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psnet.ahrq.gov/node/853627/psn-pdf
September 20, 2023 - Understanding And Addressing Pre-Hospital Diagnostic
Delays.
September 20, 2023
Health Affairs Forefront; May-September 2023.
https://psnet.ahrq.gov/issue/understanding-and-addressing-pre-hospital-diagnostic-delays
Diagnostic delays stem from both human and process failures. This series of articles examines how
s…
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psnet.ahrq.gov/node/39033/psn-pdf
October 21, 2009 - Enhancing medication use safety: benefits of learning
from your peers.
October 21, 2009
Kazandjian VA, Ogunbo S, Wicker KG, et al. Enhancing medication use safety: benefits of learning from
your peers. Qual Saf Health Care. 2009;18(5):331-5. doi:10.1136/qshc.2008.027938.
https://psnet.ahrq.gov/issue/enhancing-medi…
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psnet.ahrq.gov/node/36277/psn-pdf
October 21, 2010 - Are the Agency for Healthcare Research and Quality
obstetric trauma indicators valid measures of hospital
safety?
October 21, 2010
Grobman WA, Feinglass J, Murthy S. Are the Agency for Healthcare Research and Quality obstetric
trauma indicators valid measures of hospital safety? Am J Obstet Gynecol. 2006;195(3):86…
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psnet.ahrq.gov/node/867648/psn-pdf
January 01, 2023 - Opioid Taskforce Playbook.
January 1, 2023
College of Healthcare Information Management Executives; 2023. Opioid Taskforce Playbook.
https://psnet.ahrq.gov/issue/opioid-taskforce-playbook
Hospitals play an important role in identifying and preventing the misuse and abuse of prescription opioids.
This Opioid Playbo…
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psnet.ahrq.gov/node/40677/psn-pdf
August 10, 2011 - Board quality scorecards: measuring improvement.
August 10, 2011
Goeschel CA, Berenholtz SM, Culbertson R, et al. Board quality scorecards: measuring improvement. Am
J Med Qual. 2011;26(4):254-60. doi:10.1177/1062860610389324.
https://psnet.ahrq.gov/issue/board-quality-scorecards-measuring-improvement
Hospital boa…
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psnet.ahrq.gov/node/837981/psn-pdf
August 31, 2022 - Improving medication reconciliation in hospitals.
August 31, 2022
Schnipper JL. Ann Intern Med. 2022;175(8):ho2-ho3.
https://psnet.ahrq.gov/issue/improving-medication-reconciliation-hospitals
Medication reconciliation is a primary method for improving the safety of medication administration in acute
care. Thi…
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psnet.ahrq.gov/node/45261/psn-pdf
June 22, 2016 - Hospitals that mess up are urged to confess.
June 22, 2016
Tozzi J. Bloomberg News Service. June 10, 2016.
https://psnet.ahrq.gov/issue/hospitals-mess-are-urged-confess
The concept of proactively responding to medical mistakes through disclosure and compensation has
gained acceptance in recent years. This news art…
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psnet.ahrq.gov/node/35541/psn-pdf
March 29, 2010 - Feasibility first: developing public performance indicators
on patient safety and clinical effectiveness for Dutch
hospitals.
March 29, 2010
Berg M, Meijerink Y, Gras M, et al. Feasibility first: developing public performance indicators on patient
safety and clinical effectiveness for Dutch hospitals. Health Polic…
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psnet.ahrq.gov/node/43026/psn-pdf
March 05, 2014 - Common formats for patient safety data collection and
event reporting.
March 5, 2014
Federal Register. Rockville, MD: Agency for Healthcare Research and Quality. February 18, 2014;79:9214-
9215.
https://psnet.ahrq.gov/issue/common-formats-patient-safety-data-collection-and-event-reporting-1
This announcement call…
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psnet.ahrq.gov/node/851068/psn-pdf
June 28, 2023 - Building a Culture of Safety in Health Care.
