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psnet.ahrq.gov/node/855091/psn-pdf
November 08, 2023 - Handoff tool improves transitions from the operating
room to the neonatal intensive care unit.
November 8, 2023
Gallois JB, Zagory JA, Barkemeyer B, et al. Handoff tool improves transitions from the operating room to
the neonatal intensive care unit. Pediatr Qual Saf. 2023;8(5):e695. doi:10.1097/pq9.000000000000069…
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psnet.ahrq.gov/node/853059/psn-pdf
August 30, 2023 - Anesthesia Risk Alert program: a proactive safety
initiative.
August 30, 2023
Lee B, Marhalik-Helms J, Penzi L. Anesthesia Risk Alert program: a proactive safety initiative. Jt Comm J
Qual Patient Saf. 2023;49(9):441-449. doi:10.1016/j.jcjq.2023.06.005.
https://psnet.ahrq.gov/issue/anesthesia-risk-alert-program-pr…
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psnet.ahrq.gov/node/843411/psn-pdf
February 01, 2023 - Sustaining improvement of hospital-wide initiative for
patient safety and quality: a systematic scoping review.
February 1, 2023
Moon SEJ, Hogden A, Eljiz K. Sustaining improvement of hospital-wide initiative for patient safety and
quality: a systematic scoping review. BMJ Open Qual. 2022;11(4):e002057. doi:10.1136…
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psnet.ahrq.gov/node/853611/psn-pdf
September 20, 2023 - Preventing potential patient harm through clinical content
interventions during oncology clinical trial
implementation.
September 20, 2023
Loo VC, Kim S, Johnson LM, et al. Preventing potential patient harm through clinical content interventions
during oncology clinical trial implementation. J Patient Saf. 2023;19…
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psnet.ahrq.gov/node/74842/psn-pdf
February 16, 2022 - An initiative to reduce insulin-related adverse drug events
in a children's hospital.
February 16, 2022
Lawson SA, Hornung LN, Lawrence M, et al. An initiative to reduce insulin-related adverse drug events in a
children's hospital. Pediatrics. 2022;149(1):e2020004937. doi:10.1542/peds.2020-004937.
https://psnet.ah…
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psnet.ahrq.gov/node/43909/psn-pdf
March 11, 2015 - Summary and frequency of barriers to adoption of CPOE
in the US.
March 11, 2015
Kruse CS, Goetz K. Summary and frequency of barriers to adoption of CPOE in the U.S. J Med Syst.
2015;39(2):15. doi:10.1007/s10916-015-0198-2.
https://psnet.ahrq.gov/issue/summary-and-frequency-barriers-adoption-cpoe-us
Although compu…
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psnet.ahrq.gov/node/47870/psn-pdf
April 17, 2019 - Saving without compromising: teaching trainees to safely
provide high value care.
April 17, 2019
Judson TJ, Press MJ, Detsky AS. Saving without compromising: Teaching trainees to safely provide high
value care. Healthc (Amst). 2019;7(1):4-6. doi:10.1016/j.hjdsi.2018.05.003.
https://psnet.ahrq.gov/issue/saving-with…
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psnet.ahrq.gov/node/836836/psn-pdf
March 30, 2022 - Deficiencies after the New Electronic Health Record Go-
Live at the Mann-Grandstaff VA Medical Center in
Spokane, WA.
March 30, 2022
Washington, DC: VA Office of Inspector General; March 17, 2022.
https://psnet.ahrq.gov/issue/deficiencies-after-new-electronic-health-record-go-live-mann-grandstaff-va-
medical-cent…
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psnet.ahrq.gov/node/50706/psn-pdf
December 04, 2019 - Improving end-of-rotation transitions of care among ICU
patients
December 4, 2019
Denson JL, Knoeckel J, Kjerengtroen S, et al. Improving end-of-rotation transitions of care among ICU
patients. BMJ Qual Saf. 2019;29(3):250-259. doi:10.1136/bmjqs-2019-009867.
https://psnet.ahrq.gov/issue/improving-end-rotation-tran…
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psnet.ahrq.gov/node/866937/psn-pdf
October 09, 2024 - Improving nursing home safety through adoption of a
practical resilient health care approach.
