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2941. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/38182/psn-pdf
      October 29, 2008 - On the Edge: Nursing in the Age of Complexity. October 29, 2008 Lindberg C, Nash S, Lindberg C. Bordentown, NJ: PlexusPress; 2008. ISBN: 1438246765. https://psnet.ahrq.gov/issue/edge-nursing-age-complexity This book provides a foundation on complexity science concepts and examines how they can be applied to effect…

2942. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/40054/psn-pdf
      December 01, 2010 - Multilayered approach to patient safety culture. December 1, 2010 Reiman T, Pietikäinen E, Oedewald P. Multilayered approach to patient safety culture. Qual Saf Health Care. 2010;19(5):e20. doi:10.1136/qshc.2008.029793. https://psnet.ahrq.gov/issue/multilayered-approach-patient-safety-culture This piece discusses …

2943. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/39311/psn-pdf
      February 17, 2010 - Exploring the role of patients in promoting safety: policy to practice. February 17, 2010 Holme A. Exploring the role of patients in promoting safety: policy to practice. Br J Nurs. 2009;18(22):1392- 5. https://psnet.ahrq.gov/issue/exploring-role-patients-promoting-safety-policy-practice This commentary examines …

2944. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/39640/psn-pdf
      June 30, 2010 - Beyond patient safety Flatland. June 30, 2010 Braithwaite J, Coiera E. Beyond patient safety Flatland. J R Soc Med. 2010;103(6):219-25. doi:10.1258/jrsm.2010.100032. https://psnet.ahrq.gov/issue/beyond-patient-safety-flatland This essay examines three dimensions of patient safety and emphasizes the need for a deep…

2945. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/37949/psn-pdf
      May 24, 2015 - 2008 Recommendations for Pre-Anesthesia Checkout Procedures.  May 24, 2015 ASA Committee on Equipment and Facilities. Park Ridge, IL: American Society of Anesthesiologists; 2008.  https://psnet.ahrq.gov/issue/2008-recommendations-pre-anesthesia-checkout-procedures These guidelines explain how to examine equipment …

2946. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/40915/psn-pdf
      January 04, 2012 - Simulation in obstetric anesthesia. January 4, 2012 Pratt SD. Focused review: simulation in obstetric anesthesia. Anesth Analg. 2012;114(1):186-90. doi:10.1213/ANE.0b013e3182377bbc. https://psnet.ahrq.gov/issue/simulation-obstetric-anesthesia This review examines how simulation training can improve performance, id…

2947. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/42217/psn-pdf
      December 18, 2013 - A concept analysis of situational awareness in nursing. December 18, 2013 Fore AM, Sculli GL. A concept analysis of situational awareness in nursing. J Adv Nurs. 2013;69(12):2613- 21. doi:10.1111/jan.12130. https://psnet.ahrq.gov/issue/concept-analysis-situational-awareness-nursing This review examines situational…

2948. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/42325/psn-pdf
      March 02, 2023 - Hospital discharge and readmission. March 2, 2023 Alper E, O'Malley TA, Greenwald J. UpToDate. February 3, 2023. https://psnet.ahrq.gov/issue/hospital-discharge-and-readmission This review examines hospital discharge, details elements of the process that can increase risk of readmission, and reveals interventions …

2949. Final Progress Report: Developing and Training Interruption Management Strategies for Emergency Physicians (pdf file)
      www.ahrq.gov/sites/default/files/2024-09/ratwani-report.pdf
      January 01, 2024 - In addition to examining the source of the interruptions we examined the primary task that was being

2950. U.S. Department of Veterans Affairs Medical Center, Houston, TX, and Baylor College of Medicine Revised Safer Diagnosis (Safer Dx) Instrument | PSNet
      psnet.ahrq.gov/innovation/us-department-veterans-affairs-medical-center-houston-tx-and-baylor-college-medicine
      February 26, 2025 - Quality (AHRQ) funded study is looking at the incidence of diagnostic error in inpatient settings, examining