June 28, 2023
Chicago, IL: American Hospital Association: May 2023.
https://psnet.ahrq.gov/issue/building-culture-safety-health-care
Healthcare-acquired infections (HAIs) are a common complication of hospital care. This report summarizes
lessons learned at a series of i…
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psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.341_slideshow.ppt
March 01, 2015 - PowerPoint Presentation
Spotlight
Two Wrongs Don't Make a Right (Kidney)
This presentation is based on the March 2015
AHRQ WebM&M Spotlight Case
See the full article at http://webmm.ahrq.gov
CME credit is available
Commentary by: John G. DeVine, MD, Professor of Orthopaedic Surgery, Medical College of Georgia
Ed…
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psnet.ahrq.gov/node/33563/psn-pdf
September 16, 2024 - Culture of Safety
September 16, 2024
Culture of Safety. PSNet [internet]. 2019.
https://psnet.ahrq.gov/primer/culture-safety
PSNet primers are regularly reviewed and updated by the UC Davis PSNet Editorial Team to ensure that
they reflect current research and practice in the patient safety field. Last reviewed in …
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psnet.ahrq.gov/node/33716/psn-pdf
September 01, 2011 - In Conversation With…Kaveh G. Shojania, MD
September 1, 2011
In Conversation With…Kaveh G. Shojania, MD. PSNet [internet]. 2011.
https://psnet.ahrq.gov/perspective/conversation-withkaveh-g-shojania-md
Editor's note: Kaveh G. Shojania, MD, is the Canada Research Chair in Patient Safety and Quality
Improvement and t…
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psnet.ahrq.gov/perspective/health-care-acquired-urinary-tract-infection-problem-and-solutions
November 01, 2008 - Health Care–Acquired Urinary Tract Infection: The Problem and Solutions
Lindsay E. Nicolle, MD | November 1, 2008
Also Read a Conversation
View more articles from the same authors.
Citation Text:
Nicolle LE. Health Care–Acquired Urinary Tract Infection: The Pr…
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psnet.ahrq.gov/perspective/organizational-change-face-highly-public-errors-ii-duke-experience
July 20, 2010 - Organizational Change in the Face of Highly Public Errors—II. The Duke Experience
Karen Frush, MD | May 1, 2005
View more articles from the same authors.
Citation Text:
Frush K. Organizational Change in the Face of Highly Public Errors—II. The Duke Experience. PSN…
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psnet.ahrq.gov/node/33564/psn-pdf
March 15, 2025 - Computerized Provider Order Entry
March 15, 2025
Computerized Provider Order Entry. PSNet [internet]. 2019.
https://psnet.ahrq.gov/primer/computerized-provider-order-entry
PSNet primers are regularly reviewed and updated by the UC Davis PSNet Editorial Team to ensure that
they reflect current research and practice…
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psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.236_slideshow.ppt
March 01, 2011 - Spotlight Case July 2008
Spotlight Case March 2011
Volume Too Low: In and Out
Pediatric Patient Safety
*
*
Source and Credits
This presentation is based on the March 2011
AHRQ WebM&M Spotlight Case
See the full article at http://webmm.ahrq.gov
CME credit is available
Commentary by: Marlene Miller, MD, MSc…
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psnet.ahrq.gov/perspective/what-have-we-learned-about-safe-inpatient-handovers
March 01, 2011 - What Have We Learned About Safe Inpatient Handovers?
Sunil Kripalani, MD, MSc | March 1, 2011
Also Read a Conversation
View more articles from the same authors.
Citation Text:
Kripalani S. What Have We Learned About Safe Inpatient Handovers?. PSNet [internet]. …
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psnet.ahrq.gov/issue/factors-associated-mental-health-outcomes-among-health-care-workers-exposed-coronavirus
March 24, 2019 - Study
Factors associated with mental health outcomes among health care workers exposed to coronavirus disease 2019.
Citation Text:
Lai J, Ma S, Wang Y, et al. Factors associated with mental health outcomes among health care workers exposed to coronavirus disease 2019. JAMA Netw Open. 20…
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psnet.ahrq.gov/issue/challenges-and-remediation-patient-safety-indicators-transition-icd-10-cm
September 23, 2020 - Study
Challenges and remediation for Patient Safety Indicators in the transition to ICD-10-CM.
Citation Text:
Boyd AD, Yang YM, Li J, et al. Challenges and remediation for Patient Safety Indicators in the transition to ICD-10-CM. J Am Med Inform Assoc. 2015;22(1):19-28. doi:10.1136/amiaj…