiting
weekly work hours of medical residents to 80. Am J Health Syst Pharm. 2005;62(15):1592-5.
https:/…
-
psnet.ahrq.gov/node/864863/psn-pdf
March 20, 2024 - All in Her Head. The Truth and Lies Early Medicine Taught
Us About Women's Bodies and Why It Matters Today.
March 20, 2024
New York, NY: Harper Wave; 2024. ISBN: 9780063293014.
https://psnet.ahrq.gov/issue/all-her-head-truth-and-lies-early-medicine-taught-us-about-womens-bodies-
and-why-it-matters
Gender bias is …
-
psnet.ahrq.gov/node/45768/psn-pdf
July 02, 2017 - What patients' complaints and praise tell the health
practitioner: implications for health care quality. A
qualitative research study.
July 2, 2017
Mattarozzi K, Sfrisi F, Caniglia F, et al. What patients' complaints and praise tell the health practitioner:
implications for health care quality. A qualitative resea…
-
psnet.ahrq.gov/node/50706/psn-pdf
December 04, 2019 - Improving end-of-rotation transitions of care among ICU
patients
December 4, 2019
Denson JL, Knoeckel J, Kjerengtroen S, et al. Improving end-of-rotation transitions of care among ICU
patients. BMJ Qual Saf. 2019;29(3):250-259. doi:10.1136/bmjqs-2019-009867.
https://psnet.ahrq.gov/issue/improving-end-rotation-tran…
-
psnet.ahrq.gov/node/853073/psn-pdf
August 30, 2023 - Mind the power gap: how hierarchical leadership in
healthcare is a risk to patient safety.
August 30, 2023
Kanaris C. Mind the power gap: how hierarchical leadership in healthcare is a risk to patient safety. J Child
Health Care. 2023;27(3):319-322. doi:10.1177/13674935231196197.
https://psnet.ahrq.gov/issue/mind-…
-
psnet.ahrq.gov/node/60019/psn-pdf
March 04, 2020 - Chronic pain diagnoses and opioid dispensings among
insured individuals with serious mental illness.
March 4, 2020
Owen-Smith A, Stewart C, Sesay MM, et al. Chronic pain diagnoses and opioid dispensings among insured
individuals with serious mental illness. BMC Psych. 2020;20(1):40. doi:10.1186/s12888-020-2456-1.
…
-
psnet.ahrq.gov/node/50630/psn-pdf
November 06, 2019 - Non-dispensing pharmacists' actions and solutions of
drug therapy problems among elderly polypharmacy
patients in primary care.
November 6, 2019
Hazen ACM, Zwart DLM, Poldervaart JM, et al. Non-dispensing pharmacists' actions and solutions of drug
therapy problems among elderly polypharmacy patients in primary car…
-
psnet.ahrq.gov/node/43774/psn-pdf
March 06, 2015 - A prospective cohort study of medication reconciliation
using pharmacy technicians in the emergency department
to reduce medication errors among admitted patients.
March 6, 2015
Cater SW, Luzum M, Serra AE, et al. A prospective cohort study of medication reconciliation using
pharmacy technicians in the emergency d…
-
psnet.ahrq.gov/node/72482/psn-pdf
November 18, 2020 - Real-time debriefing after critical events: exploring the
gap between principle and reality.
November 18, 2020
Arriaga AF, Szyld D, Pian-Smith MCM. Real-time debriefing after critical events: exploring the gap between
principle and reality. Anesthesiol Clin. 2020;38(4):801-820. doi:10.1016/j.anclin.2020.08.003.
ht…
-
psnet.ahrq.gov/node/34957/psn-pdf
February 28, 2011 - Coordinating care across diseases, settings, and
clinicians: a key role for the generalist in practice.
February 28, 2011
Stille CJ, Jerant A, Bell D, et al. Coordinating care across diseases, settings, and clinicians: a key role for
the generalist in practice. Ann Intern Med. 2005;142(8):700-708.
https://psnet.ah…
-
psnet.ahrq.gov/node/45821/psn-pdf
May 09, 2017 - Putting knowledge into practice: does information on
adverse drug interactions influence people's dosing
behaviour?
May 9, 2017
Dohle S, Dawson IGJ. Putting knowledge into practice: Does information on adverse drug interactions
influence people's dosing behaviour? Br J Health Psychol. 2017;22(2):330-344. doi:10.11…