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  1. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/46933/psn-pdf
    April 04, 2018 - Pain states, the opioid epidemic, and the role of radiologists. April 4, 2018 Jones MR, Kaye AD, Manchikanti L, et al. Pain States, the Opioid Epidemic, and the Role of Radiologists. Curr Pain Headache Rep. 2018;22(3):20. doi:10.1007/s11916-018-0672-x. https://psnet.ahrq.gov/issue/pain-states-opioid-epidemic-and-r…
  2. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/43182/psn-pdf
    May 14, 2014 - Quality and safety in pediatric anesthesia: how can guidelines, checklists, and initiatives improve the outcome? May 14, 2014 Hagerman NS, Varughese AM, Kurth D. Quality and safety in pediatric anesthesia: how can guidelines, checklists, and initiatives improve the outcome? Curr Opin Anaesthesiol. 2014;27(3):323-9…
  3. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/45670/psn-pdf
    November 16, 2016 - Not thinking clearly? Play a game, seriously! November 16, 2016 Mohan D, Schell J, Angus DC. Not Thinking Clearly? Play a Game, Seriously!. JAMA. 2016;316(18):1867- 1868. doi:10.1001/jama.2016.14174. https://psnet.ahrq.gov/issue/not-thinking-clearly-play-game-seriously Heuristics enable experts to build off their …
  4. www.ahrq.gov/hai/quality/tools/cauti-ltc/engage.html
    March 01, 2017 - Engage Residents and Families Resident and Family Engagement brochure for residents ( PDF , 132 KB) Describes what resident and family engagement is and how to engage with long-term care facility staff as partners in infection-prevention care. Resident and Family Engagement: What Is My Role as a Leader? …
  5. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/73426/psn-pdf
    June 23, 2021 - The perfect storm: exam of a medical error and factors contributing to its possible escalation. June 23, 2021 Walters GK. The perfect storm: exam of a medical error and factors contributing to its possible escalation. J Patient Saf. 2021;17(4):e264-e267. doi:10.1097/pts.0000000000000846. https://psnet.ahrq.gov/iss…
  6. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/45869/psn-pdf
    March 25, 2017 - Data-driven implementation of alarm reduction interventions in a cardiovascular surgical ICU. March 25, 2017 Allan SH, Doyle PA, Sapirstein A, et al. Data-Driven Implementation of Alarm Reduction Interventions in a Cardiovascular Surgical ICU. Jt Comm J Qual Patient Saf. 2017;43(2):62-70. doi:10.1016/j.jcjq.2016.1…
  7. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/47068/psn-pdf
    June 25, 2018 - The need for closed-loop systems for management of abnormal test results. June 25, 2018 Zuccotti G, Samal L, Maloney FL, et al. The Need for Closed-Loop Systems for Management of Abnormal Test Results. Ann Intern Med. 2018;168(11):820-821. doi:10.7326/M17-2425. https://psnet.ahrq.gov/issue/need-closed-loop-systems…
  8. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/45341/psn-pdf
    July 27, 2016 - How to avoid catastrophic events on the ward. July 27, 2016 Bein B, Seewald S, Gräsner J-T. How to avoid catastrophic events on the ward. Best Pract Res Clin Anaesthesiol. 2016;30(2):237-45. doi:10.1016/j.bpa.2016.04.003. https://psnet.ahrq.gov/issue/how-avoid-catastrophic-events-ward Hospitals require robust esca…
  9. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/46175/psn-pdf
    September 24, 2017 - Applying lessons from social psychology to transform the culture of error disclosure. September 24, 2017 Han J, LaMarra D, Vapiwala N. Applying lessons from social psychology to transform the culture of error disclosure. Med Educ. 2017;51(10):996-1001. doi:10.1111/medu.13345. https://psnet.ahrq.gov/issue/applying-…
  10. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/45740/psn-pdf
    January 23, 2017 - Patient perspectives on delays in diagnosis and treatment of cancer: a qualitative analysis of free-text data. January 23, 2017 Parsonage RK, Hiscock J, Law R-J, et al. Patient perspectives on delays in diagnosis and treatment of cancer: a qualitative analysis of free-text data. Br J Gen Pract. 2017;67(654):e49-e56…
