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psnet.ahrq.gov/node/38354/psn-pdf
September 24, 2010 - Barriers to emergency departments' adherence to four
medication safety–related Joint Commission National
Patient Safety Goals.
September 24, 2010
Juarez A, Gacki-Smith J, Bauer MR, et al. Barriers to emergency departments' adherence to four
medication safety-related Joint Commission National Patient Safety Goals. …
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psnet.ahrq.gov/node/45641/psn-pdf
October 11, 2017 - Improving health care quality and patient safety through
peer-to-peer assessment: demonstration project in two
academic medical centers.
October 11, 2017
Mort E, Bruckel J, Donelan K, et al. Improving Health Care Quality and Patient Safety Through Peer-to-
Peer Assessment: Demonstration Project in Two Academic Med…
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psnet.ahrq.gov/node/34053/psn-pdf
March 02, 2011 - Prevention of ventilator-associated pneumonia: an
evidence-based systematic review.
March 2, 2011
Collard HR, Saint S, Matthay MA. Prevention of ventilator-associated pneumonia: an evidence-based
systematic review. Ann Intern Med. 2003;138(6):494-501.
https://psnet.ahrq.gov/issue/prevention-ventilator-associated-p…
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psnet.ahrq.gov/node/40893/psn-pdf
November 02, 2011 - Systematic review of safety checklists for use by medical
care teams in acute hospital settings—limited evidence of
effectiveness.
November 2, 2011
Ko HCH, Turner TJ, Finnigan MA. Systematic review of safety checklists for use by medical care teams in
acute hospital settings--limited evidence of effectiveness. BMC…
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psnet.ahrq.gov/node/847717/psn-pdf
April 19, 2023 - Quality improvement initiative to decrease central line-
associated bloodstream infections during the COVID-19
pandemic: a "zero harm" approach.
April 19, 2023
Redstone CS, Zadeh M, Wilson M-A, et al. Quality improvement initiative to decrease central line-
associated bloodstream infections during the COVID-19 pan…
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psnet.ahrq.gov/node/40871/psn-pdf
October 26, 2011 - Rethinking resident supervision to improve safety: from
hierarchical to interprofessional models.
October 26, 2011
Tamuz M, Giardina TD, Thomas EJ, et al. Rethinking resident supervision to improve safety: From
hierarchical to interprofessional models. J Hosp Med. 2011;6(8):445-452. doi:10.1002/jhm.919.
https://ps…
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psnet.ahrq.gov/node/45323/psn-pdf
June 28, 2017 - Effects of health information technology on patient
outcomes: a systematic review.
June 28, 2017
Brenner SK, Kaushal R, Grinspan Z, et al. Effects of health information technology on patient outcomes: a
systematic review. J Am Med Inform Assoc. 2016;23(5):1016-36. doi:10.1093/jamia/ocv138.
https://psnet.ahrq.gov/i…
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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-…
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psnet.ahrq.gov/node/45356/psn-pdf
May 09, 2017 - Screening for medication errors using an outlier detection
system.
May 9, 2017
Schiff G, Volk LA, Volodarskaya M, et al. Screening for medication errors using an outlier detection system.
J Am Med Inform Assoc. 2017;24(2):281-287. doi:10.1093/jamia/ocw171.
https://psnet.ahrq.gov/issue/screening-medication-errors-u…
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psnet.ahrq.gov/node/40941/psn-pdf
April 13, 2016 - Medication administration quality and health information
technology: a national study of US hospitals.
April 13, 2016
Appari A, Carian EK, Johnson E, et al. Medication administration quality and health information technology:
a national study of US hospitals. J Am Med Inform Assoc. 2012;19(3):360-7. doi:10.1136/ami…
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psnet.ahrq.gov/node/40766/psn-pdf
September 14, 2011 - Medicines reconciliation using a shared electronic health
care record.
September 14, 2011
Moore P, Armitage G, Wright J, et al. Medicines reconciliation using a shared electronic health care record.
