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  1. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/43051/psn-pdf
    May 29, 2014 - A just culture after Mid Staffordshire. May 29, 2014 Dekker SWA, Hugh TB. A just culture after Mid Staffordshire. BMJ Qual Saf. 2014;23(5):356-8. doi:10.1136/bmjqs-2013-002483. https://psnet.ahrq.gov/issue/just-culture-after-mid-staffordshire In the context of public reactions to the Francis report, this commentar…

  2. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/44121/psn-pdf
    May 13, 2015 - Educating medical trainees on medication reconciliation: a systematic review. May 13, 2015 Ramjaun A, Sudarshan M, Patakfalvi L, et al. Educating medical trainees on medication reconciliation: a systematic review. BMC Med Educ. 2015;15:33. doi:10.1186/s12909-015-0306-5. https://psnet.ahrq.gov/issue/educating-medic…

  3. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/837907/psn-pdf
    August 24, 2022 - ISMP Guidelines for Safe Medication Use in Perioperative and Procedural Settings. August 24, 2022 Plymouth Meeting, PA: Institute for Safe Medication Practices; 2022. https://psnet.ahrq.gov/issue/ismp-guidelines-safe-medication-use-perioperative-and-procedural-settings Medication errors associated with surgery and…

  4. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/47749/psn-pdf
    June 19, 2019 - A simulation-based approach to training in heuristic clinical decision-making. June 19, 2019 Altabbaa G, Raven AD, Laberge J. A simulation-based approach to training in heuristic clinical decision- making. Diagnosis (Berl). 2019;6(2):91-99. doi:10.1515/dx-2018-0084. https://psnet.ahrq.gov/issue/simulation-based-ap…

  5. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/47712/psn-pdf
    February 20, 2019 - A cognitive forcing tool to mitigate cognitive bias—a randomised control trial. February 20, 2019 O'Sullivan ED, Schofield SJ. A cognitive forcing tool to mitigate cognitive bias - a randomised control trial. BMC Med Educ. 2019;19(1):12. doi:10.1186/s12909-018-1444-3. https://psnet.ahrq.gov/issue/cognitive-forcing…

  6. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/50781/psn-pdf
    January 08, 2020 - Harnessing the power of medical malpractice data to improve patient care. January 8, 2020 Siegal D, Swift J, Forget J, et al. Harnessing the power of medical malpractice data to improve patient care. J Healthc Risk Manag. 2020;39(3):28-36. doi:10.1002/jhrm.21393. https://psnet.ahrq.gov/issue/harnessing-power-medic…

  7. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/848044/psn-pdf
    April 26, 2023 - Effect of a hospital command centre on patient safety: an interrupted time series study. April 26, 2023 Mebrahtu TF, McInerney CD, Benn J, et al. BMJ Health Care Inform. 2023;30(1):e100653. https://psnet.ahrq.gov/issue/effect-hospital-command-centre-patient-safety-interrupted-time-series-study Command centers…

  8. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/60945/psn-pdf
    September 23, 2020 - Safety in pediatric hospice and palliative care: a qualitative study. September 23, 2020 Pestian T, Thienprayoon R, Grossoehme D, et al. Safety in pediatric hospice and palliative care: a qualitative study. Pediatr Qual Saf. 2020;5(4):e328. doi:10.1097/pq9.0000000000000328. https://psnet.ahrq.gov/issue/safety-pedi…

  9. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/845352/psn-pdf
    September 06, 2023 - Understanding and Improving Diagnostic Safety in Ambulatory Care. September 6, 2023 Rockville, MD: Agency for Healthcare Quality and Research; August 22, 2023. https://psnet.ahrq.gov/issue/understanding-and-improving-diagnostic-safety-ambulatory-care The articulation of diagnostic error in the ambulatory setting i…

  10. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/42574/psn-pdf
    December 21, 2014 - Physicians' diagnostic accuracy, confidence, and resource requests: a vignette study. December 21, 2014 Meyer AND, Payne VL, Meeks DW, et al. Physicians' diagnostic accuracy, confidence, and resource requests: a vignette study. JAMA Intern Med. 2013;173(21):1952-1958. doi:10.1001/jamainternmed.2013.10081. https:/…

