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psnet.ahrq.gov/node/42229/psn-pdf
July 03, 2014 - Relationship between occurrence of surgical
complications and hospital finances.
July 3, 2014
Eappen S, Lane BH, Rosenberg B, et al. Relationship between occurrence of surgical complications and
hospital finances. JAMA. 2013;309(15):1599-606. doi:10.1001/jama.2013.2773.
https://psnet.ahrq.gov/issue/relationship-be…
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psnet.ahrq.gov/node/840153/psn-pdf
November 16, 2022 - Team debriefing in the COVID-19 pandemic: a qualitative
study of a hospital-wide clinical event debriefing program
and a novel qualitative model to analyze debriefing
content.
November 16, 2022
Welch-Horan TB, Mullan PC, Momin Z, et al. Team debriefing in the COVID-19 pandemic: a qualitative
study of a hospital-w…
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psnet.ahrq.gov/node/836967/psn-pdf
April 20, 2022 - Hospital acquired infections in surgical patients: impact
of COVID-19-related infection prevention measures.
April 20, 2022
Tham N, Fazio T, Johnson D, et al. Hospital acquired infections in surgical patients: impact of COVID-19-
related infection prevention measures. World J Surg. 2022;46:1249-1258. doi:10.1007/s0…
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psnet.ahrq.gov/node/840484/psn-pdf
November 30, 2022 - Interdisciplinary collaboration across secondary and
primary care to improve medication safety in the elderly
(The IMMENSE study) - a randomized controlled trial.
November 30, 2022
Johansen JS, Halvorsen KH, Svendsen K, et al. Interdisciplinary collaboration across secondary and
primary care to improve medication …
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patientsafetyculture/hospital/hospwebinar/just-culture-webcast-3-closing.pdf
June 01, 2017 - Just Culture Webcast Closing
Updating the Hospital Survey and
Nonpunitive Response to Error
• HSOPS 2.0
– Conducting cognitive testing and a pilot study
– Version 2.0 to be released in early 2018
– Revising the Nonpunitive Response to Error composite
to reflect Just Culture concepts
31
Nonpunitive
Response to
…
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psnet.ahrq.gov/node/45802/psn-pdf
December 12, 2018 - Intravenous smart pump drug library compliance: a
descriptive study of 44 hospitals.
December 12, 2018
Giuliano KK, Su W-T, Degnan DD, et al. Intravenous Smart Pump Drug Library Compliance: A Descriptive
Study of 44 Hospitals. J Patient Saf. 2018;14(4):e76-e82. doi:10.1097/PTS.0000000000000383.
https://psnet.ahrq.…
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digital.ahrq.gov/sites/default/files/docs/publication/r18hs022674-adler-milstein-final-report-2014.pdf
January 01, 2014 - EHR functionality for receiving information during patient care transitions: Referrals and
Hospitalizations … Hospitalizations: Many practices relied on hospital portals to learn if their patients were hospitalized … overwhelmed by the volume of separate notices received
throughout a patient’s hospital visit and post-hospitalization
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psnet.ahrq.gov/issue/analgesic-prescribing-errors-and-associated-medication-characteristics
November 01, 2003 - Study
Analgesic prescribing errors and associated medication characteristics.
Citation Text:
Smith HS, Lesar TS. Analgesic prescribing errors and associated medication characteristics. The journal of pain : official journal of the American Pain Society. 2011;12(1):29-40. doi:10.1016/j.…
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psnet.ahrq.gov/issue/inpatient-suicide-preventing-common-sentinel-event
May 28, 2015 - Review
Inpatient suicide: preventing a common sentinel event.
Citation Text:
Tishler CL, Reiss NS. Inpatient suicide: preventing a common sentinel event. Gen Hosp Psychiatry. 2009;31(2):103-9. doi:10.1016/j.genhosppsych.2008.09.007.
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psnet.ahrq.gov/issue/medication-safety-pharmacy-technician-large-tertiary-care-community-hospital
July 08, 2020 - Commentary
Medication safety pharmacy technician in a large, tertiary care, community hospital.