2951. Slide 1
      effectivehealthcare.ahrq.gov/sites/default/files/estimation-and-reporting_chapter-3.pptx
      January 01, 2013 - Subgroup Analysis Subgroup Analysis Subgroup analysis is the most popular analytic approach for examining

2952. Disposition of Comments: Comparative Effectiveness Review No. 238 Cervical Ripening in the Outpatient Setting (pdf file)
      effectivehealthcare.ahrq.gov/sites/default/files/cer-238-cervical-ripening-outpatient-setting-comments.pdf
      March 22, 2021 - reported on the fetal heart rate (FHR) monitoring protocols used in the trials, we did not find evidence examining

2953. The Effectiveness of an HIT-based Care Transition Information Transfer System to Improve Outpatient Post-Hospital Care for Medically Complex Patients - Final Report (pdf file)
      digital.ahrq.gov/sites/default/files/docs/publication/r18hs017864-ciemins-final-report-2012.pdf
      January 01, 2012 - This study contributes to the literature by describing and examining the effects of an 6 intervention

2954. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/37293/psn-pdf
      June 16, 2019 - ISMP medication error report analysis. June 16, 2019 Cohen MR; Smetzer JL. Hosp Pharm. 2007;42(10):884-887. https://psnet.ahrq.gov/issue/ismp-medication-error-report-analysis-18 This monthly analysis examines recently reported errors in prescribing fentanyl patches, ordering insulin, and administering vincristine.…

2955. Facilities/Ancillary Services | Agency for Healthcare Research and Quality
      www.ahrq.gov/research/shuttered/toolkitchecklist/facancil.html
      July 01, 2018 - Facilities/Ancillary Services Availability of other space for ancillary services. Examine general condition of facilities. Other experts will look at these areas from a different perspective. Date: ____________  Location: _______________________  Team member: __________________________ Administrative Areas …

2956. 191. Specific Populations and Other Topics (Continued) | Agency for Healthcare Research and Quality
      www.ahrq.gov/prevention/guidelines/tobacco/clinicians/presentations/2008update-full/slide191.html
      October 01, 2014 - 191. Specific Populations and Other Topics (Continued) Treating Tobacco Use and Dependence: 2008 Update Text version of slide presentation. Evidence of effectiveness of tobacco dependence interventions in specific populations Population of Smokers Review of Evidence HIV-positive No long-…

2957. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/35528/psn-pdf
      February 22, 2010 - The Swiss cheese model of safety incidents: are there holes in the metaphor? February 22, 2010 Perneger T. The Swiss cheese model of safety incidents: are there holes in the metaphor? BMC Health Serv Res. 2005;5:71. https://psnet.ahrq.gov/issue/swiss-cheese-model-safety-incidents-are-there-holes-metaphor The auth…

2958. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/39410/psn-pdf
      March 31, 2010 - Doctors fear work caps for residents may be bad medicine. March 31, 2010 Shapira I. https://psnet.ahrq.gov/issue/doctors-fear-work-caps-residents-may-be-bad-medicine This news piece examines the work week of resident physicians and discusses how further limiting trainees' work hours might reduce their experientia…

2959. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/40847/psn-pdf
      October 12, 2011 - Human and organizational biases affecting the management of safety. October 12, 2011 Reiman T, Rollenhagen C. Human and organizational biases affecting the management of safety. Reliab Eng Syst Saf. 2011;96(10). doi:10.1016/j.ress.2011.05.010. https://psnet.ahrq.gov/issue/human-and-organizational-biases-affecting-…

2960. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/41350/psn-pdf
      May 02, 2012 - Medication reconciliation in the hospital: what, why, where, when, who and how? May 2, 2012 Fernandes O; Shojania KG. https://psnet.ahrq.gov/issue/medication-reconciliation-hospital-what-why-where-when-who-and-how This commentary examines the practical considerations required to implement a high quality medication…