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psnet.ahrq.gov/issue/debrief-it-all-tool-inclusion-safety-ii
June 08, 2022 - Study
Debrief it all: a tool for inclusion of Safety-II.
Citation Text:
Bentley SK, McNamara S, Meguerdichian MJ, et al. Debrief it all: a tool for inclusion of Safety-II. Adv Simul (Lond). 2021;6(1):9. doi:10.1186/s41077-021-00163-3.
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psnet.ahrq.gov/issue/communication-matters-when-it-comes-adverse-events-associations-adverse-events-during-implant
December 15, 2021 - Study
Communication matters when it comes to adverse events: associations of adverse events during implant treatment with patients' communication quality and trust assessments.
Citation Text:
Schrimpff C, Link E, Fisse T, et al. Communication matters when it comes to adverse events: asso…
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psnet.ahrq.gov/issue/implementation-sustainment-large-scale-adverse-event-disclosure-support-program-generated
March 26, 2015 - Study
From implementation to sustainment: a large-scale adverse event disclosure support program generated through embedded research in the Veterans Health Administration.
Citation Text:
Elwy AR, Maguire EM, McCullough M, et al. From implementation to sustainment: a large-scale adverse e…
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psnet.ahrq.gov/issue/disparities-adverse-event-reporting-hospitalized-children
July 27, 2022 - Study
Disparities in adverse event reporting for hospitalized children.
Citation Text:
Halvorson EE, Thurtle DP, Easter A, et al. Disparities in adverse event reporting for hospitalized children. J Patient Saf. 2022;18(6):e928-e933. doi:10.1097/pts.0000000000001049.
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psnet.ahrq.gov/issue/quality-framework-remote-antenatal-care-qualitative-study-women-healthcare-professionals-and
October 21, 2020 - Study
Quality framework for remote antenatal care: qualitative study with women, healthcare professionals and system-level stakeholders.
Citation Text:
Hinton L, Dakin FH, Kuberska K, et al. Quality framework for remote antenatal care: qualitative study with women, healthcare professiona…
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psnet.ahrq.gov/issue/medication-dispensing-errors-and-potential-adverse-drug-events-and-after-implementing-bar
June 28, 2010 - Study
Classic
Medication dispensing errors and potential adverse drug events before and after implementing bar code technology in the pharmacy.
Citation Text:
Poon EG, Cina J, Churchill WW, et al. Medication dispensing errors and potential adverse drug events …
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psnet.ahrq.gov/issue/covid-19-and-patient-safety-time-tap-our-investment-high-reliability
July 21, 2021 - Commentary
COVID-19 and patient safety: time to tap into our investment in high reliability.
Citation Text:
Adelman JS, Gandhi TK. COVID-19 and patient safety: time to tap into our investment in high reliability. J Patient Saf. 2021;17(4):331-333. doi:10.1097/pts.0000000000000843.
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psnet.ahrq.gov/issue/application-strong-matrix-management-and-pdca-cycle-management-severe-covid-19-patients
March 24, 2019 - Commentary
The application of strong matrix management and PDCA cycle in the management of severe COVID-19 patients.
Citation Text:
Li Y, Wang H, Jiao J. The application of strong matrix management and PDCA cycle in the management of severe COVID-19 patients. Crit Care. 2020;24(1):157. d…
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psnet.ahrq.gov/node/851971/psn-pdf
July 31, 2023 - Failure to Adhere to Dietary Restrictions Leading to
Complications and Poor Follow-up
July 31, 2023
Bohringer C, Bourgeois J, Xiong G, et al. Failure to adhere to dietary restrictions leading to complications
and poor follow-up. PSNet [internet]. 2023.
https://psnet.ahrq.gov/web-mm/failure-adhere-dietary-restricti…
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psnet.ahrq.gov/web-mm/need-eat
February 10, 2021 - The Need to Eat
Citation Text:
Widaman AM. The Need to Eat. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2019.