Citation Text:
Brown KN, Bergsbaken J, Reichard JS. Medication safety pharmacy technician in a large, tertiary care, community hospital. Am J Health Syst Pharm. 2016;73(4):188-191. doi:10.2146…
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psnet.ahrq.gov/issue/hospitalist-handoffs-systematic-review-and-task-force-recommendations
September 09, 2013 - Review
Hospitalist handoffs: a systematic review and task force recommendations.
Citation Text:
Arora VM, Manjarrez E, Dressler DD, et al. Hospitalist handoffs: A systematic review and task force recommendations. J Hosp Med. 2009;4(7). doi:10.1002/jhm.573.
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psnet.ahrq.gov/issue/network-collaboration-implementing-technology-improve-medication-dispensing-and
December 15, 2010 - Study
A network collaboration implementing technology to improve medication dispensing and administration in critical access hospitals.
Citation Text:
Wakefield DS, Ward MM, Loes JL, et al. A network collaboration implementing technology to improve medication dispensing and administrati…
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psnet.ahrq.gov/issue/state-sepsis-mandates-new-era-regulation-hospital-quality
October 02, 2019 - Commentary
State sepsis mandates—a new era for regulation of hospital quality.
Citation Text:
Hershey TB, Kahn JM. State Sepsis Mandates - A New Era for Regulation of Hospital Quality. N Engl J Med. 2017;376(24):2311-2313. doi:10.1056/NEJMp1611928.
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psnet.ahrq.gov/issue/preventing-healthcare-associated-infections-results-and-lessons-learned-ahrqs-hai-program
May 06, 2015 - Special or Theme Issue
Preventing Healthcare-Associated Infections: Results and Lessons Learned from AHRQ's HAI Program.
Citation Text:
Preventing Healthcare-Associated Infections: Results and Lessons Learned from AHRQ's HAI Program. Battles JB, Cleeman JI, Kahn KL, Weinberg DA, eds. Inf…
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psnet.ahrq.gov/issue/strategic-work-arounds-accommodate-new-technology-case-smart-pumps-hospital-care
July 14, 2010 - Study
Strategic work-arounds to accommodate new technology: the case of smart pumps in hospital care.
Citation Text:
McAlearney AS, Vrontos J, Schneider PJ, et al. Strategic Work-Arounds to Accommodate New Technology. J Patient Saf. 2008;3(2). doi:10.1097/01.jps.0000242987.93789.63.
…
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psnet.ahrq.gov/issue/work-systems-analysis-approach-understanding-fatigue-hospital-nurses
July 08, 2020 - Study
A work systems analysis approach to understanding fatigue in hospital nurses.
Citation Text:
Steege LM, Pasupathy KS, Drake DA. A work systems analysis approach to understanding fatigue in hospital nurses. Ergonomics. 2017;61(1):148-161. doi:10.1080/00140139.2017.1280186.
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psnet.ahrq.gov/issue/patient-safety-climate-hospitals-act-locally-variation-across-units
August 27, 2012 - Study
Patient safety climate in hospitals: act locally on variation across units.
Citation Text:
Campbell EG, Singer SJ, Kitch BT, et al. Patient safety climate in hospitals: act locally on variation across units. Jt Comm J Qual Patient Saf. 2010;36(7):319-26.
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psnet.ahrq.gov/issue/case-study-getting-boards-board-allen-memorial-hospital-iowa-health-system
August 04, 2021 - Commentary
Case study: getting boards on board at Allen Memorial Hospital, Iowa Health System.
Citation Text:
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.
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psnet.ahrq.gov/issue/rating-raters-evaluation-publicly-reported-hospital-quality-rating-systems
April 06, 2022 - Study
Rating the raters: an evaluation of publicly reported hospital quality rating systems.
Citation Text:
Rating the raters: an evaluation of publicly reported hospital quality rating systems. Bilimoria KY, Birkmeyer JD, Burstin H, et al. NEJM Catalyst. August 14, 2019.
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psnet.ahrq.gov/issue/economic-burden-patient-safety-targets-acute-care-systematic-review
April 05, 2013 - Review
The economic burden of patient safety targets in acute care: a systematic review.
Citation Text:
Mittmann N, Matlow A. The economic burden of patient safety targets in acute care: a systematic review. Drug Healthc Patient Saf. 2012. doi:10.2147/dhps.s33288.
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