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psnet.ahrq.gov/issue/taking-risky-business-out-mri-suite
September 12, 2016 - Newspaper/Magazine Article
Taking risky business out of the MRI suite.
Citation Text:
Rozovsky FA, Gilk TB, Latina RJ. Managing liability exposure and safety. Taking risky business out of the MRI suite. Materials management in health care. 2006;15(1):18-23.
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psnet.ahrq.gov/issue/three-australian-whistleblowing-sagas-lessons-internal-and-external-regulation
August 17, 2005 - Study
Three Australian whistleblowing sagas: lessons for internal and external regulation.
Citation Text:
Faunce TA, Bolsin SNC. Three Australian whistleblowing sagas: lessons for internal and external regulation. Med J Aust. 2004;181(1):44-7.
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psnet.ahrq.gov/issue/smart-pumps-implications-nurse-leaders
February 02, 2022 - Commentary
Smart pumps: implications for nurse leaders.
Citation Text:
Kirkbride G, Vermace B. Smart pumps: implications for nurse leaders. Nurs Adm Q. 2011;35(2):110-118. doi:10.1097/NAQ.0b013e31820fbdc0.
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psnet.ahrq.gov/issue/towards-framework-select-techniques-error-prediction-supporting-novice-users-healthcare
March 28, 2011 - Review
Towards a framework to select techniques for error prediction: supporting novice users in the healthcare sector.
Citation Text:
Lyons M. Towards a framework to select techniques for error prediction: supporting novice users in the healthcare sector. Appl Ergon. 2009;40(3):379-95…
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psnet.ahrq.gov/issue/physician-quality-officer-new-model-engaging-physicians-quality-improvement
May 03, 2017 - Commentary
Physician Quality Officer: a new model for engaging physicians in quality improvement.
Citation Text:
Walsh KE, Ettinger WH, Klugman R. Physician quality officer: a new model for engaging physicians in quality improvement. Am J Med Qual. 2009;24(4):295-301. doi:10.1177/10628…
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psnet.ahrq.gov/issue/designing-strategy-promote-safe-innovative-label-use-medications
May 06, 2009 - Commentary
Designing a strategy to promote safe, innovative off-label use of medications.
Citation Text:
Ansani N, Sirio CA, Smitherman T, et al. Designing a strategy to promote safe, innovative off-label use of medications. Am J Med Qual. 2006;21(4):255-261.
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psnet.ahrq.gov/issue/standardizing-hand-processes
June 03, 2020 - Commentary
Standardizing hand-off processes.
Citation Text:
Gregory BSC. Standardizing hand-off processes. AORN J. 2006;84(6):1059-61.
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www.ahrq.gov/hai/tools/ambulatory-surgery/sections/sustainability/training-tools/tool.html
June 01, 2017 - Sustainability Tool - Sustainability Module
Background: This tool can be used to identify sustainability issues in planning and implementing your improvement efforts.
How to use this tool: The Implementation Team leader (or individual designated by the leader) should complete this checklist.
Us…
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psnet.ahrq.gov/issue/improving-operating-room-and-perioperative-safety-background-and-specific-recommendations
August 29, 2011 - Commentary
Improving operating room and perioperative safety: background and specific recommendations.
Citation Text:
Schimpff SC. Improving operating room and perioperative safety: background and specific recommendations. Surg Innov. 2007;14(2):127-35.
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psnet.ahrq.gov/issue/my-life-was-upended-35-years-cancer-diagnosis-doctor-just-told-me-i-was-misdiagnosed
April 11, 2018 - Newspaper/Magazine Article
My life was upended for 35 years by a cancer diagnosis. A doctor just told me I was misdiagnosed.
Citation Text:
My life was upended for 35 years by a cancer diagnosis. A doctor just told me I was misdiagnosed. Henigson J. Washington Post. March 26, 2021. …
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psnet.ahrq.gov/issue/safety-hospital-stroke-care
December 02, 2020 - Study
The safety of hospital stroke care.
Citation Text:
Holloway RG, Tuttle D, Baird T, et al. The safety of hospital stroke care. Neurology. 2007;68(8):550-555.
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psnet.ahrq.gov/issue/tubing-safety-obstetric-setting-preventing-medication-errors
November 04, 2020 - Commentary
Tubing safety in the obstetric setting: preventing medication errors.
Citation Text:
Broussard BS. Tubing safety in the obstetric setting: preventing medication errors. Nurs Womens Health. 2009;13(2):155-158. doi:10.1111/j.1751-486X.2009.01407.x.
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/quality-resources/tools/cap-toolkit/ed-workflowdiagrams.pdf
January 01, 2018 - Emergency Department Workflow Diagrams
Emergency Department
Workflow Diagrams
Ambulatory patient
arrives.
Provider assigns
patient to self and
evaluates patient.
Diagnostic testing
including labwork and
chest x-ray. Diagnosis
CAP?
Pursue other
diagnoses.
Inpatient treatment
warranted? Based on
clin…
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psnet.ahrq.gov/issue/eight-year-experience-neurosurgical-checklist
September 27, 2023 - Study
Eight-year experience with a neurosurgical checklist.
Citation Text:
Lyons MK. Eight-year experience with a neurosurgical checklist. Am J Med Qual. 2010;25(4):285-8. doi:10.1177/1062860610363305.
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psnet.ahrq.gov/issue/costly-issues-uncommunicative-or
July 29, 2020 - Newspaper/Magazine Article
Costly issues of an uncommunicative OR.
Citation Text:
Neil R. Costly issues of an uncommunicative OR. Materials management in health care. 2006;15(3):30-3.
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psnet.ahrq.gov/issue/sample-sample-carryover-source-analytical-laboratory-error-and-its-relevance-integrated
January 12, 2022 - Study
Sample to sample carryover: a source of analytical laboratory error and its relevance to integrated clinical chemistry/immunoassay systems.
Citation Text:
Armbruster DA, Alexander DB. Sample to sample carryover: a source of analytical laboratory error and its relevance to integra…
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www.ahrq.gov/patient-safety/news-events/psaw-2021/index.html
July 01, 2022 - Patient Safety Awareness Week
AHRQ and colleagues from the U.S. Department of Health and Human Services, the Health Resources and Services Administration, the Institute for Healthcare Improvement, and the entire patient safety community are collaborating to observe Patient Safety Awareness Week. While AHRQ's …
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psnet.ahrq.gov/issue/john-m-eisenberg-patient-safety-awards-system-innovation-concord-hospital
October 19, 2022 - Commentary
John M. Eisenberg Patient Safety Awards. System innovation: Concord Hospital.
Citation Text:
Uhlig PN, Brown J, Nason AK, et al. John M. Eisenberg Patient Safety Awards. System innovation: Concord Hospital. Jt Comm J Qual Improv. 2002;28(12):666-672.
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psnet.ahrq.gov/node/49791/psn-pdf
April 01, 2017 - The
fall occurred as she attempted to sit down in the bathroom and missed the toilet, falling backwards
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psnet.ahrq.gov/issue/better-approach-medical-malpractice-claims-university-michigan-experience
March 19, 2008 - July 23, 2010
How to avoid falling victim to a hospital mistake.