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psnet.ahrq.gov/issue/improving-handoffs-perioperative-environment-conceptual-framework-key-theories-system-factors
November 16, 2022 - Commentary
Improving handoffs in the perioperative environment: a conceptual framework of key theories, system factors, methods, and core interventions to ensure success.
Citation Text:
Starmer AJ, Michael MM, Spector ND, et al. Improving handoffs in the perioperative environment: a conc…
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psnet.ahrq.gov/issue/improving-self-reported-empathy-and-communication-skills-through-harm-healthcare-response
March 09, 2022 - Study
Improving self-reported empathy and communication skills through harm in healthcare response training.
Citation Text:
Samuels A, Broome ME, McDonald TB, et al. Improving self-reported empathy and communication skills through harm in healthcare response training. J Patient Saf Risk …
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psnet.ahrq.gov/issue/handoff-mnemonics-used-perioperative-handoff-intervention-studies-systematic-review
November 16, 2022 - Review
Handoff mnemonics used in perioperative handoff intervention studies: a systematic review.
Citation Text:
Patel SM, Fuller S, Michael MM, et al. Handoff mnemonics used in perioperative handoff intervention studies: a systematic review. Anesth Analg. 2024;Epub Nov 26. doi:10.1213/a…
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psnet.ahrq.gov/issue/association-diagnostic-stewardship-blood-cultures-critically-ill-children-culture-rates
October 19, 2022 - Study
Association of diagnostic stewardship for blood cultures in critically ill children with culture rates, antibiotic use, and patient outcomes: results of the Bright STAR Collaborative.
Citation Text:
Woods-Hill CZ, Colantuoni EA, Koontz DW, et al. Association of diagnostic stewardsh…
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psnet.ahrq.gov/issue/development-and-usability-testing-agency-healthcare-research-and-quality-common-formats
October 12, 2022 - Study
Development and usability testing of the Agency for Healthcare Research and Quality Common Formats to capture diagnostic safety events.
Citation Text:
Bradford A, Shahid U, Schiff GD, et al. Development and usability testing of the Agency for Healthcare Research and Quality Common …
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psnet.ahrq.gov/issue/speaking-behaviours-safety-voices-healthcare-workers-metasynthesis-qualitative-research
June 23, 2021 - Review
Speaking up behaviours (safety voices) of healthcare workers: a metasynthesis of qualitative research studies.
Citation Text:
Morrow KJ, Gustavson AM, Jones J. Speaking up behaviours (safety voices) of healthcare workers: a metasynthesis of qualitative research studies. Int J Nurs…
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psnet.ahrq.gov/issue/shining-light-safer-health-care-through-transparency
November 23, 2016 - Book/Report
Shining a Light: Safer Health Care Through Transparency.
Citation Text:
Shining a Light: Safer Health Care Through Transparency. Boston, MA: National Patient Safety Foundation Lucian Leape Institute; January 2015.
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psnet.ahrq.gov/issue/adherence-black-box-warnings-prescription-medications-outpatients
September 29, 2017 - Study
Adherence to black box warnings for prescription medications in outpatients.
Citation Text:
Lasser KE, Seger DL, Yu T, et al. Adherence to black box warnings for prescription medications in outpatients. Arch Intern Med. 2006;166(3):338-44.
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psnet.ahrq.gov/issue/use-prospective-risk-analysis-method-improve-safety-cancer-chemotherapy-process
May 29, 2019 - Study
Use of a prospective risk analysis method to improve the safety of the cancer chemotherapy process.
Citation Text:
Bonnabry P, Cingria L, Ackermann M, et al. Use of a prospective risk analysis method to improve the safety of the cancer chemotherapy process. Int J Qual Health Care…
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psnet.ahrq.gov/issue/grading-recommendations-enhanced-patient-safety-sentinel-event-analysis-recommendation
April 15, 2020 - Study
Grading recommendations for enhanced patient safety in sentinel event analysis: the recommendation improvement matrix.
