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  1. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/45139/psn-pdf
    May 25, 2016 - Alarm management: promoting safety and establishing guidelines. May 25, 2016 Criscitelli T. Alarm Management: Promoting Safety and Establishing Guidelines. AORN J. 2016;103(5):518- 21. doi:10.1016/j.aorn.2016.03.008. https://psnet.ahrq.gov/issue/alarm-management-promoting-safety-and-establishing-guidelines Alarms…

  2. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/848829/psn-pdf
    May 10, 2023 - Lessons from the Covid War: An Investigative Report. May 10, 2023 Covid Crisis Group. New York: Public Affairs; 2023. ISBN?: ?9781541703803. https://psnet.ahrq.gov/issue/lessons-covid-war-investigative-report The transfer of failure experiences to generate learning and improve service is a complicated responsibilit…

  3. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/45654/psn-pdf
    July 11, 2017 - Hospital prescribing of opioids to Medicare beneficiaries. July 11, 2017 Jena AB, Goldman D, Karaca-Mandic P. Hospital Prescribing of Opioids to Medicare Beneficiaries. JAMA Intern Med. 2016;176(7):990-7. doi:10.1001/jamainternmed.2016.2737. https://psnet.ahrq.gov/issue/hospital-prescribing-opioids-medicare-benefic…

  4. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/43123/psn-pdf
    August 04, 2015 - Redesigning surgical decision making for high-risk patients. August 4, 2015 Glance LG, Osler T, Neuman MD. Redesigning surgical decision making for high-risk patients. N Engl J Med. 2014;370(15):1379-1381. doi:10.1056/NEJMp1315538. https://psnet.ahrq.gov/issue/redesigning-surgical-decision-making-high-risk-patient…

  5. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/72537/psn-pdf
    December 02, 2020 - Automation failures and patient safety. December 2, 2020 Ruskin KJ, Ruskin AC, O’Connor M. Automation failures and patient safety. Curr Opin Anaesthesiol. 2020;33(6):788-792. doi:10.1097/aco.0000000000000935. https://psnet.ahrq.gov/issue/automation-failures-and-patient-safety Task automation in medicine is a core …

  6. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/35108/psn-pdf
    April 06, 2011 - Improving medication management for patients: the effect of a pharmacist on post-admission ward rounds. April 6, 2011 Fertleman M, Barnett N, Patel T. Improving medication management for patients: the effect of a pharmacist on post-admission ward rounds. Qual Saf Health Care. 2005;14(3):207-11. https://psnet.ahrq.…

  7. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/40064/psn-pdf
    July 08, 2013 - Hand Hygiene Project: Best Practices from Hospitals Participating in the Joint Commission Center for Transforming Healthcare Project. July 8, 2013 Health Research and Educational Trust. Chicago, IL: American Hospital Association; 2010. https://psnet.ahrq.gov/issue/hand-hygiene-project-best-practices-hospitals-part…

  8. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/60935/psn-pdf
    September 23, 2020 - Resilience from a stakeholder perspective: the role of next of kin in cancer care. September 23, 2020 Bergerød IJ, Braut GS, Wiig S. Resilience from a stakeholder perspective: the role of next of kin in cancer care. J Patient Saf. 2020;16(3):e205-e210. doi:10.1097/pts.0000000000000532. https://psnet.ahrq.gov/issue…

  9. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/72667/psn-pdf
    January 20, 2021 - Virtual urgent care quality and safety in the time of Coronavirus. January 20, 2021 Smith SW, Tiu J, Caspers CG, et al. Virtual Urgent Care Quality and Safety in the Time of Coronavirus. Jt Comm J Qual Patient Saf. 2021;47(2):86-98. doi:10.1016/j.jcjq.2020.10.001. https://psnet.ahrq.gov/issue/virtual-urgent-care-q…

  10. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/47492/psn-pdf
    August 07, 2019 - Pediatric clinician perspectives on communicating diagnostic uncertainty. August 7, 2019 Meyer AND, Giardina TD, Khanna A, et al. Pediatric clinician perspectives on communicating diagnostic uncertainty. Int J Health Care Qual. 2019;31(9):g107-g112. doi:10.1093/intqhc/mzz061. https://psnet.ahrq.gov/issue/pediatric…

