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psnet.ahrq.gov/node/60232/psn-pdf
April 15, 2020 - Sustaining innovations in complex health care
environments: a multiple-case study of rapid response
teams.
April 15, 2020
Stolldorf DP, Havens DS, Jones CB. Sustaining innovations in complex health care environments: a
multiple-case study of rapid response teams. J Patient Saf. 2020;16(1).
doi:10.1097/pts.0000000…
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psnet.ahrq.gov/node/47890/psn-pdf
June 15, 2019 - Systems engineering and human factors support of a
system of novel EHR-integrated tools to prevent harm in
the hospital.
June 15, 2019
Dalal A, Fuller T, Garabedian P, et al. Systems engineering and human factors support of a system of
novel EHR-integrated tools to prevent harm in the hospital. J Am Med Inform Ass…
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psnet.ahrq.gov/node/865876/psn-pdf
May 15, 2024 - Systematic review on the frequency and quality of
reporting patient and public involvement in patient safety
research.
May 15, 2024
Hammoud S, Alsabek L, Rogers L, et al. Systematic review on the frequency and quality of reporting
patient and public involvement in patient safety research. BMC Health Serv Res. 2024…
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psnet.ahrq.gov/node/36226/psn-pdf
August 30, 2006 - New York, NY; The Commonwealth Fund: 2006.
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psnet.ahrq.gov/node/36223/psn-pdf
May 27, 2011 - Prescribers' responses to alerts during medication
ordering in the long term care setting.
May 27, 2011
Judge J, Field T, DeFlorio M, et al. Prescribers' responses to alerts during medication ordering in the long
term care setting. J Am Med Inform Assoc. 2006;13(4):385-90.
https://psnet.ahrq.gov/issue/prescribers-…
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psnet.ahrq.gov/node/35375/psn-pdf
January 02, 2017 - Integrating the intensive care unit safety reporting system
with existing incident reporting systems.
January 2, 2017
Thompson DA, Lubomski LH, Holzmueller CG, et al. Integrating the intensive care unit safety reporting
system with existing incident reporting systems. Jt Comm J Qual Patient Saf. 2005;31(10):585-93.…
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psnet.ahrq.gov/node/44359/psn-pdf
January 06, 2016 - What happens when healthcare innovations collide?
January 6, 2016
Pendharkar SR, Woiceshyn J, da Silveira GJC, et al. What happens when healthcare innovations collide?
BMJ Qual Saf. 2016;25(1):9-13. doi:10.1136/bmjqs-2015-004441.
https://psnet.ahrq.gov/issue/what-happens-when-healthcare-innovations-collide
Innovat…
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psnet.ahrq.gov/node/37228/psn-pdf
December 15, 2011 - A comparison of two distribution methods on response
rates to a patient safety questionnaire in nursing homes.
December 15, 2011
Lapane KL, Quilliam BJ, Hughes C. A comparison of two distribution methods on response rates to a
patient safety questionnaire in nursing homes. J Am Med Dir Assoc. 2007;8(7):446-52.
htt…
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psnet.ahrq.gov/node/37097/psn-pdf
October 04, 2011 - The relationship of organizational culture, stress,
satisfaction, and burnout with physician-reported error
and suboptimal patient care: results from the MEMO
study.
October 4, 2011
Williams E, Manwell LB, Konrad TR, et al. The relationship of organizational culture, stress, satisfaction,
and burnout with physici…
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psnet.ahrq.gov/node/36107/psn-pdf
September 28, 2010 - The "Big Dog" effect: variability assessing the causes of
error in diagnoses of patients with lung cancer.
September 28, 2010
Raab SS, Meier FA, Zarbo RJ, et al. The "Big Dog" effect: variability assessing the causes of error in
diagnoses of patients with lung cancer. J Clin Oncol. 2006;24(18):2808-14.
https://psn…
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psnet.ahrq.gov/node/35101/psn-pdf
November 04, 2015 - Hospital finances and patient safety outcomes.