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psnet.ahrq.gov/node/50755/psn-pdf
December 18, 2019 - The Need to Eat
December 18, 2019
Widaman AM. The Need to Eat. PSNet [internet]. 2019.
https://psnet.ahrq.gov/web-mm/need-eat
The Case
A 62-year-old man with a history of Wernicke–Korsakoff encephalopathy – a degenerative brain disorder
caused by the lack of vitamin B1 – was admitted for possible aspiration pneum…
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psnet.ahrq.gov/issue/patients-and-providers-perceptions-preventability-hospital-readmission-prospective
September 07, 2016 - Study
Patients' and providers' perceptions of the preventability of hospital readmission: a prospective, observational study in four European countries.
Citation Text:
van Galen LS, Brabrand M, Cooksley T, et al. Patients' and providers' perceptions of the preventability of hospital read…
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psnet.ahrq.gov/issue/using-patient-internet-portal-prevent-adverse-drug-events-randomized-controlled-trial
September 15, 2011 - Study
Using a patient internet portal to prevent adverse drug events: a randomized, controlled trial.
Citation Text:
Weingart SN, Carbo AR, Tess A, et al. Using a Patient Internet Portal to Prevent Adverse Drug Events. J Patient Saf. 2013;9(3). doi:10.1097/pts.0b013e31829e4b95.
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psnet.ahrq.gov/issue/were-all-together-how-covid-19-revealed-co-construction-mindful-organising-and-organisational
February 16, 2022 - Commentary
We're all in this together: how COVID-19 revealed the co-construction of mindful organising and organisational reliability.
Citation Text:
Vogus TJ, Wilson AD, Randall KH, et al. We’re all in this together: how COVID-19 revealed the co-construction of mindful organising and or…
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psnet.ahrq.gov/issue/clinical-benefits-electronic-health-record-use-national-findings
November 16, 2022 - Study
Clinical benefits of electronic health record use: national findings.
Citation Text:
King J, Patel V, Jamoom EW, et al. Clinical benefits of electronic health record use: national findings. Health Serv Res. 2014;49(1 Pt 2):392-404. doi:10.1111/1475-6773.12135.
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psnet.ahrq.gov/issue/video-based-communication-assessment-physician-error-disclosure-skills-crowdsourced-laypeople
August 21, 2024 - Study
Video-based communication assessment of physician error disclosure skills by crowdsourced laypeople and patient advocates who experienced medical harm: reliability assessment with generalizability theory.
Citation Text:
White AA, King AM, D’Addario AE, et al. Video-based communicat…
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psnet.ahrq.gov/issue/primary-care-closed-claims-experience-massachusetts-malpractice-insurers
August 14, 2017 - Study
Classic
Primary care closed claims experience of Massachusetts malpractice insurers.
Citation Text:
Schiff G, Puopolo AL, Huben-Kearney A, et al. Primary care closed claims experience of Massachusetts malpractice insurers. JAMA Intern Med. 2013;173(22):206…
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psnet.ahrq.gov/issue/research-designs-studies-evaluating-effectiveness-change-and-improvement-strategies
September 20, 2011 - Study
Classic
Research designs for studies evaluating the effectiveness of change and improvement strategies.
Citation Text:
Eccles M, Grimshaw J, Campbell M, et al. Research designs for studies evaluating the effectiveness of change and improvement strategies. …
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psnet.ahrq.gov/issue/safety-culture-and-complications-after-bariatric-surgery
August 02, 2015 - Study
Safety culture and complications after bariatric surgery.
Citation Text:
Birkmeyer NJO, Finks JF, Greenberg CK, et al. Safety culture and complications after bariatric surgery. Ann Surg. 2013;257(2):260-5. doi:10.1097/SLA.0b013e31826c0085.
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psnet.ahrq.gov/issue/unrealized-potential-and-residual-consequences-electronic-prescribing-pharmacy-workflow
December 31, 2014 - Study
Unrealized potential and residual consequences of electronic prescribing on pharmacy workflow in the outpatient pharmacy.
Citation Text:
Nanji KC, Rothschild JM, Boehne JJ, et al. Unrealized potential and residual consequences of electronic prescribing on pharmacy workflow in the o…