  11. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/34722/psn-pdf
    April 07, 2011 - A preliminary taxonomy of medical errors in family practice. April 7, 2011 Dovey S, Meyers DS, Phillips RL, et al. A preliminary taxonomy of medical errors in family practice. Qual Saf Health Care. 2002;11(3):233-8. https://psnet.ahrq.gov/issue/preliminary-taxonomy-medical-errors-family-practice Efforts to improv…

  12. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/43890/psn-pdf
    April 22, 2015 - Lack of timely follow-up of abnormal imaging results and radiologists' recommendations. April 22, 2015 Al-Mutairi A, Meyer AND, Chang P, et al. Lack of timely follow-up of abnormal imaging results and radiologists' recommendations. J Am Coll Radiol. 2015;12(4):385-389. doi:10.1016/j.jacr.2014.09.031. https://psnet…

  13. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/38488/psn-pdf
    March 18, 2009 - Intensive care units, communication between nurses and physicians, and patients' outcomes. March 18, 2009 Manojlovich M, Antonakos CL, Ronis DL. Intensive care units, communication between nurses and physicians, and patients' outcomes. Am J Crit Care. 2009;18(1):21-30. doi:10.4037/ajcc2009353. https://psnet.ahrq.g…

  14. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/73354/psn-pdf
    June 02, 2021 - Advancing Maternal Health Equity and Reducing Maternal Mortality Workshop. June 2, 2021 National Academies of Sciences, Engineering, and Medicine. June 7-8, 2021. https://psnet.ahrq.gov/issue/advancing-maternal-health-equity-and-reducing-maternal-mortality-workshop Maternal safety is challenged by clinical, equity…

  15. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/73972/psn-pdf
    October 13, 2021 - The less-discussed consequence of healthcare's labor shortage. October 13, 2021 Bean M, Masson G. Becker's Hospital Review. October 4, 2021. https://psnet.ahrq.gov/issue/less-discussed-consequence-healthcares-labor-shortage Staffing shortages can impact the safety of care by enabling burnout, care omission, a…

  16. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/42939/psn-pdf
    March 02, 2014 - Healthcare personnel attire in non–operating-room settings. March 2, 2014 Bearman G, Bryant K, Leekha S, et al. Healthcare personnel attire in non-operating-room settings. Infect Control Hosp Epidemiol. 2014;35(2):107-21. doi:10.1086/675066. https://psnet.ahrq.gov/issue/healthcare-personnel-attire-non-operating-ro…

  17. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/40217/psn-pdf
    April 04, 2011 - The objective impact of clinical peer review on hospital quality and safety. April 4, 2011 Edwards MT. The objective impact of clinical peer review on hospital quality and safety. Am J Med Qual. 2011;26(2):110-9. doi:10.1177/1062860610380732. https://psnet.ahrq.gov/issue/objective-impact-clinical-peer-review-hospi…

  18. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/837982/psn-pdf
    August 31, 2022 - Patient Safety Incident Response Framework. August 31, 2022 London, England: NHS England; August 2022. https://psnet.ahrq.gov/issue/patient-safety-incident-response-framework Effective response to medical error requires a comprehensive systemic and process-focused incident examination approach to ensure organizati…

  19. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/34637/psn-pdf
    March 02, 2011 - Risk management: extreme honesty may be the best policy. March 2, 2011 Kraman SS, Hamm G. Risk management: extreme honesty may be the best policy. Ann Intern Med. 1999;131(12):963-967. https://psnet.ahrq.gov/issue/risk-management-extreme-honesty-may-be-best-policy This article reviews a humanistic risk management…

  20. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/73225/psn-pdf
    May 05, 2021 - Black or 'other'? Doctors may be relying on race to make decisions about your health. May 5, 2021 Smith J, Spodak C. CNN. April 25, 2021. https://psnet.ahrq.gov/issue/black-or-other-doctors-may-be-relying-race-make-decisions-about-your-health Race-adjusted decision making tools perpetuate the potential for diagnos…
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