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psnet.ahrq.gov/issue/using-simulation-improve-root-cause-analysis-adverse-surgical-outcomes
May 19, 2021 - Study
Using simulation to improve root cause analysis of adverse surgical outcomes.
Citation Text:
Slakey DP, Simms ER, Rennie K, et al. Using simulation to improve root cause analysis of adverse surgical outcomes. Int J Qual Health Care. 2014;26(2):144-50. doi:10.1093/intqhc/mzu011.
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psnet.ahrq.gov/issue/there-july-phenomenon-pediatric-neurosurgery-teaching-hospitals
May 23, 2018 - Study
Is there a "July phenomenon" in pediatric neurosurgery at teaching hospitals?
Citation Text:
Smith ER, Butler WE, Barker FG. Is there a "July phenomenon" in pediatric neurosurgery at teaching hospitals? J Neurosurg. 2006;105(3 Suppl):169-76.
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psnet.ahrq.gov/issue/compliance-central-line-maintenance-bundle-and-infection-rates
August 16, 2023 - Study
Compliance with central line maintenance bundle and infection rates.
Citation Text:
Tripathi S, McGarvey J, Lee K, et al. Compliance with central line maintenance bundle and infection rates. Pediatrics. 2023;152(3):e2022059688. doi:10.1542/peds.2022-059688.
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psnet.ahrq.gov/issue/ashp-guidelines-preventing-diversion-controlled-substances
June 15, 2022 - Organizational Policy/Guidelines
ASHP Guidelines on Preventing Diversion of Controlled Substances.
Citation Text:
Clark J, Fera T, Fortier CR, et al. ASHP Guidelines on Preventing Diversion of Controlled Substances. Am J Health Syst Pharm. 2022;79(24):2279-2306. doi:10.1093/ajhp/zxac246.…
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psnet.ahrq.gov/issue/effect-80-hour-work-week-resident-case-coverage
July 21, 2010 - Study
Effect of the 80-hour work week on resident case coverage.
Citation Text:
Shin S, Britt R, Britt LD. Effect of the 80-hour work week on resident case coverage. J Am Coll Surg. 2008;206(5):798-800; discussion 801-3. doi:10.1016/j.jamcollsurg.2007.12.028.
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psnet.ahrq.gov/issue/changes-nursing-practice-associations-responses-and-coping-errors
October 19, 2022 - Study
Changes in nursing practice: associations with responses to and coping with errors.
Citation Text:
Karga M, Kiekkas P, Aretha D, et al. Changes in nursing practice: associations with responses to and coping with errors. J Clin Nurs. 2011;20(21-22):3246-55. doi:10.1111/j.1365-2702…
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psnet.ahrq.gov/issue/sensemaking-patient-safety-risks-and-hazards
March 03, 2011 - Commentary
Sensemaking of patient safety risks and hazards.
Citation Text:
Battles J, Dixon NM, Borotkanics RJ, et al. Sensemaking of patient safety risks and hazards. Health Serv Res. 2006;41(4 Pt 2):1555-1575.
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psnet.ahrq.gov/issue/incidents-and-errors-neonatal-intensive-care-review-literature
June 15, 2011 - Review
Incidents and errors in neonatal intensive care: a review of the literature.
Citation Text:
Snijders C, van Lingen RA, Molendijk A, et al. Incidents and errors in neonatal intensive care: a review of the literature. Arch Dis Child Fetal Neonatal Ed. 2007;92(5):F391-8.
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psnet.ahrq.gov/issue/development-patient-safety-measures-identify-inappropriate-diagnosis-common-infections
April 10, 2024 - Study
Development of patient safety measures to identify inappropriate diagnosis of common infections.
Citation Text:
White AT, Vaughn VM, Petty LA, et al. Development of patient safety measures to identify inappropriate diagnosis of common infections. Clin Infect Dis. 2024;78(6):1403-14…
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psnet.ahrq.gov/issue/health-system-wide-initiative-decrease-opioid-related-morbidity-and-mortality
November 16, 2022 - Commentary
Emerging Classic
A health system–wide initiative to decrease opioid-related morbidity and mortality.
