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  1. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/847718/psn-pdf
    April 19, 2023 - Effect of a Veterans Health Administration mandate to case review patients with opioid prescriptions on mortality among patients with opioid use disorder: a secondary analysis of the STORM randomized control trial. April 19, 2023 Auty SG, Barr KD, Frakt AB, et al. Effect of a Veterans Health Administration mandat…
  2. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/46404/psn-pdf
    December 07, 2017 - Preventable and mitigable adverse events in cancer care: measuring risk and harm across the continuum. December 7, 2017 Lipitz-Snyderman A, Pfister D, Classen D, et al. Preventable and mitigable adverse events in cancer care: measuring risk and harm across the continuum. Cancer. 2017;123(23):4728-4736. doi:10.1002/…
  3. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/47088/psn-pdf
    May 02, 2018 - Medical Office Survey on Patient Safety Culture: 2018 User Database Report. May 2, 2018 Famolaro T, Yount N, Hare R, et al. Rockville, MD: Agency for Healthcare Research and Quality; April 2018. AHRQ Publication No. 18-0030-EF. https://psnet.ahrq.gov/issue/medical-office-survey-patient-safety-culture-2018-user-dat…
  4. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/42900/psn-pdf
    September 19, 2016 - Suicide attempts and completions on medical-surgical and intensive care units. September 19, 2016 Mills PD, Watts V, Hemphill RR. Suicide attempts and completions on medical-surgical and intensive care units. J Hosp Med. 2014;9(3):182-5. doi:10.1002/jhm.2141. https://psnet.ahrq.gov/issue/suicide-attempts-and-compl…
  5. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/41539/psn-pdf
    January 07, 2015 - Dying for the weekend: a retrospective cohort study on the association between day of hospital presentation and the quality and safety of stroke care. January 7, 2015 Palmer WL, Bottle A, Davie C, et al. Dying for the weekend: a retrospective cohort study on the association between day of hospital presentation and…
  6. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/42693/psn-pdf
    December 23, 2016 - Preventing unintended retained foreign objects. December 23, 2016 Preventing unintended retained foreign objects. Sentinel event alert. 2013;(51):1-5. https://psnet.ahrq.gov/issue/preventing-unintended-retained-foreign-objects Sentinel event alerts are issued periodically by The Joint Commission to identify common …
  7. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/40726/psn-pdf
    July 03, 2014 - Automated identification of postoperative complications within an electronic medical record using natural language processing. July 3, 2014 Murff HJ, FitzHenry F, Matheny ME, et al. Automated identification of postoperative complications within an electronic medical record using natural language processing. JAMA. …
  8. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/60562/psn-pdf
    June 03, 2020 - A case-controlled study of relatives' complaints concerning patients who died in hospital: the role of treatment escalation/limitation planning. June 3, 2020 Taylor DR, Bouttell J, Campbell JN, et al. A case-controlled study of relatives’ complaints concerning patients who died in hospital: the role of treatment e…
  9. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/845357/psn-pdf
    March 29, 2023 - Reducing hospital harm: establishing a command centre to foster situational awareness. March 29, 2023 Collins B. Reducing hospital harm: establishing a command centre to foster situational awareness. Healthc Q. 2022;25(2):75-81. doi:10.12927/hcq.2022.26885. https://psnet.ahrq.gov/innovation/reducing-hospital-harm-…
  10. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/41226/psn-pdf
    April 22, 2012 - Defining impact of a rapid response team: qualitative study with nurses, physicians and hospital administrators. April 22, 2012 Benin AL, Borgstrom CP, Jenq GY, et al. Defining impact of a rapid response team: qualitative study with nurses, physicians and hospital administrators. BMJ Qual Saf. 2012;21(5):391-8. do…
  11. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/866191/psn-pdf
    June 26, 2024 - Quality improvement lessons learned from National Implementation of the "Patient Safety Events in Community Care: Reporting, Investigation, and Improvement Guidebook". June 26, 2024 Sullivan JL, Shin MH, Chan J, et al. Quality improvement lessons learned from National Implementation of the “Patient Safety Events …
  12. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/43016/psn-pdf
    May 28, 2014 - Identification of serious and reportable events in home care: a Delphi survey to develop consensus. May 28, 2014 Doran DM, Baker R, Szabo C, et al. Identification of serious and reportable events in home care: a Delphi survey to develop consensus. Int J Health Care Qual. 2014;26(2):136-143. doi:10.1093/intqhc/mzu00…
  13. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/43207/psn-pdf
    April 25, 2016 - Root cause analysis of serious adverse events among older patients in the Veterans Health Administration. April 25, 2016 Lee A, Mills PD, Neily J, et al. Root cause analysis of serious adverse events among older patients in the Veterans Health Administration. Jt Comm J Qual Patient Saf. 2014;40(6):253-62. https://…
  14. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/40785/psn-pdf
    May 04, 2012 - A framework for evaluating the appropriateness of clinical decision support alerts and responses. May 4, 2012 McCoy AB, Waitman LR, Lewis JB, et al. A framework for evaluating the appropriateness of clinical decision support alerts and responses. J Am Med Inform Assoc. 2012;19(3):346-52. doi:10.1136/amiajnl- 2011-…
  15. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/45814/psn-pdf
    March 22, 2017 - Emergency medical services responders' perceptions of the effect of stress and anxiety on patient safety in the out-of-hospital emergency care of children: a qualitative study. March 22, 2017 Guise J-M, Hansen M, O'Brien K, et al. Emergency medical services responders' perceptions of the effect of stress and anxi…
  16. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/45905/psn-pdf
    December 22, 2017 - Safe practice recommendations for the use of copy- forward with nursing flow sheets in hospital settings. December 22, 2017 Patterson ES, Sillars DM, Staggers N, et al. Safe Practice Recommendations for the Use of Copy-Forward with Nursing Flow Sheets in Hospital Settings. Jt Comm J Qual Patient Saf. 2017;43(8):375…
  17. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/43486/psn-pdf
    September 01, 2016 - Indication alerts intercept drug name confusion errors during computerized entry of medication orders. September 1, 2016 Galanter W, Bryson M, Falck S, et al. Indication alerts intercept drug name confusion errors during computerized entry of medication orders. PLoS One. 2014;9(7):e101977. doi:10.1371/journal.pone…
  18. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/42118/psn-pdf
    March 20, 2013 - Simulation exercises as a patient safety strategy: a systematic review. March 20, 2013 Schmidt E, Goldhaber-Fiebert SN, Ho LA, et al. Simulation exercises as a patient safety strategy: a systematic review. Ann Intern Med. 2013;158(5 Pt 2):426-32. doi:10.7326/0003-4819-158-5-201303051- 00010. https://psnet.ahrq.go…
  19. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/47609/psn-pdf
    December 19, 2018 - Nurse Staffing Levels, Missed Vital Signs and Mortality in Hospitals: Retrospective Longitudinal Observational Study. December 19, 2018 Griffiths P, Ball JE, Bloor K, et al. Nurse Staffing Levels, Missed Vital Signs And Mortality In Hospitals: Retrospective Longitudinal Observational Study. Southampton, UK: NIHR J…
  20. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/844801/psn-pdf
    January 01, 2021 - A mixed-methods study of challenges experienced by clinical teams in measuring improvement. September 11, 2019 Woodcock T, Liberati EG, Dixon-Woods M. A mixed-methods study of challenges experienced by clinical teams in measuring improvement. BMJ Qual Saf. 2021;30(2):106-115. doi:10.1136/bmjqs-2018-009048. https:/…

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