November 4, 2015
Encinosa W, Bernard DM. Hospital finances and patient safety outcomes. Inquiry. 2005;42(1):60-72.
https://psnet.ahrq.gov/issue/hospital-finances-and-patient-safety-outcomes
This AHRQ–funded study examined the relationship between hospital profit margin…
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psnet.ahrq.gov/node/44854/psn-pdf
March 16, 2016 - Bring back the autopsy.
March 16, 2016
Jauhar S. New York Times. March 3, 2016.
https://psnet.ahrq.gov/issue/bring-back-autopsy
Performance of autopsies, previously considered an essential learning tool for clinicians, has decreased in
recent years due to insufficient funding to cover costs and lack of physician e…
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psnet.ahrq.gov/node/42925/psn-pdf
February 05, 2014 - Understanding the Role of Facility Design in the
Acquisition and Prevention of Healthcare-Associated
Infections.
February 5, 2014
Hamilton DK, Stichler JF, eds. HERD. 2013;7(suppl):1-154.
https://psnet.ahrq.gov/issue/understanding-role-facility-design-acquisition-and-prevention-healthcare-
associated
Articles in…
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psnet.ahrq.gov/node/34904/psn-pdf
February 27, 2009 - Suboptimal prescribing in elderly outpatients: potentially
harmful drug-drug and drug-disease combinations.
February 27, 2009
Zhan C, Correa-de-Araujo R, Bierman AS, et al. Suboptimal prescribing in elderly outpatients: potentially
harmful drug-drug and drug-disease combinations. J Am Geriatr Soc. 2005;53(2):262-7.…
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psnet.ahrq.gov/node/45194/psn-pdf
December 14, 2016 - Wounded care: failure at one Indian Health Service
hospital reveals a system in crisis.
December 14, 2016
Herman B, Fei F. Mod Healthc. December 2, 2016.
https://psnet.ahrq.gov/issue/wounded-care-failure-one-indian-health-service-hospital-reveals-system-crisis
Underserved communities face challenges to receiving h…
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psnet.ahrq.gov/node/36770/psn-pdf
July 14, 2010 - Evaluation of nurse interaction with bar code medication
administration technology in the work environment.
July 14, 2010
Carayon P, Wetterneck TB, Hundt AS, et al. Evaluation of Nurse Interaction With Bar Code Medication
Administration Technology in the Work Environment. J Patient Saf. 2008;3(1):34-42.
doi:10.109…
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psnet.ahrq.gov/node/50393/psn-pdf
September 01, 2019 - Patient Safety and the Evolution of WebM&M and PSNet
September 1, 2019
Ranji SR, Wachter R. Patient Safety and the Evolution of WebM&M and PSNet. PSNet [internet]. 2019.
https://psnet.ahrq.gov/perspective/patient-safety-and-evolution-webmm-and-psnet
Perspective
Progress in any field requires scholarship and dissem…
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psnet.ahrq.gov/node/36027/psn-pdf
March 28, 2011 - Medical injuries among hospitalized children.
March 28, 2011
Meurer JR, Yang H, Guse CE, et al. Medical injuries among hospitalized children. Qual Saf Health Care.
2006;15(3):202-7.
https://psnet.ahrq.gov/issue/medical-injuries-among-hospitalized-children
This AHRQ–funded study applied new screening criteria to ca…
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psnet.ahrq.gov/node/34086/psn-pdf
May 27, 2011 - Overcoming barriers to adopting and implementing
computerized physician order entry systems in U.S.
hospitals.
May 27, 2011
Poon EG, Blumenthal D, Jaggi T, et al. Overcoming barriers to adopting and implementing computerized
physician order entry systems in U.S. hospitals. Health Aff (Millwood). 2004;23(4):184-90.…
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psnet.ahrq.gov/node/38737/psn-pdf
July 13, 2009 - Reengineering hospital discharge: a protocol to improve
patient safety, reduce costs, and boost patient
satisfaction.
July 13, 2009
Clancy CM. Reengineering hospital discharge: a protocol to improve patient safety, reduce costs, and
boost patient satisfaction. Am J Med Qual. 2009;24(4):344-6. doi:10.1177/106286060…