Citation Text:
Weiner SG, Price CN, Atalay AJ, et al. A Health System-Wide Initiative to Decrease Opioid-Related Morbidity and Mortality. Jt Comm J Qu…
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psnet.ahrq.gov/issue/using-incident-reporting-improve-patient-safety-conceptual-model
June 29, 2009 - Commentary
Using incident reporting to improve patient safety: a conceptual model.
Citation Text:
Pronovost PJ, Holzmueller CG, Young J, et al. Using Incident Reporting to Improve Patient Safety. J Patient Saf. 2008;3(1). doi:10.1097/pts.0b013e318030ca05.
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psnet.ahrq.gov/issue/failures-communication-and-information-transfer-across-surgical-care-pathway-interview-study
August 09, 2013 - Study
Failures in communication and information transfer across the surgical care pathway: interview study.
Citation Text:
Nagpal K, Arora S, Vats A, et al. Failures in communication and information transfer across the surgical care pathway: interview study. BMJ Qual Saf. 2012;21(10):8…
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psnet.ahrq.gov/issue/peer-training-using-cognitive-rehearsal-promote-culture-safety-health-care
November 16, 2022 - Study
Peer training using cognitive rehearsal to promote a culture of safety in health care.
Citation Text:
Roberts T, Hanna K, Hurley S, et al. Peer Training Using Cognitive Rehearsal to Promote a Culture of Safety in Health Care. Nurse Educ. 2018;43(5):262-266. doi:10.1097/NNE.00000000…
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psnet.ahrq.gov/issue/prospective-controlled-trial-effect-multi-faceted-intervention-early-recognition-and
June 13, 2011 - Study
A prospective controlled trial of the effect of a multi-faceted intervention on early recognition and intervention in deteriorating hospital patients.
Citation Text:
Mitchell IA, McKay H, Van Leuvan C, et al. A prospective controlled trial of the effect of a multi-faceted interve…
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psnet.ahrq.gov/issue/joy-medical-practice-clinician-satisfaction-healthy-work-place-trial
January 23, 2017 - Study
Joy in medical practice: clinician satisfaction in the Healthy Work Place trial.
Citation Text:
Linzer M, Sinsky CA, Poplau S, et al. Joy In Medical Practice: Clinician Satisfaction In The Healthy Work Place Trial. Health Aff (Millwood). 2017;36(10):1808-1814. doi:10.1377/hlthaff.2…
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psnet.ahrq.gov/issue/experiences-risk-managers-providing-emotional-support-health-care-workers-after-adverse
September 19, 2016 - Study
The experiences of risk managers in providing emotional support for health care workers after adverse events.
Citation Text:
Edrees HH, Brock DM, Wu AW, et al. The experiences of risk managers in providing emotional support for health care workers after adverse events. J Healthc Ri…
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psnet.ahrq.gov/issue/barriers-staff-adoption-surgical-safety-checklist
February 25, 2015 - Study
Barriers to staff adoption of a surgical safety checklist.
Citation Text:
Fourcade A, Blache J-L, Grenier C, et al. Barriers to staff adoption of a surgical safety checklist. BMJ Qual Saf. 2012;21(3):191-7. doi:10.1136/bmjqs-2011-000094.
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psnet.ahrq.gov/issue/surgical-checklists-human-factor
December 10, 2014 - Study
Surgical checklists: the human factor.
Citation Text:
O'Connor P, Reddin C, O'Sullivan M, et al. Surgical checklists: the human factor. Patient Saf Surg. 2013;7(1):14. doi:10.1186/1754-9493-7-14.
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psnet.ahrq.gov/issue/comprehensive-analysis-medication-dosing-error-related-cpoe
June 01, 2005 - Commentary
Comprehensive analysis of a medication dosing error related to CPOE.
Citation Text:
Horsky J, Kuperman GJ, Patel VL. Comprehensive Analysis of a Medication Dosing Error Related to CPOE: Table 1. J Am Med Info Assoc. 2005;12(4). doi:10.1197/jamia.m1740.
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psnet.ahrq.gov/issue/systemwide-strategy-embed-equity-patient-safety-event-analysis
November 16, 2022 - Study
A systemwide strategy to embed equity into patient safety event analysis.
Citation Text:
Chandra K, Garcia M, Bajaj K, et al. A systemwide strategy to embed equity into patient safety event analysis. Jt Comm J Qual Patient Saf. 2024;50(8):606-611 . doi:10.1016/j.jcjq.2024.04.004.
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