  11. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/43079/psn-pdf
    May 28, 2014 - Confirming delivery: understanding the role of the hospitalized patient in medication administration safety. May 28, 2014 Macdonald M, Heilemann MS, MacKinnon NJ, et al. Confirming delivery: understanding the role of the hospitalized patient in medication administration safety. Qual Health Res. 2014;24(4):536-50. …
  12. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/45455/psn-pdf
    June 29, 2017 - JAMA professionalism: disclosure of medical error. June 29, 2017 Levinson W, Yeung J, Ginsburg S. Disclosure of Medical Error. JAMA. 2016;316(7):764-5. doi:10.1001/jama.2016.9136. https://psnet.ahrq.gov/issue/jama-professionalism-disclosure-medical-error Disclosing medical errors to patients is essential for maint…
  13. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/45351/psn-pdf
    July 20, 2016 - Building a Patient Safety Toolkit for use in general practice. July 20, 2016 Bell BG, Spencer R, Marsden K, et al. Building a Patient Safety Toolkit for use in general practice. InnovAiT. 2016;9(9):557-562. doi:10.1177/1755738016650468. https://psnet.ahrq.gov/issue/patient-safety-toolkit-general-practice Although…
  14. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/47160/psn-pdf
    August 08, 2018 - Preventing dispensing errors by alerting for drug confusions in the pharmacy information system—a survey of users. August 8, 2018 Campmans Z, van Rhijn A, Dull RM, et al. Preventing dispensing errors by alerting for drug confusions in the pharmacy information system-A survey of users. PLoS One. 2018;13(5):e0197469…
  15. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/60018/psn-pdf
    March 04, 2020 - 2019 update on pediatric medical overuse: a systematic review. March 4, 2020 Money NM, Schroeder AR, Quinonez RA, et al. 2019 Update on Pediatric Medical Overuse. JAMA Pediatr. 2020;174(4):375-382. doi:10.1001/jamapediatrics.2019.5849. https://psnet.ahrq.gov/issue/2019-update-pediatric-medical-overuse-systematic-r…
  16. www.ahrq.gov/practiceimprovement/systemdesign/leancasestudies/lean-exhibit1-14.html
    November 01, 2014 - Improving Care Delivery Through Lean: Implementation Case Studies Exhibit 1.14. Lean Tools and Activities for Clinic Flow Previous Page Next Page Table of Contents Improving Care Delivery Through Lean: Implementation Case Studies Introduction to the Case Studies Case 1. Lakeview Healthcare Cas…
  17. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/46642/psn-pdf
    December 13, 2017 - Intravenous fluid prescribing errors in children: mixed methods analysis of critical incidents. December 13, 2017 Conn RL, McVea S, Carrington A, et al. Intravenous fluid prescribing errors in children: Mixed methods analysis of critical incidents. PLoS One. 2017;12(10):e0186210. doi:10.1371/journal.pone.0186210. …
  18. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/47507/psn-pdf
    December 21, 2018 - The fate of medicine in the time of AI. December 21, 2018 Coiera E. The fate of medicine in the time of AI. Lancet. 2018;392(10162):2331-2332. doi:10.1016/S0140- 6736(18)31925-1. https://psnet.ahrq.gov/issue/fate-medicine-time-ai Artificial intelligence can improve practice by making synthesized data available in …
  19. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/45766/psn-pdf
    February 08, 2017 - Prescription Drug Monitoring Programs: Evidence-based Practices to Optimize Prescriber Use. February 8, 2017 Philadelphia, PA: Pew Charitable Trusts and Institute for Behavioral Health, Heller School for Social Policy and Management at Brandeis University; 2016. https://psnet.ahrq.gov/issue/prescription-drug-monit…
  20. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/43528/psn-pdf
    October 01, 2014 - Critical incident stress management (CISM) in complex systems: cultural adaptation and safety impacts in healthcare. October 1, 2014 Müller-Leonhardt A, Mitchell SG, Vogt J, et al. Critical Incident Stress Management (CISM) in complex systems: cultural adaptation and safety impacts in healthcare. Accid Anal Prev. …