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  1. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/47827/psn-pdf
    February 27, 2019 - Improving Usability, Safety and Patient Outcomes With Health Information Technology. February 27, 2019 Lau F, Bartle-Clar JA, Bliss G, et al, eds. Stud Health Technol Inform. 2019;257:1-539. ISBN: 9781614999508. https://psnet.ahrq.gov/issue/improving-usability-safety-and-patient-outcomes-health-information-technol…
  2. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/41440/psn-pdf
    August 17, 2016 - The Toolkit for Using the AHRQ Quality Indicators: How To Improve Hospital Quality and Safety. August 17, 2016 Rockville, MD: Agency for Healthcare Research and Quality; July 2016. https://psnet.ahrq.gov/issue/toolkit-using-ahrq-quality-indicators-how-improve-hospital-quality-and-safety This toolkit provides resou…
  3. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/39735/psn-pdf
    January 03, 2017 - A practical guide to Failure Mode and Effects Analysis in health care: making the most of the team and its meetings. January 3, 2017 Ashley L, Armitage G, Neary M, et al. A practical guide to Failure Mode and Effects Analysis in health care: making the most of the team and its meetings. Jt Comm J Qual Patient Saf.…
  4. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/73245/psn-pdf
    May 12, 2021 - Just culture: the foundation of staff safety in the perioperative environment. May 12, 2021 Fencl JL, Willoughby C, Jackson K. Just culture: the foundation of staff safety in the perioperative environment. AORN J. 2021;113(4):329-336. doi:10.1002/aorn.13352. https://psnet.ahrq.gov/issue/just-culture-foundation-sta…
  5. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/45111/psn-pdf
    May 11, 2016 - Educational opportunities with postevent debriefing. May 11, 2016 Mullan PC, Kessler DO, Cheng A. Educational opportunities with postevent debriefing. JAMA. 2014;312(22):2333-4. doi:10.1001/jama.2014.15741. https://psnet.ahrq.gov/issue/educational-opportunities-postevent-debriefing Real-time or near real-time lear…
  6. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/38945/psn-pdf
    November 25, 2009 - The negative impact of nurse-physician disruptive behavior on patient safety: a review of the literature. November 25, 2009 Saxton R, Hines T, Enriquez M. The negative impact of nurse-physician disruptive behavior on patient safety: a review of the literature. J Patient Saf. 2009;5(3):180-183. doi:10.1097/pts.0b013…
  7. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/839327/psn-pdf
    December 05, 2024 - The National Healthcare System Action Alliance for Patient and Workforce Safety. December 5, 2024 US Department of Health and Human Services. https://psnet.ahrq.gov/issue/national-healthcare-system-action-alliance-advance-patient-safety The large system change required to reduce patient harm requires multi-stakeho…
  8. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/41835/psn-pdf
    May 19, 2015 - Interventions for reducing wrong-site surgery and invasive procedures. May 19, 2015 Algie CM, Mahar RK, Wasiak J, et al. Interventions for reducing wrong-site surgery and invasive clinical procedures. Cochrane Database Syst Rev. 2015;3)(3):CD009404. doi:10.1002/14651858.CD009404.pub3. https://psnet.ahrq.gov/issue/…
  9. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/60065/psn-pdf
    March 18, 2020 - Safety in Numbers: Hospital Performance on Leapfrog’s Surgical Volume Standard Based on Results of the 2019 Leapfrog Hospital Survey. March 18, 2020 Washington DC: Leapfrog Group; 2020. https://psnet.ahrq.gov/issue/safety-numbers-hospital-performance-leapfrogs-surgical-volume-standard- based-results-2019 Surgica…
  10. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/44291/psn-pdf
