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psnet.ahrq.gov/issue/how-coronavirus-delaying-life-altering-surgeries
May 20, 2020 - Audiovisual
How the coronavirus is delaying life-altering surgeries.
Citation Text:
How the coronavirus is delaying life-altering surgeries. Booker C, Kargbo C. PBS News Hour. April 26, 2020.
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psnet.ahrq.gov/issue/medical-error-and-moral-luck
October 02, 2024 - Commentary
Medical error and moral luck.
Citation Text:
Allhoff F. Medical Error and Moral Luck. Kennedy Inst Ethics J. 2019;29(3):187-203. doi:10.1353/ken.2019.0022.
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DOI Google Scholar PubMed BibTeX EndNote X3 XML EndNote 7 XML Endnote tagged PubMedId…
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psnet.ahrq.gov/issue/gift-failure-new-approaches-analyzing-and-learning-events-and-near-misses
August 07, 2019 - Special or Theme Issue
The Gift of Failure: New Approaches to Analyzing and Learning from Events and Near-Misses.
Citation Text:
The Gift of Failure: New Approaches to Analyzing and Learning from Events and Near-Misses. Fahlbruch B, Carroll JS, eds. Safety Sci. 2011;49(1):1-106  …
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psnet.ahrq.gov/issue/ihi-framework-improving-joy-work
September 06, 2017 - Book/Report
Classic
IHI Framework for Improving Joy in Work.
Citation Text:
IHI Framework for Improving Joy in Work. Perlo J, Balik B, Swensen S, et al. Cambridge, MA: Institute for Healthcare Improvement; 2017.
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psnet.ahrq.gov/issue/addressing-opioid-crisis-united-states
November 18, 2011 - Book/Report
Addressing the Opioid Crisis in the United States.
Citation Text:
Addressing the Opioid Crisis in the United States. Martin L, Laderman M, Hyatt J, Krueger J. Cambridge, MA: Institute for Healthcare Improvement; April 2016.
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psnet.ahrq.gov/print/pdf/node/840940
March 22, 2024 - PSNet
Curated Library
AHRQ: Agency for Healthcare Research and Quality
PSNet How-to Videos
Curated Library
All Library Content
Optimizing PSNet Search for Patient Safety Resources
February 15, 2024
Optimizing PSNet Search for Patient Safety Resources PSNet has over 17,000 patient safety resources
available - d…
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psnet.ahrq.gov/issue/safety-numbers-hospital-performance-leapfrogs-surgical-volume-standard-based-results-2019
June 21, 2023 - Book/Report
Safety in Numbers: Hospital Performance on Leapfrog’s Surgical Volume Standard Based on Results of the 2019 Leapfrog Hospital Survey.
Citation Text:
Safety in Numbers: Hospital Performance on Leapfrog’s Surgical Volume Standard Based on Results of the 2019 Leapfrog Hospital S…
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psnet.ahrq.gov/issue/clinician-support-five-years-lessons-learned
March 20, 2017 - Newspaper/Magazine Article
Clinician support: five years of lessons learned.
Citation Text:
Clinician support: five years of lessons learned. Hirschinger LE, Scott SD, Hahn-Cover K. Patient Saf Qual Heathc. April 2015;12:26-31.
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psnet.ahrq.gov/issue/health-literacy-prescription-end-confusion
August 15, 2012 - Book/Report
Health Literacy: A Prescription to End Confusion.
Citation Text:
Health Literacy: A Prescription to End Confusion. Nielsen-Bohlman L; Panzer AM; Kindig DA; Board on Neuroscience and Behavioral Health, Institute of Medicine. Washington, DC: The National Academies Press; 2004. …
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psnet.ahrq.gov/issue/improving-diagnosis
November 28, 2018 - Special or Theme Issue
Improving Diagnosis.
Citation Text:
Improving Diagnosis. Deutsch E, ed. PA-PSRS Pa Patient Saf Advis. 2018 Oct 31;15(suppl 1):1-70.
