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  1. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/44733/psn-pdf
    December 07, 2018 - Patient Safety in Ambulatory Settings: Technical Brief. December 7, 2018 Evidence-based Practice Center. Rockville, MD: Agency for Healthcare Research and Quality; October 19, 2016. https://psnet.ahrq.gov/issue/patient-safety-ambulatory-settings-technical-brief The primary focus on patient safety research has been…
  2. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/40294/psn-pdf
    September 24, 2016 - Hospital doctors' workflow interruptions and activities: an observation study. September 24, 2016 Weigl M, Müller A, Zupanc A, et al. Hospital doctors' workflow interruptions and activities: an observation study. BMJ Qual Saf. 2011;20(6):491-7. doi:10.1136/bmjqs.2010.043281. https://psnet.ahrq.gov/issue/hospital-d…
  3. Psn-Pdf (pdf file)

    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…
  4. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/46331/psn-pdf
    September 14, 2018 - Health IT Patient Safety Supplemental Items for Hospitals. September 14, 2018 Agency for Healthcare Research and Quality. July 25, 2018.  https://psnet.ahrq.gov/issue/health-it-patient-safety-supplemental-items-hospitals Tracking the intersection of organizational culture with health information technology use can …
  5. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/33808/psn-pdf
    May 01, 2016 - Reducing the Safety Hazards of Monitor Alert and Alarm Fatigue May 1, 2016 Jacques S, Williams E. Reducing the Safety Hazards of Monitor Alert and Alarm Fatigue. PSNet [internet]. 2016. https://psnet.ahrq.gov/perspective/reducing-safety-hazards-monitor-alert-and-alarm-fatigue Perspective Alarm fatigue occurs whe…
  6. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49814/psn-pdf
    December 01, 2017 - Miscommunication in the OR Leads to Anticoagulation Mishap December 1, 2017 Solsky I, Haynes AB. Miscommunication in the OR Leads to Anticoagulation Mishap. PSNet [internet]. 2017. https://psnet.ahrq.gov/web-mm/miscommunication-or-leads-anticoagulation-mishap The Case A 63-year-old man with a history of coronary…
  7. psnet.ahrq.gov/perspective/conversation-withjames-l-reinertsen-md
    August 01, 2007 - In Conversation with...James L. Reinertsen, MD August 1, 2007  Also Read an Essay Citation Text: In Conversation with..James L. Reinertsen, MD. PSNet [internet]. 2007.In Conversation with...James L. Reinertsen, MD. PSNet [internet]. Rockville (MD): Agency for Heal…
  8. psnet.ahrq.gov/issue/surgeons-disclosures-clinical-adverse-events
    August 18, 2021 - Study Surgeons' disclosures of clinical adverse events. Citation Text: Elwy R, Itani KMF, Bokhour BG, et al. Surgeons' Disclosures of Clinical Adverse Events. JAMA Surg. 2016;151(11):1015-1021. doi:10.1001/jamasurg.2016.1787. Copy Citation Format: DOI Google Scholar PubMed …
  9. psnet.ahrq.gov/issue/doing-right-things-and-doing-them-right-way-association-between-hospital-guideline-adherence
    February 03, 2011 - Study Doing the right things and doing them the right way: association between hospital guideline adherence, dosing safety, and outcomes among patients with acute coronary syndrome. Citation Text: Mehta RH, Chen AY, Alexander KP, et al. Doing the right things and doing them the right way…
  10. psnet.ahrq.gov/issue/measuring-teamwork-health-care-settings-review-survey-instruments
    December 14, 2016 - Review Measuring teamwork in health care settings: a review of survey instruments. Citation Text: Valentine MA, Nembhard IM, Edmondson A. Measuring teamwork in health care settings: a review of survey instruments. Med Care. 2015;53(4):e16-e30. doi:10.1097/MLR.0b013e31827feef6. Copy Cit…
  11. psnet.ahrq.gov/issue/four-years-experience-hospitalist-led-medical-emergency-team-interrupted-time-series
