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psnet.ahrq.gov/node/61029/psn-pdf
October 14, 2020 - A doctor gave me an inept diagnosis for a neurological
problem. I should know: I’m a neurologist.
October 14, 2020
Horowitz SH. Washington Post. October 4, 2020.
https://psnet.ahrq.gov/issue/doctor-gave-me-inept-diagnosis-neurological-problem-i-should-know-im-
neurologist
The harm of misdiagnosis can be exte…
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psnet.ahrq.gov/node/47351/psn-pdf
August 22, 2018 - Social disparities in patient safety in primary care: a
systematic review.
August 22, 2018
Piccardi C, Detollenaere J, Bussche PV, et al. Social disparities in patient safety in primary care: a
systematic review. Int J Equity Health. 2018;17(1):114. doi:10.1186/s12939-018-0828-7.
https://psnet.ahrq.gov/issue/socia…
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psnet.ahrq.gov/node/34814/psn-pdf
January 01, 2015 - Prescribing for the elderly. Part I: Sensitivity of the elderly
to adverse drug reactions.
March 28, 2005
Nolan L, O'Malley K. Prescribing for the Elderly Part I: Sensitivity of the Elderly to Adverse Drug
Reactions*. J Am Geriatr Soc. 2015;36(2):142-149. doi:10.1111/j.1532-5415.1988.tb01785.x.
https://psnet.ahrq.…
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psnet.ahrq.gov/node/38448/psn-pdf
March 04, 2009 - Medication errors: the impact of prescribing and
transcribing errors on preventable harm in hospitalised
patients.
March 4, 2009
van Doormaal JE, van den Bemt PMLA, Mol PGM, et al. Medication errors: the impact of prescribing and
transcribing errors on preventable harm in hospitalised patients. Qual Saf Health Car…
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psnet.ahrq.gov/node/46777/psn-pdf
January 24, 2018 - Safety analysis over time: seven major changes to
adverse event investigation.
January 24, 2018
Vincent CA, Carthey J, Macrae C, et al. Safety analysis over time: seven major changes to adverse event
investigation. Implementation Science. 2017;12(1). doi:10.1186/s13012-017-0695-4.
https://psnet.ahrq.gov/issue/safe…
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psnet.ahrq.gov/node/47520/psn-pdf
February 06, 2019 - Improving patient safety in developing countries—moving
towards an integrated approach.
February 6, 2019
Elmontsri M, Banarsee R, Majeed A. Improving patient safety in developing countries - moving towards an
integrated approach. JRSM Open. 2018;9(11):2054270418786112. doi:10.1177/2054270418786112.
https://psnet.a…
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January 02, 2017 - Medication reconciliation in acute care: ensuring an
accurate drug regimen on admission and discharge.
January 2, 2017
Rodehaver C, Fearing D. Medication reconciliation in acute care: ensuring an accurate drug regimen on
admission and discharge. Jt Comm J Qual Patient Saf. 2005;31(7):406-13.
https://psnet.ahrq.gov…
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psnet.ahrq.gov/node/46821/psn-pdf
June 06, 2018 - Focus on the Quadruple Aim: development of a resiliency
center to promote faculty and staff wellness initiatives.
June 6, 2018
Morrow E, Call M, Marcus R, et al. Focus on the Quadruple Aim: Development of a Resiliency Center to
Promote Faculty and Staff Wellness Initiatives. Jt Comm J Qual Patient Saf. 2018;44(5):2…
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psnet.ahrq.gov/node/836753/psn-pdf
March 16, 2022 - Inequities in quality and safety outcomes for hospitalized
children with intellectual disability.
March 16, 2022
Mimmo L, Harrison R, Travaglia J, et al. Inequities in quality and safety outcomes for hospitalized children
with intellectual disability. Dev Med Child Neurol. 2022;64(3):314-322. doi:10.1111/dmcn.15066…
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psnet.ahrq.gov/node/72676/psn-pdf
January 27, 2021 - Risk of COVID-19-related bullying, harassment and stigma
among healthcare workers: an analytical cross-sectional
global study.
January 27, 2021
Dye TD, Alcantara L, Siddiqi S, et al. Risk of COVID-19-related bullying, harassment and stigma among
healthcare workers: an analytical cross-sectional global study. BMJ O…
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psnet.ahrq.gov/node/844057/psn-pdf
February 08, 2023 - Impact of medical education on patient safety: finding the
signal through the noise.
