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psnet.ahrq.gov/issue/journal-reporting-medical-errors-wisdom-solomon-bravery-achilles-and-foolishness-pan
April 24, 2018 - Review
Journal reporting of medical errors: the wisdom of Solomon, the bravery of Achilles, and the foolishness of Pan.
Citation Text:
Murphy JG, Stee LA, McEvoy MT, et al. Journal reporting of medical errors: the wisdom of Solomon, the bravery of Achilles, and the foolishness of Pan. Ch…
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psnet.ahrq.gov/issue/medication-reconciliation-rural-trauma-population
April 24, 2018 - Study
Medication reconciliation in a rural trauma population.
Citation Text:
Miller L, Miller S, Balon J, et al. Medication reconciliation in a rural trauma population. Ann Emerg Med. 2008;52(5):483-91. doi:10.1016/j.annemergmed.2008.03.021.
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psnet.ahrq.gov/issue/influence-tall-man-lettering-errors-visual-perception-recognition-written-drug-names
December 19, 2017 - Study
The influence of 'Tall Man' lettering on errors of visual perception in the recognition of written drug names.
Citation Text:
Darker IT, Gerret D, Filik R, et al. The influence of 'Tall Man' lettering on errors of visual perception in the recognition of written drug names. Ergono…
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psnet.ahrq.gov/issue/financial-incentives-promote-health-care-quality-hospital-acquired-conditions-nonpayment
November 08, 2023 - Commentary
Financial incentives to promote health care quality: the hospital acquired conditions nonpayment policy.
Citation Text:
Kavanagh KT. Financial incentives to promote health care quality: the hospital acquired conditions nonpayment policy. Soc Work Public Health. 2011;26(5):52…
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psnet.ahrq.gov/issue/using-abcs-situational-awareness-patient-safety
November 16, 2022 - Commentary
Using the ABCs of situational awareness for patient safety.
Citation Text:
Cohen NL. Using the ABCs of situational awareness for patient safety. Nursing (Brux). 2013;43(4):64-5. doi:10.1097/01.NURSE.0000428332.23978.82.
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psnet.ahrq.gov/issue/it-vulnerabilities-highlighted-errors-malfunctions-veterans-medical-centers
January 31, 2024 - Commentary
IT vulnerabilities highlighted by errors, malfunctions at veterans' medical centers.
Citation Text:
Kuehn BM. IT Vulnerabilities Highlighted by Errors, Malfunctions at Veterans’ Medical Centers. JAMA. 2009;301(9):919. doi:10.1001/jama.2009.239.
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psnet.ahrq.gov/issue/case-study-identifying-potential-problems-humantechnical-interface-complex-clinical-systems
July 22, 2009 - Commentary
Case study: identifying potential problems at the human/technical interface in complex clinical systems.
Citation Text:
Caudill-Slosberg M, Weeks WB. Case study: identifying potential problems at the human/technical interface in complex clinical systems. Am J Med Qual. 2005;…
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psnet.ahrq.gov/issue/teaching-teamwork-during-neonatal-resuscitation-program-randomized-trial
April 08, 2011 - Study
Teaching teamwork during the Neonatal Resuscitation Program: a randomized trial.
Citation Text:
Thomas EJ, Taggart B, Crandell S, et al. Teaching teamwork during the Neonatal Resuscitation Program: a randomized trial. Journal of Perinatology. 2007;27(7). doi:10.1038/sj.jp.7211771…
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psnet.ahrq.gov/issue/measuring-cost-hospital-adverse-patient-safety-events
November 16, 2022 - Study
Measuring the cost of hospital adverse patient safety events.
Citation Text:
Carey K, Stefos T. Measuring the cost of hospital adverse patient safety events. Health Econ. 2011;20(12):1417-30. doi:10.1002/hec.1680.
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psnet.ahrq.gov/issue/interventions-improve-oral-chemotherapy-safety-and-quality-systematic-review
December 13, 2023 - Review
Interventions to improve oral chemotherapy safety and quality: a systematic review.