    October 03, 2011 - Study Four years' experience with a hospitalist-led medical emergency team: an interrupted time series. Citation Text: Rothberg MB, Belforti R, Fitzgerald J, et al. Four years' experience with a hospitalist-led medical emergency team: an interrupted time series. J Hosp Med. 2012;7(2):9…
  12. psnet.ahrq.gov/issue/whos-covering-our-loved-ones-surprising-barriers-sign-out-process
    October 19, 2022 - Study Who's covering our loved ones: surprising barriers in the sign-out process. Citation Text: Antonoff MB, Berdan EA, Kirchner VA, et al. Who's covering our loved ones: surprising barriers in the sign-out process. Am J Surg. 2013;205(1):77-84. doi:10.1016/j.amjsurg.2012.05.009. Co…
  13. psnet.ahrq.gov/issue/pharmacy-led-medication-reconciliation-programmes-hospital-transitions-systematic-review-and
    April 18, 2018 - Review Pharmacy-led medication reconciliation programmes at hospital transitions: a systematic review and meta-analysis. Citation Text: Mekonnen AB, McLachlan AJ, Brien J-AE. Pharmacy-led medication reconciliation programmes at hospital transitions: a systematic review and meta-analysis.…
  14. psnet.ahrq.gov/issue/interdisciplinary-icu-cardiac-arrest-debriefing-improves-survival-outcomes
    September 02, 2020 - Study Interdisciplinary ICU cardiac arrest debriefing improves survival outcomes. Citation Text: Wolfe H, Zebuhr C, Topjian AA, et al. Interdisciplinary ICU cardiac arrest debriefing improves survival outcomes*. Crit Care Med. 2014;42(7):1688-95. doi:10.1097/CCM.0000000000000327. Copy …
  15. psnet.ahrq.gov/issue/nurse-burnout-predicts-self-reported-medication-administration-errors-acute-care-hospitals
    August 25, 2021 - Study Nurse burnout predicts self-reported medication administration errors in acute care hospitals. Citation Text: Montgomery AP, Azuero A, Baernholdt MB, et al. Nurse burnout predicts self-reported medication administration errors in acute care hospitals. J Healthc Qual. 2020;43(1):13…
  16. psnet.ahrq.gov/issue/monitoring-and-reducing-central-line-associated-bloodstream-infections-national-survey-state
    December 01, 2010 - Study Monitoring and reducing central line-associated bloodstream infections: a national survey of state hospital associations. Citation Text: Murphy DJ, Needham DM, Goeschel CA, et al. Monitoring and reducing central line-associated bloodstream infections: a national survey of state h…
  17. psnet.ahrq.gov/issue/hand-hygiene-and-healthcare-system-change-within-multi-modal-promotion-narrative-review
    January 05, 2012 - Review Hand hygiene and healthcare system change within multi-modal promotion: a narrative review. Citation Text: Allegranzi B, Sax H, Pittet D. Hand hygiene and healthcare system change within multi-modal promotion: a narrative review. J Hosp Infect. 2013;83 Suppl 1:S3-10. doi:10.1016…
  18. psnet.ahrq.gov/issue/inpatient-suicide-mental-health-units-veterans-affairs-va-hospitals-avoiding-environmental
    September 05, 2018 - Study Inpatient suicide on mental health units in Veterans Affairs (VA) hospitals: avoiding environmental hazards. Citation Text: Mills PD, King LA, Watts B, et al. Inpatient suicide on mental health units in Veterans Affairs (VA) hospitals: avoiding environmental hazards. Gen Hosp Psych…
  19. psnet.ahrq.gov/issue/patient-perception-fall-risk-and-fall-risk-screening-scores
    December 07, 2022 - Study Patient perception of fall risk and fall risk screening scores. Citation Text: Solares NP, Calero P, Connelly CD. Patient perception of fall risk and fall risk screening scores. J Nurs Care Qual. 2023;38(2):100-106. doi:10.1097/ncq.0000000000000645. Copy Citation Format: …
  20. psnet.ahrq.gov/issue/challenges-implementing-communication-and-resolution-program-where-multiple-organizations
    May 11, 2016 - Study Challenges of implementing a communication-and-resolution program where multiple organizations must cooperate. Citation Text: Mello MM, Armstrong S, Greenberg Y, et al. Challenges of Implementing a Communication-and-Resolution Program Where Multiple Organizations Must Cooperate. He…

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