February 8, 2023
Hwang J, Kelz RR. Impact of medical education on patient safety: finding the signal through the noise. BMJ
Qual Saf. 2023;32(2):61-64. doi:10.1136/bmjqs-2022-015054.
https://psnet.ahrq.gov/issue/impact-medical-edu…
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psnet.ahrq.gov/node/837191/psn-pdf
May 25, 2022 - Adverse Events in Hospitals: A Quarter of Medicare
Patients Experienced Harm in October 2018.
May 25, 2022
Grimm CA. Washington DC: Office of the Inspector General; May 2022. Report no. OEI-06-18-00400.
https://psnet.ahrq.gov/issue/adverse-events-hospitals-quarter-medicare-patients-experienced-harm-
october-2018
…
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psnet.ahrq.gov/node/47964/psn-pdf
May 15, 2019 - Deaths among opioid users: impact of potential
inappropriate prescribing practices.
May 15, 2019
Jayawardhana J, Abraham AJ, Perri M. Deaths among opioid users: impact of potential inappropriate
prescribing practices. Am J Manag Care. 2019;25(4):e98-e103.
https://psnet.ahrq.gov/issue/deaths-among-opioid-users-impa…
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psnet.ahrq.gov/node/72832/psn-pdf
March 10, 2021 - Communication and Transparency as a Means to
Strengthening Workplace Culture During COVID-19.
March 10, 2021
Nadkarni A, Levy-Carrick NC, Kroll DS, et al. Communication And Transparency As A Means To
Strengthening Workplace Culture During Covid-19. National Academy of Medicine; 2021.
doi:10.31478/202103a.
https:/…
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psnet.ahrq.gov/node/45258/psn-pdf
September 07, 2016 - Pathologists, patients and diagnostic errors—part 1 and
part 2.
September 7, 2016
Miller N.
https://psnet.ahrq.gov/issue/pathologists-patients-and-diagnostic-errors-part-1-and-part-2
In light of the growing focus on diagnostic errors, this magazine series reports on unique challenges that
pathologists face when t…
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psnet.ahrq.gov/node/60621/psn-pdf
June 24, 2020 - Design and implementation of the infection prevention
program into risk management: managing high level
disinfection and sterilization in the outpatient setting.
June 24, 2020
Sweet W, Snyder D, Raymond M. Design and implementation of the infection prevention program into risk
management: Managing high level disin…
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psnet.ahrq.gov/node/840489/psn-pdf
November 30, 2022 - A longitudinal study on the impact of simulation on
positive deviance through speaking up.
November 30, 2022
M. Violato E. A longitudinal study on the impact of simulation on positive deviance through speaking up.
Can J Respir Ther. 2022;58:137-142. doi:10.29390/cjrt-2022-006.
https://psnet.ahrq.gov/issue/longitud…
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psnet.ahrq.gov/node/866325/psn-pdf
July 17, 2024 - "What do health inequities have to do with anything?".
July 17, 2024
Kalinowski J. "What do health inequities have to do with anything?". N Engl J Med. 2024;390(23):e61.
doi:10.1056/nejmpv2404787.
https://psnet.ahrq.gov/issue/what-do-health-inequities-have-do-anything
Personal stories of poor care can catalyze the…
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psnet.ahrq.gov/node/46887/psn-pdf
May 03, 2018 - Financial incentives to reduce hospital-acquired
infections under alternative payment arrangements.
May 3, 2018
Cohen CC, Liu J, Cohen B, et al. Financial Incentives to Reduce Hospital-Acquired Infections Under
Alternative Payment Arrangements. Infect Control Hosp Epidemiol. 2018;39(5):509-515.
doi:10.1017/ice.201…
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psnet.ahrq.gov/node/46355/psn-pdf
October 09, 2017 - Diagnostic reasoning: an endangered competency in
internal medicine training.
October 9, 2017
Simpkin AL, Vyas JM, Armstrong KA. Diagnostic Reasoning: An Endangered Competency in Internal
Medicine Training. Ann Intern Med. 2017;167(7):507-508. doi:10.7326/M17-0163.
https://psnet.ahrq.gov/issue/diagnostic-reasoning…