Citation Text:
Zerillo JA, Goldenberg BA, Kotecha RR, et al. Interventions to Improve Oral Chemotherapy Safety and Quality. JAMA Oncol. 2017;4(1):105-117. doi:10.1001/jamaoncol.2017.0625.
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psnet.ahrq.gov/issue/physician-implicit-review-identify-preventable-errors-during-hospital-cardiac-arrest
August 02, 2013 - Study
Physician implicit review to identify preventable errors during in-hospital cardiac arrest.
Citation Text:
Jain R, Kuhn L, Repaskey W, et al. Physician implicit review to identify preventable errors during in-hospital cardiac arrest. Arch Intern Med. 2011;171(1):89-90. doi:10.1001/…
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psnet.ahrq.gov/issue/mastering-improvement-science-skills-new-era-quality-and-safety-veterans-affairs-national
December 12, 2012 - Commentary
Mastering improvement science skills in the new era of quality and safety: the Veterans Affairs National Quality Scholars Program.
Citation Text:
Estrada CA, Dolansky MA, Singh MK, et al. Mastering improvement science skills in the new era of quality and safety: the Veterans…
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psnet.ahrq.gov/issue/designing-safer-rotas-junior-doctors-48-hour-week
August 01, 2018 - May 14, 2018
Optimizing Graduate Medical Trainee (Resident) Hours and Work Schedules … June 18, 2013
The new recommendations on duty hours from the ACGME Task Force. … November 15, 2011
Impact of reduction in working hours for doctors in training on postgraduate
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psnet.ahrq.gov/web-mm/delay-initiating-antibiotics-results-fatal-error
August 02, 2015 - In the morning, 10 hours after admission, her condition began to deteriorate. … hours with an additional 6 hours for education and transfer of care.( 10 ) To meet these requirements … Resident duty hours language: final requirements. … Resident work hours benchmarking project summary. University Health System Consortium Web site. … in-hospital duty hours among medical interns: a randomized trial.
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psnet.ahrq.gov/node/39114/psn-pdf
November 18, 2009 - how-long-does-it-take-train-surgeon
This commentary addresses the evidence on the effectiveness of limiting work hours … psnet.ahrq.gov/issue/how-long-does-it-take-train-surgeon
https://psnet.ahrq.gov/issue/resident-duty-hours-enhancing-sleep-supervision-and-safety
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psnet.ahrq.gov/node/42441/psn-pdf
July 24, 2013 - some-doctors-questioning-whether-shorter-shifts-interns-are-endangering-patients
https://psnet.ahrq.gov/primer/duty-hours-and-patient-safety … https://psnet.ahrq.gov/primer/duty-hours-and-patient-safety
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psnet.ahrq.gov/node/39060/psn-pdf
October 28, 2009 - psnet.ahrq.gov/issue/impact-duty-hour-restriction-resident-inpatient-teaching
After the implementation of duty hours … impact-duty-hour-restriction-resident-inpatient-teaching
https://psnet.ahrq.gov/issue/common-program-requirements-learning-and-working-environment-duty-hours
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psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.278_slideshow.ppt
September 01, 2012 - the risk of catheter-related infections, scheduled replacement of peripheral IV catheters every 48–72 hours … or every 72–96 hours has been widely used
However, there is no strong evidence to support this practice … Prevention (CDC) recommends against replacing peripheral IV catheters more frequently than every 72–96 hours … to 72−96 hours does not significantly increase the risk of true catheter infection
In the absence of … flushing to maintain the peripheral IV catheter patency
Replace peripheral IV catheters every 72–96 hours
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psnet.ahrq.gov/node/39879/psn-pdf
September 29, 2010 - effect-resident-duty-hour-restriction-trauma-center-outcomes-teaching-hospitals-state
https://psnet.ahrq.gov/primer/duty-hours-and-patient-safety
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psnet.ahrq.gov/issue/phantom-menace-sleep-deprived-doctors
February 06, 2013 - May 1, 2013
Duty hours, quality of care, and patient safety: general surgery resident … June 20, 2012
Limiting resident physicians' work hours to save lives. … Effects of the Accreditation Council for Graduate Medical Education duty hour limits on sleep, work hours