    September 13, 2016 - A piece of my mind. I'm sorry. September 13, 2016 Kahn JS. A PIECE OF MY MIND. I'm Sorry. JAMA. 2015;313(24):2427-8. doi:10.1001/jama.2014.6507. https://psnet.ahrq.gov/issue/piece-my-mind-im-sorry Being accountable for errors and working to learn from them is key to improving patient safety. This commentary descri…
  11. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/47220/psn-pdf
    September 12, 2018 - Strategically Advancing Patient and Family Advisory Councils in New York State Hospitals. September 12, 2018 Bethesda, MD: Institute for Patient- and Family-Centered Care; June 2018. https://psnet.ahrq.gov/issue/strategically-advancing-patient-and-family-advisory-councils-new-york-state- hospitals Hospital patien…
  12. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/865931/psn-pdf
    July 22, 2024 - Examining the Impact of Artificial Intelligence (AI) on Healthcare Safety (R18). July 22, 2024 Rockville, MD: Agency for Research and Quality; July 15, 2024. PA-24-261. https://psnet.ahrq.gov/issue/notice-intent-publish-funding-opportunity-announcement-examining-impact- artificial Health systems are increasingly …
  13. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/60990/psn-pdf
    October 07, 2020 - Tiered daily huddles: the power of teamwork in managing large healthcare organisations. October 7, 2020 Mihaljevic T. Tiered daily huddles: the power of teamwork in managing large healthcare organisations. BMJ Qual Saf. 2020;29(12):1050-1052. doi:10.1136/bmjqs-2019-010575. https://psnet.ahrq.gov/issue/tiered-daily…
  14. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/837747/psn-pdf
    July 27, 2022 - Measure Dx: A Resource to Identify, Analyze, and Learn from Diagnostic Safety Events. July 27, 2022 Rockville, MD: Agency for Healthcare Research and Quality; July 2022.  AHRQ Publication No. 22- 0038. https://psnet.ahrq.gov/issue/measure-dx-resource-identify-analyze-and-learn-diagnostic-safety-events Diagno…
  15. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/867601/psn-pdf
    January 22, 2025 - AI: promise or peril for patient safety. January 22, 2025 Ullem BD, Hatlie MJ, Lounsbury O. AI: promise or peril for patient safety. J Patient Saf. 2025;21(1):34-37. doi:10.1097/pts.0000000000001301. https://psnet.ahrq.gov/issue/ai-promise-or-peril-patient-safety Patients for Patient Safety US (PFPS-US) is a patie…
  16. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/73499/psn-pdf
    July 14, 2021 - Ethics & Governance of Artificial Intelligence for Health. July 14, 2021 Health Ethics & Governance, World Health Organization. Geneva, Switzerland: World Health Organization; 2021.  ISBN: 9789240029200 https://psnet.ahrq.gov/issue/ethics-governance-artificial-intelligence-health Advanced computing t…
  17. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/47943/psn-pdf
    May 20, 2019 - Governing the safety of artificial intelligence in healthcare. May 20, 2019 Macrae C. Governing the safety of artificial intelligence in healthcare. BMJ Qual Saf. 2019;28(6):495-498. doi:10.1136/bmjqs-2019-009484. https://psnet.ahrq.gov/issue/governing-safety-artificial-intelligence-healthcare The unintended risk…
  18. psnet.ahrq.gov/perspective/conversation-withwilliam-b-weeks-md-mba
    May 01, 2009 - though we don't have hard data on this, I believe that the full-featured electronic health record we implemented
  19. psnet.ahrq.gov/perspective/patient-safety-during-hospital-discharge
    April 01, 2018 - Patient Safety During Hospital Discharge Katherine Liang and Eric Alper, MD | April 1, 2018  Also Read a Conversation View more articles from the same authors. Citation Text: Liang K, Alper E. Patient Safety During Hospital Discharge. PSNet [internet]. Rockville…
  20. psnet.ahrq.gov/perspective/conversation-joel-willis-do-pa-ma-mphil-and-neal-sikka-md
    May 14, 2020 - Conclusion   If implemented appropriately, telehealth can be an incredibly effective approach to ensuring

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