Citation Text:
Bos K, van der Laan MJ, Groeneweg J, et al. Grading recommendations for enhanced patient safety in sentinel event analysis: the recommendation impro…
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psnet.ahrq.gov/issue/rapid-response-teams-patient-safety-practice-failure-rescue
January 26, 2022 - Commentary
Rapid response teams as a patient safety practice for failure to rescue.
Citation Text:
Fischer CP, Bilimoria KY, Ghaferi AA. Rapid Response Teams as a Patient Safety Practice for Failure to Rescue. JAMA. 2021;326(2):179-180. doi:10.1001/jama.2021.7510.
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psnet.ahrq.gov/issue/trends-central-line-associated-bloodstream-infections-trauma-surgical-intensive-care-unit
September 13, 2023 - Study
Trends in central line–associated bloodstream infections in a trauma-surgical intensive care unit.
Citation Text:
Ong A, Dysert K, Herbert C, et al. Trends in central line-associated bloodstream infections in a trauma-surgical intensive care unit. Arch Surg. 2011;146(3):302-7. doi:…
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psnet.ahrq.gov/issue/safety-culture-assessment-community-pharmacy-development-face-validity-and-feasibility
June 09, 2011 - Study
Safety culture assessment in community pharmacy: development, face validity, and feasibility of the Manchester Patient Safety Assessment Framework.
Citation Text:
Ashcroft DM, Morecroft C, Parker D, et al. Safety culture assessment in community pharmacy: development, face validit…
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psnet.ahrq.gov/issue/medical-record-review-deaths-unexpected-intensive-care-unit-admissions-and-clinician
October 12, 2022 - Study
Medical record review of deaths, unexpected intensive care unit admissions and clinician referrals: detection of adverse events and insight into the system.
Citation Text:
Dunn KL, Reddy P, Moulden A, et al. Medical record review of deaths, unexpected intensive care unit admissio…
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psnet.ahrq.gov/issue/combined-sna-and-lda-methods-understand-adverse-medical-events
November 15, 2023 - Journal Article
Combined SNA and LDA methods to understand adverse medical events
Citation Text:
Zhu L, Reychav I, McHaney R, et al. Combined SNA and LDA methods to understand adverse medical events. Int J Risk Saf Med. 2019;30(3):129-153. doi:10.3233/JRS-180052.
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psnet.ahrq.gov/issue/medication-safety-neonatal-care-review-medication-errors-among-neonates
August 15, 2016 - Review
Medication safety in neonatal care: a review of medication errors among neonates.
Citation Text:
Krzyzaniak N, Bajorek B. Medication safety in neonatal care: a review of medication errors among neonates. Ther Adv Drug Saf. 2016;7(3):102-119. doi:10.1177/2042098616642231.
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psnet.ahrq.gov/issue/multidisciplinary-model-reviewing-severe-maternal-morbidity-cases-and-teaching-residents
August 23, 2023 - Study
A multidisciplinary model for reviewing severe maternal morbidity cases and teaching residents patient safety principles.
Citation Text:
Ogunyemi D, Hage N, Kim SK, et al. A Multidisciplinary Model for Reviewing Severe Maternal Morbidity Cases and Teaching Residents Patient Safety …
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psnet.ahrq.gov/issue/perceptions-safety-culture-vary-across-intensive-care-units-single-institution
June 27, 2011 - Study
Classic
Perceptions of safety culture vary across the intensive care units of a single institution.
Citation Text:
Huang DT, Clermont G, Sexton B, et al. Perceptions of safety culture vary across the intensive care units of a single institution. Crit Car…
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psnet.ahrq.gov/issue/creating-high-reliability-health-care-organizations
September 20, 2011 - Commentary
Creating high reliability in health care organizations.
Citation Text:
Pronovost P, Berenholtz SM, Goeschel CA, et al. Creating high reliability in health care organizations. Health Serv Res. 2006;41(4 Pt 2):1599-1617.
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psnet.ahrq.gov/issue/medical-team-training-applying-crew-resource-management-veterans-health-administration
April 30, 2014 - Study
Classic
Medical team training: applying crew resource management in the Veterans Health Administration.
Citation Text:
Dunn EJ, Mills PD, Neily J, et al. Medical team training: applying crew resource management in the Veterans Health Administration. Jt Com…