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psnet.ahrq.gov/issue/premature-closure-not-so-fast
September 28, 2022 - Commentary
Premature closure? Not so fast.
Citation Text:
Dhaliwal G. Premature closure? Not so fast. BMJ Qual Saf. 2017;26(2):87-89. doi:10.1136/bmjqs-2016-005267.
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psnet.ahrq.gov/issue/strategies-hospitals-improve-patient-safety-review-literature
May 20, 2020 - Book/Report
Strategies for Hospitals to Improve Patient Safety: A Review of the Literature.
Citation Text:
Strategies for Hospitals to Improve Patient Safety: A Review of the Literature. Wong J, Beglaryan H. Toronto, ON: The Change Foundation; February 2004.
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psnet.ahrq.gov/issue/diagnostic-excellence-age-friendly-health-systems-dxex-afhs-seed-grant-program-improving
September 16, 2020 - Grant Announcement
Diagnostic Excellence– Age-Friendly Health Systems (DxEx–AFHS) Seed Grant Program Improving Diagnosis for Older Adults.
Citation Text:
Diagnostic Excellence– Age-Friendly Health Systems (DxEx–AFHS) Seed Grant Program Improving Diagnosis for Older Adults. Boston, MA: In…
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psnet.ahrq.gov/issue/amid-covid-19-discipline-against-bad-doctors-plummets-more-medical-errors-may-slip-through
June 24, 2020 - Newspaper/Magazine Article
Amid COVID-19, discipline against bad doctors plummets; more medical errors may slip through cracks.
Citation Text:
Amid COVID-19, discipline against bad doctors plummets; more medical errors may slip through cracks. O'Donnell J. USA Today. September 8, 2020
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psnet.ahrq.gov/issue/making-complaints-count-supporting-complaints-handling-nhs-and-uk-government-departments
July 19, 2023 - Book/Report
Making Complaints Count: Supporting Complaints Handling in the NHS and UK Government Departments.
Citation Text:
Making Complaints Count: Supporting Complaints Handling in the NHS and UK Government Departments. Manchester, UK: The Parliamentary and Health Service Ombudsman; J…
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psnet.ahrq.gov/issue/lessons-learned-death-outside-hospitals-doorstep
October 30, 2019 - Newspaper/Magazine Article
Lessons learned from a death outside a hospital's doorstep.
Citation Text:
Lessons learned from a death outside a hospital's doorstep. Palmer J. Patient Saf Qual Healthc. May/June 2019.
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psnet.ahrq.gov/perspective/role-patient-facing-technologies-empower-patients-and-improve-safety
November 01, 2017 - But by and large, it seems like most people have had very positive experiences and felt like they could
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psnet.ahrq.gov/node/50610/psn-pdf
October 30, 2019 - First, Do No Harm: Value-driven Patient Safety in the
Neonatal Intensive Care Unit
October 30, 2019
Profit J, Scheid A, Ridout E. First, Do No Harm: Value-driven Patient Safety in the Neonatal Intensive Care
Unit. PSNet [internet]. 2019.
https://psnet.ahrq.gov/perspective/first-do-no-harm-value-driven-patient-safe…
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psnet.ahrq.gov/node/33851/psn-pdf
January 01, 2017 - The Weekend Effect
January 1, 2017
Ranji SR. The Weekend Effect. PSNet [internet]. 2017.
https://psnet.ahrq.gov/perspective/weekend-effect
Annual Perspective 2017
Introduction
Anyone who has spent time in a hospital as a patient or staff member may recognize that the availability of
services and personnel can va…
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psnet.ahrq.gov/node/49416/psn-pdf
September 01, 2003 - Check the Bags
September 1, 2003
Caldwell M, Dracup KA. Check the Bags. PSNet [internet]. 2003.
https://psnet.ahrq.gov/web-mm/check-bags
The Case
A 50-year-old man with new atrial fibrillation was placed on a diltiazem drip in the emergency department
for rate control. After arriving at the cardiac care unit (CCU…