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psnet.ahrq.gov/node/37652/psn-pdf
September 24, 2010 - Case study: getting boards on board at Allen Memorial
Hospital, Iowa Health System.
September 24, 2010
Slessor SR, Crandall JB, Nielsen GA. Case study: getting boards on board at Allen Memorial Hospital,
Iowa Health System. Jt Comm J Qual Patient Saf. 2008;34(4):221-227.
https://psnet.ahrq.gov/issue/case-study-get…
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psnet.ahrq.gov/node/50807/psn-pdf
January 15, 2020 - Artificial intelligence is rushing into patient care - and
could raise risks.
January 15, 2020
Szabo L. Scientific American and Kaiser Health News. December 24, 2019.
https://psnet.ahrq.gov/issue/artificial-intelligence-rushing-patient-care-and-could-raise-risks
Artificial intelligence (AI) has the potential to im…
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psnet.ahrq.gov/node/37596/psn-pdf
May 01, 2016 - Patient Safety Organization (PSO) Program.
May 1, 2016
Agency for Healthcare Research and Quality
https://psnet.ahrq.gov/issue/patient-safety-organization-pso-program
In order to encourage "voluntary, provider-driven initiatives to improve the safety and quality of patient
care," the Agency for Healthcare Research…
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psnet.ahrq.gov/issue/creating-high-reliability-health-care-system-improving-performance-core-processes-care-johns
January 27, 2016 - Study
Creating a high-reliability health care system: improving performance on core processes of care at Johns Hopkins Medicine.
Citation Text:
Pronovost P, Armstrong M, Demski R, et al. Creating a high-reliability health care system: improving performance on core processes of care at Jo…
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psnet.ahrq.gov/issue/learning-safety-incidents-high-reliability-organizations-systematic-review-learning-tools
May 26, 2021 - Review
Learning from safety incidents in high reliability organizations: a systematic review of learning tools that could be adapted and used in healthcare.
Citation Text:
Serou N, Sahota LM, Husband AK, et al. Learning from safety incidents in high-reliability organizations: a systemati…
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psnet.ahrq.gov/issue/artificial-intelligence-related-safety-issues-associated-fda-medical-device-reports
May 29, 2024 - Study
Artificial intelligence related safety issues associated with FDA medical device reports.
Citation Text:
Handley JL, Krevat SA, Fong A, et al. Artificial intelligence related safety issues associated with FDA medical device reports. NPJ Digit Med. 2024;7(1):351. doi:10.1038/s41746-…
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psnet.ahrq.gov/issue/learning-incident-reporting-analysis-incidents-resulting-patient-injuries-web-based-system
August 04, 2021 - Study
Learning from incident reporting? Analysis of incidents resulting in patient injuries in a web-based system in Swedish health care.
Citation Text:
Ahlberg E-L, Elfström J, Borgstedt MR, et al. Learning from incident reporting? Analysis of incidents resulting in patient injuries in …
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psnet.ahrq.gov/issue/how-incident-reporting-systems-can-stimulate-social-and-participative-learning-mixed-methods
November 04, 2020 - Study
How incident reporting systems can stimulate social and participative learning: a mixed-methods study.
Citation Text:
de Kam D, Kok J, Grit K, et al. How incident reporting systems can stimulate social and participative learning: a mixed-methods study. Health Policy (New York). 202…
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psnet.ahrq.gov/node/41436/psn-pdf
October 19, 2012 - Which clinical errors lead to the referral of UK
paediatricians to the National Clinical Assessment
Service?
October 19, 2012
Raine J, Scarrott D. Which clinical errors lead to the referral of UK paediatricians to the National Clinical
Assessment Service? Eur J Pediatr. 2012;171(10):1449-52.
https://psnet.ahrq.go…
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psnet.ahrq.gov/node/47052/psn-pdf
July 31, 2018 - The risks to patient safety from health system
expansions.
July 31, 2018
Haas S, Gawande AA, Reynolds ME. The Risks to Patient Safety From Health System Expansions. JAMA.
2018;319(17):1765-1766. doi:10.1001/jama.2018.2074.
https://psnet.ahrq.gov/issue/risks-patient-safety-health-system-expansions
Changes in organ…
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psnet.ahrq.gov/node/866169/psn-pdf
June 19, 2024 - Safe and equitable pediatric clinical use of AI.
June 19, 2024
Handley JL, Lehmann CU, Ratwani RM. Safe and equitable pediatric clinical use of AI. JAMA Pediatr.
2024;178(7):637-638. doi:10.1001/jamapediatrics.2024.0897.
https://psnet.ahrq.gov/issue/safe-and-equitable-pediatric-clinical-use-ai
Accepting shared res…
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psnet.ahrq.gov/node/74064/psn-pdf
May 27, 2021 - Achieving zero inequity: lessons learned from patient
safety.
May 27, 2021
Gandhi TK. NEJM Catalyst. May 27, 2021.
https://psnet.ahrq.gov/issue/achieving-zero-inequity-lessons-learned-patient-safety
The COVID-19 pandemic has shown a spotlight on bias, disparities, and inequity in the healthcare system.
The author…
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psnet.ahrq.gov/web-mm/dying-hospital-advanced-dementia
November 01, 2016 - Fourth, the NAM recommends that government and commercial payers cover comprehensive care programs for
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psnet.ahrq.gov/web-mm/great-pretender-syphilis-still-stumping-healthcare-providers
January 07, 2022 - Generally, nationally notifiable diseases are reported to state and then federal authorities, with local government
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psnet.ahrq.gov/node/865413/psn-pdf
March 27, 2024 - I would suggest starting there and reading the threat
bulletins from the government.5
Barbara Pelletreau
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psnet.ahrq.gov/node/72613/psn-pdf
December 22, 2020 - Additionally, a big problem in
dentistry is the limited government payer coverage.
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psnet.ahrq.gov/perspective/annual-perspective-topics-medication-safety
April 27, 2022 - than 255 million prescriptions dispensed. 4 In response to improper prescribing and use of opioids, government
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psnet.ahrq.gov/web-mm/risks-absent-interoperability-medication-induced-hemolysis-patient-known-allergy
April 08, 2019 - meaningful use, there would be no compelling reason for care providers to use their newly purchased (with government
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psnet.ahrq.gov/node/46753/psn-pdf
January 30, 2018 - Leadership oversight for patient safety programs: an
essential element.
January 30, 2018
Moffatt-Bruce SD, Clark S, DiMaio M, et al. Leadership Oversight for Patient Safety Programs: An Essential
Element. Ann Thorac Surg. 2017;105(2):351-356. doi:10.1016/j.athoracsur.2017.11.021.
https://psnet.ahrq.gov/issue/leade…
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psnet.ahrq.gov/node/72829/psn-pdf
March 10, 2021 - Safe Practices to Reduce CPOE Alert Fatigue through
Monitoring, Analysis, and Optimization.
March 10, 2021
Partnership for Health IT Patient Safety. Plymouth Meeting, PA: ECRI Institute; 2021.
https://psnet.ahrq.gov/issue/safe-practices-reduce-cpoe-alert-fatigue-through-monitoring-analysis-and-
optimization
Alert…