October 9, 2024
Hartmann CW, Clark V, Nash P, et al. Improving nursing home safety through adoption of a practical
resilient health care approach. J Am Med Dir Assoc. 2024;25(9):105014. doi:10.1016/j.jamda.2024.03.124.
ht…
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psnet.ahrq.gov/node/851356/psn-pdf
July 12, 2023 - Leveraging the science of teamwork to sustain handoff
improvements in cardiovascular surgery.
July 12, 2023
Keebler JR, Lynch I, Ngo F, et al. Leveraging the science of teamwork to sustain handoff improvements in
cardiovascular surgery. Jt Comm J Qual Patient Saf. 2023;49(8):373-383. doi:10.1016/j.jcjq.2023.05.006.…
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psnet.ahrq.gov/node/47732/psn-pdf
February 06, 2019 - Surgical safety checklists in children's surgery: surgeons'
attitudes and review of the literature.
February 6, 2019
Roybal J, Tsao KJ, Rangel S, et al. Surgical Safety Checklists in Children's Surgery: Surgeons' Attitudes
and Review of the Literature. Pediatr Qual Saf. 2018;3(5):e108. doi:10.1097/pq9.0000000000000…
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psnet.ahrq.gov/node/860718/psn-pdf
January 17, 2024 - Impact of hospital accreditation on quality improvement
in healthcare: a systematic review.
January 17, 2024
Alhawajreh MJ, Paterson AS, Jackson WJ. Impact of hospital accreditation on quality improvement in
healthcare: a systematic review. PLoS ONE. 2023;18(12):e0294180. doi:10.1371/journal.pone.0294180.
https://…
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psnet.ahrq.gov/node/867092/psn-pdf
November 06, 2024 - Surgical intraoperative handoff initiative: standardizing
operating room communication using SHRIMPS.
November 6, 2024
Stephens WA, Anderson MJ, Levy BE, et al. Surgical intraoperative handoff initiative: standardizing
operating room communication using SHRIMPS. J Am Coll Surg. 2024;239(4):387-393.
doi:10.1097/xcs…
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psnet.ahrq.gov/node/849607/psn-pdf
May 31, 2023 - Use of technology to improve the adherence to surgical
safety checklists in the operating room.
May 31, 2023
Pati AB, Mishra TS, Chappity P, et al. Use of technology to improve the adherence to surgical safety
checklists in the operating room. Jt Comm J Qual Patient Saf. 2023;49(10):572-577.
doi:10.1016/j.jcjq.202…
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psnet.ahrq.gov/node/837675/psn-pdf
July 13, 2022 - Dashboard design to identify and balance competing risk
of multiple hospital-acquired conditions.
July 13, 2022
Makic MBF, Stevens KR, Gritz RM, et al. Dashboard design to identify and balance competing risk of
multiple hospital-acquired conditions. Appl Clin Inform. 2022;13(3):621-631. doi:10.1055/s-0042-1749598.
…
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psnet.ahrq.gov/node/838013/psn-pdf
September 07, 2022 - Using the Global Trigger Tool in surgical and
neurosurgical patients: a feasibility study.
September 7, 2022
Brösterhaus M, Hammer A, Gruber R, et al. Using the Global Trigger Tool in surgical and neurosurgical
patients: a feasibility study. PLoS ONE. 2022;17(8):e0272853. doi:10.1371/journal.pone.0272853.
https://…
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psnet.ahrq.gov/node/43669/psn-pdf
November 12, 2014 - Multiple interacting factors influence adherence, and
outcomes associated with surgical safety checklists: a
qualitative study.
November 12, 2014
Gagliardi AR, Straus SE, Shojania KG, et al. Multiple interacting factors influence adherence, and
outcomes associated with surgical safety checklists: a qualitative stu…
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psnet.ahrq.gov/node/47688/psn-pdf
March 19, 2019 - Evaluation of an electronic health record structured
discharge summary to provide real time adverse event
reporting in thoracic surgery.
March 19, 2019
Graham AJ, Ocampo W, Southern DA, et al. Evaluation of an electronic health record structured discharge
summary to provide real time adverse event reporting in tho…
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psnet.ahrq.gov/node/45653/psn-pdf
January 25, 2017 - Opioid prescribing after surgical extraction of teeth in
Medicaid patients, 2000–2010.
January 25, 2017
Baker JA, Avorn J, Levin R, et al. Opioid Prescribing After Surgical Extraction of Teeth in Medicaid
Patients, 2000-2010. JAMA. 2016;315(15):1653-4. doi:10.1001/jama.2015.19058.
https://psnet.ahrq.gov/issue/opio…