J Patient Saf. 2011;7(3):148-154. doi:10.1097/PTS.0b013e31822c5bf9.
https://psnet.ahrq.gov/issue/medicines-reconcili…
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psnet.ahrq.gov/node/60314/psn-pdf
May 13, 2020 - Preparedness for COVID-19: in situ simulation to enhance
infection control systems in the intensive care unit.
May 13, 2020
Choi GYS, Wan WTP, Chan AKM, et al. Preparedness for COVID-19: in situ simulation to enhance
infection control systems in the intensive care unit. Br J Anaesth. 2020;125(2):e236-e239.
doi:10.…
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psnet.ahrq.gov/node/46454/psn-pdf
August 20, 2018 - First, Do No Harm: Marshaling Clinician Leadership to
Counter the Opioid Epidemic.
August 20, 2018
Adams SM, Blanco C, Chaudhry HJ, et al. Washington, DC: National Academy of Medicine; 2017. ISBN
9781947103108.
https://psnet.ahrq.gov/issue/first-do-no-harm-marshaling-clinician-leadership-counter-opioid-epidemic
M…
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psnet.ahrq.gov/node/42895/psn-pdf
December 18, 2014 - National trends in patient safety for four common
conditions, 2005–2011.
December 18, 2014
Wang Y, Eldridge N, Metersky M, et al. National trends in patient safety for four common conditions, 2005-
2011. N Engl J Med. 2014;370(4):341-51. doi:10.1056/NEJMsa1300991.
https://psnet.ahrq.gov/issue/national-trends-patie…
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psnet.ahrq.gov/node/38076/psn-pdf
February 15, 2011 - Consequences of inadequate sign-out for patient care.
February 15, 2011
Horwitz LI, Moin T, Krumholz HM, et al. Consequences of inadequate sign-out for patient care. Arch Intern
Med. 2008;168(16):1755-60. doi:10.1001/archinte.168.16.1755.
https://psnet.ahrq.gov/issue/consequences-inadequate-sign-out-patient-care
W…
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psnet.ahrq.gov/node/40092/psn-pdf
December 22, 2010 - The value of adding a verbal report to written handoffs on
early readmission following prolonged respiratory failure.
December 22, 2010
Hess DR, Tokarczyk A, O'Malley M, et al. The value of adding a verbal report to written handoffs on early
readmission following prolonged respiratory failure. Chest. 2010;138(6):14…
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psnet.ahrq.gov/node/45804/psn-pdf
August 03, 2017 - Meaningful use of health information technology and
declines in in-hospital adverse drug events.
August 3, 2017
Furukawa MF, Spector WD, Limcangco R, et al. Meaningful use of health information technology and
declines in in-hospital adverse drug events. J Am Med Inform Assoc. 2017;24(4):729-736.
doi:10.1093/jamia/…
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psnet.ahrq.gov/issue/dangerous-infections-are-more-likely-pediatric-intensive-care-units
December 18, 2019 - Newspaper/Magazine Article
Dangerous infections are more likely in pediatric intensive-care units.
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February 15, 2012
Consumer Re…
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psnet.ahrq.gov/node/42606/psn-pdf
September 25, 2013 - Health economic evaluation of an infection prevention
and control program: are quality and patient safety
programs worth the investment?
September 25, 2013
Raschka S, Dempster L, Bryce E. Health economic evaluation of an infection prevention and control
program: are quality and patient safety programs worth the in…
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psnet.ahrq.gov/node/39788/psn-pdf
April 21, 2011 - Effects of reducing or eliminating resident work shifts
over 16 hours: a systematic review.
April 21, 2011
Levine AC, Adusumilli J, Landrigan CP. Effects of reducing or eliminating resident work shifts over 16
hours: a systematic review. Sleep. 2010;33(8):1043-53. doi:10.1093/sleep/33.8.1043.
https://psnet.ahrq.go…