  11. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/41453/psn-pdf
    November 26, 2014 - Judging whether a patient is actually improving: more pitfalls from the science of human perception. November 26, 2014 Redelmeier DA, Dickinson VM. Judging whether a patient is actually improving: more pitfalls from the science of human perception. J Gen Intern Med. 2012;27(9):1195-9. doi:10.1007/s11606-012-2097-2.…

  12. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/837336/psn-pdf
    June 08, 2022 - Automated identification of diagnostic labelling errors in medicine. June 8, 2022 Hautz WE, Kündig MM, Tschanz R, et al. Automated identification of diagnostic labelling errors in medicine. Diagnosis. 2021;9(2):241-249. doi:10.1515/dx-2021-0039. https://psnet.ahrq.gov/issue/automated-identification-diagnostic-labe…

  13. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/837339/psn-pdf
    June 08, 2022 - Mindful workarounds in bar code medication administration. June 8, 2022 Lichtner V, Dowding D. Mindful workarounds in bar code medication administration. Stud Health Technol Inform. 2022;294:740-744. doi:10.3233/shti220575. https://psnet.ahrq.gov/issue/mindful-workarounds-bar-code-medication-administration Barcod…

  14. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/836934/psn-pdf
    March 12, 2025 - Top 10 Patient Safety Concerns. March 12, 2025 Plymouth Meeting, PA: ECRI; March 2025. https://psnet.ahrq.gov/issue/top-10-patient-safety-concerns This annual consensus report identifies actions harboring risks that contribute to preventable patient harm. The top ten concerns for 2025 include poor response to…

  15. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/46767/psn-pdf
    January 17, 2018 - What this computer needs is a physician: humanism and artificial intelligence. January 17, 2018 Verghese A, Shah NH, Harrington RA. What This Computer Needs Is a Physician: Humanism and Artificial Intelligence. JAMA. 2018;319(1):19-20. doi:10.1001/jama.2017.19198. https://psnet.ahrq.gov/issue/what-computer-needs-p…

  16. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/44432/psn-pdf
    August 19, 2015 - Validating a decision tree for serious infection: diagnostic accuracy in acutely ill children in ambulatory care. August 19, 2015 Verbakel JY, Lemiengre MB, De Burghgraeve T, et al. Validating a decision tree for serious infection: diagnostic accuracy in acutely ill children in ambulatory care. BMJ Open. 2015;5(8):…

  17. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/42582/psn-pdf
    September 18, 2013 - When diagnostic testing leads to harm: a new outcomes- based approach for laboratory medicine. September 18, 2013 Epner PL, Gans JE, Graber ML. When diagnostic testing leads to harm: a new outcomes-based approach for laboratory medicine. BMJ Qual Saf. 2013;22 Suppl 2:ii6-ii10. doi:10.1136/bmjqs-2012-001621. https:…

  18. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/74100/psn-pdf
    November 24, 2021 - Pediatric medication errors and reduction strategies in the perioperative period. November 24, 2021 Bekes JL, Sackash CR, Voss AL, et al. AANA J. 2021;89(4):319-324. https://psnet.ahrq.gov/issue/pediatric-medication-errors-and-reduction-strategies-perioperative-period Pediatric medication errors during anesthesia …

  19. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/45837/psn-pdf
    March 08, 2017 - Promoting civility in the OR: an ethical imperative. March 8, 2017 Clark CM, Kenski D. Promoting Civility in the OR: An Ethical Imperative. AORN J. 2017;105(1):60-66. doi:10.1016/j.aorn.2016.10.019. https://psnet.ahrq.gov/issue/promoting-civility-or-ethical-imperative The operating room is a complex environment th…

  20. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/42082/psn-pdf
    January 24, 2019 - Strategies to improve patient safety: the evidence base matures. January 24, 2019 Wachter RM, Pronovost P, Shekelle PG. Strategies to Improve Patient Safety: The Evidence Base Matures. Ann Intern Med. 2013;158(5_Part_1):350. doi:10.7326/0003-4819-158-5-201303050-00010. https://psnet.ahrq.gov/issue/strategies-impro…
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