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psnet.ahrq.gov/node/45893/psn-pdf
August 28, 2017 - Exploring the roots of unintended safety threats
associated with the introduction of hospital ePrescribing
systems and candidate avoidance and/or mitigation
strategies: a qualitative study.
August 28, 2017
Mozaffar H, Cresswell K, Williams R, et al. Exploring the roots of unintended safety threats associated with
…
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psnet.ahrq.gov/innovation/algorithm-based-decision-support-system-guides-trauma-staff-during-initial-treatment
May 31, 2023 - Algorithm-Based Decision Support System Guides Trauma Staff During Initial Treatment, Leading to Fewer Medical Errors
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March 3, 2021
Innovation…
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psnet.ahrq.gov/node/33825/psn-pdf
January 01, 2017 - Rethinking Root Cause Analysis
January 1, 2016
Gupta K, Lyndon A. Rethinking Root Cause Analysis. PSNet [internet]. 2016.
https://psnet.ahrq.gov/perspective/rethinking-root-cause-analysis
Annual Perspective 2016
Introduction
Root cause analysis (RCA) is a systematic process to analyze adverse events and near miss…
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psnet.ahrq.gov/node/73643/psn-pdf
August 01, 2022 - ECHO-Care Transitions Successfully Reduces Patient
Readmissions from Skilled Nursing Facilities, Reduces
Length of Stay
August 25, 2021
https://psnet.ahrq.gov/innovation/echo-care-transitions-successfully-reduces-patient-readmissions-skilled-
nursing
Summary
ECHO-Care Transitions (ECHO-CT) intends to ensure cont…
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psnet.ahrq.gov/node/33779/psn-pdf
March 01, 2015 - Handoffs and Transitions
January 22, 2014
Sehgal NL. Handoffs and Transitions. PSNet [internet]. 2014.
https://psnet.ahrq.gov/perspective/handoffs-and-transitions
Annual Perspective 2014
Despite recent efforts to promote clinical integration, the United States health care system remains highly
fragmented. From it…
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psnet.ahrq.gov/issue/perioperative-patient-safety-correct-patient-correct-surgery-correct-side-multifaceted-cross
December 21, 2011 - events
October 9, 2019
Preventing nosocomial bloodstream infections (NBSIs) by implementing … February 1, 2023
Incident learning in pursuit of high reliability: implementing a comprehensive
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psnet.ahrq.gov/issue/assessing-value-electronic-prescribing-ambulatory-care-focus-group-study
September 01, 2016 - February 21, 2015
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Impact of implementing … February 10, 2015
Implementing medication reconciliation in outpatient pediatrics.
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psnet.ahrq.gov/issue/effect-organizational-network-patient-safety-safety-event-reporting
October 16, 2013 - RIS
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Implementing … July 8, 2008
Grand rounds in methodology: key considerations for implementing machine
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psnet.ahrq.gov/issue/using-lean-automation-human-touch-improve-medication-safety-step-closer-perfect-dose
September 16, 2015 - June 13, 2018
Implementing a bar-code medication administration system. … July 28, 2013
A network collaboration implementing technology to improve medication dispensing
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psnet.ahrq.gov/issue/beyond-communication-role-standardized-protocols-changing-health-care-environment
October 12, 2011 - February 15, 2017
Implementing SBAR across a large multihospital health system. … March 2, 2012
Implementing handoff communication.
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psnet.ahrq.gov/issue/identifying-patient-safety-risks-reporting-patient-complaints-grounded-theory-study-patients
December 20, 2017 - September 14, 2022
Dynamic pocket card for implementing ISBAR in shift handover communication … April 17, 2024
Responding to medical errors — implementing the modern ethical paradigm
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psnet.ahrq.gov/issue/i-pass-mnemonic-standardize-verbal-handoffs
November 12, 2014 - July 10, 2017
A QI initiative: implementing a patient handoff checklist for pediatric … February 8, 2017
Implementing a perioperative handoff tool to improve postprocedural
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psnet.ahrq.gov/issue/engineering-system-communication-safer-surgery
January 18, 2013 - August 11, 2010
Implementing a pediatric surgical safety checklist in the OR and beyond … July 14, 2010
Implementing a pre-operative checklist to increase patient safety: a 1-
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psnet.ahrq.gov/issue/case-outcomes-communication-and-resolution-program-new-york-hospitals
February 05, 2014 - RIS
Download Citation
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Implementing … September 29, 2017
Challenges of implementing a communication-and-resolution program
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psnet.ahrq.gov/issue/making-doctors-better
June 15, 2016 - May 15, 2013
The Patient Safety Institute demonstration project: a model for implementing … April 18, 2018
Implementing a systematic response to medication errors.
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psnet.ahrq.gov/issue/case-second-victim-support-program-pediatrics-successes-and-challenges-implementation
October 26, 2016 - RIS
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Implementing … August 5, 2020
Planning and implementing a systems-based patient safety curriculum in
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psnet.ahrq.gov/issue/pursuing-excellence-collaborative-engaging-first-year-residents-and-fellows-patient-safety
September 15, 2011 - April 24, 2018
Enhancing patient safety in pediatric primary care: implementing a patient … Partnership as a pathway to diagnostic excellence: the challenges and successes of implementing
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psnet.ahrq.gov/issue/anesthesiology-department-leads-culture-change-hospital-system-level-improve-quality-and
March 30, 2011 - March 30, 2011
The role of housestaff in implementing medication reconciliation on admission … 2, 2011
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The role of housestaff in implementing
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psnet.ahrq.gov/issue/use-board-certification-and-recertification-pediatricians-health-plan-credentialing-policies
February 02, 2011 - December 21, 2014
Implementing medication reconciliation in outpatient pediatrics. … December 18, 2014
The costs of developing, implementing, and operating a safety learning
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psnet.ahrq.gov/issue/enhancing-pediatric-perioperative-patient-safety
January 28, 2015 - March 13, 2013
Implementing a surgical checklist: more than checking a box. … January 4, 2012
Implementing a pediatric surgical safety checklist in the OR and beyond