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psnet.ahrq.gov/issue/organisational-culture-variation-across-hospitals-and-connection-patient-safety-climate
March 17, 2010 - Study
Organisational culture: variation across hospitals and connection to patient safety climate.
Citation Text:
Speroff T, Nwosu S, Greevy R, et al. Organisational culture: variation across hospitals and connection to patient safety climate. Qual Saf Health Care. 2010;19(6):592-6. do…
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psnet.ahrq.gov/issue/graduate-medical-education-and-patient-safety-busy-and-occasionally-hazardous-intersection
March 02, 2011 - Commentary
Classic
Graduate medical education and patient safety: a busy--and occasionally hazardous--intersection.
Citation Text:
Shojania KG, Fletcher KE, Saint S. Graduate medical education and patient safety: a busy--and occasionally hazardous--intersectio…
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psnet.ahrq.gov/issue/national-healthcare-safety-networks-digital-quality-measures-cdcs-automated-measures
September 23, 2020 - Study
The National Healthcare Safety Network's digital quality measures: CDC's automated measures for surveillance of patient safety.
Citation Text:
Shehab N, Alschuler L, McILvenna S, et al. The National Healthcare Safety Network’s digital quality measures: CDC’s automated measures for …
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psnet.ahrq.gov/issue/redesigning-rounds-towards-more-purposeful-approach-inpatient-teaching-and-learning
February 02, 2022 - Commentary
Redesigning rounds: towards a more purposeful approach to inpatient teaching and learning.
Citation Text:
Reilly JB, Bennett N, Fosnocht K, et al. Redesigning rounds: towards a more purposeful approach to inpatient teaching and learning. Acad Med. 2015;90(4):450-3. doi:10.1097…
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psnet.ahrq.gov/issue/safety-and-risk-management-interventions-hospitals-systematic-review-literature
April 01, 2010 - Review
Safety and risk management interventions in hospitals: a systematic review of the literature.
Citation Text:
Dückers M, Faber M, Cruijsberg J, et al. Safety and risk management interventions in hospitals: a systematic review of the literature. Med Care Res Rev. 2009;66(6 Suppl):…
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psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.146_slideshow.ppt
March 01, 2007 - Spotlight Case [MONTH] 2003
Spotlight Case March 2007
Failure to Report
Source and Credits
This presentation is based on the March 2007
AHRQ WebM&M Spotlight Case
See the full article at http://webmm.ahrq.gov
CME credit is available through the Web site
Commentary by: Patrice L. Spath, BA, RHIT, Brown-Sp…
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psnet.ahrq.gov/innovation/critical-radiology-alert-process
November 16, 2022 - Critical Radiology Alert Process
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October 30, 2024
View more articles from the same authors.
Innovation
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psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.173_slideshow.ppt
April 01, 2008 - Spotlight Case [MONTH] 2003
Spotlight Case April 2008
Antibiotics for URI/Sinusitis: A Simple Decision Gone Bad
Source and Credits
This presentation is based on the April 2008
AHRQ WebM&M Spotlight Case
See the full article at http://webmm.ahrq.gov
CME credit is available
Commentary by: Sumant Ranji, MD,…
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psnet.ahrq.gov/node/33564/psn-pdf
March 15, 2025 - Computerized Provider Order Entry
March 15, 2025
Computerized Provider Order Entry. PSNet [internet]. 2019.
https://psnet.ahrq.gov/primer/computerized-provider-order-entry
PSNet primers are regularly reviewed and updated by the UC Davis PSNet Editorial Team to ensure that
they reflect current research and practice…
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psnet.ahrq.gov/innovation/michigan-hospital-medicine-safety-consortium-hms-finds-infectious-diseases-id-physician
July 23, 2024 - The Michigan Hospital Medicine Safety Consortium (HMS) Finds Infectious Diseases (ID) Physician Approval for Placement of Peripherally Inserted Central Catheters (PICCs) Prevents Unnecessary PICC Use and Reduces Complications
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psnet.ahrq.gov/node/46572/psn-pdf
January 01, 2018 - Effects of efforts to optimise morbidity and mortality
rounds to serve contemporary quality improvement and
educational goals: a systematic review.
December 21, 2017
Smaggus A, Mrkobrada M, Marson A, et al. Effects of efforts to optimise morbidity and mortality rounds to
serve contemporary quality improvement and …
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psnet.ahrq.gov/node/74758/psn-pdf
February 09, 2022 - Emotional harm in the radiology department: analysis of
an underrecognized preventable error.
February 9, 2022
Siewert B, Swedeen S, Brook OR, et al. Emotional harm in the radiology department: analysis of an
underrecognized preventable error. Radiology. 2022;302(3):613-619. doi:10.1148/radiol.2021211846.
https://…
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psnet.ahrq.gov/node/47589/psn-pdf
January 09, 2019 - Framework for Effective Board Governance of Health
System Quality.
January 9, 2019
Daley Ullem E, Gandhi TK, Mate K, et al. IHI White Paper. Boston, MA: Institute for Healthcare
Improvement; 2018.
https://psnet.ahrq.gov/issue/framework-effective-board-governance-health-system-quality
The role of hospital boards i…
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psnet.ahrq.gov/node/45000/psn-pdf
August 15, 2016 - Medicare and Medicaid Programs; Hospital and Critical
Access Hospital (CAH) Changes to Promote Innovation,
Flexibility, and Improvement in Patient Care; Proposed
Rule.
June 29, 2016
Centers for Medicare & Medicaid Services. Fed Regist. 2016;81:39447-39480.
https://psnet.ahrq.gov/issue/medicare-and-medicaid-progra…
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psnet.ahrq.gov/node/47305/psn-pdf
March 19, 2019 - Effect of genetic diagnosis on patients with previously
undiagnosed disease.
March 19, 2019
Splinter K, Adams DR, Bacino CA, et al. Effect of Genetic Diagnosis on Patients with Previously
Undiagnosed Disease. New Engl J Med. 2018;379(22):2131-2139. doi:10.1056/NEJMoa1714458.
https://psnet.ahrq.gov/issue/effect-gen…
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psnet.ahrq.gov/node/45943/psn-pdf
March 15, 2017 - Identifying and reducing complications after emergency
room discharge.
March 15, 2017
Hofmann PB, Bagian JP. Patient Saf Qual Healthc. February 20, 2017.
https://psnet.ahrq.gov/issue/identifying-and-reducing-complications-after-emergency-room-discharge
Emergency departments are complex environments that harbor fac…
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psnet.ahrq.gov/node/50887/psn-pdf
February 12, 2020 - Lessons learned from a systems approach to engaging
patients and families in patient safety transformation.
February 12, 2020
Hatlie MJ, Nahum A, Leonard R, et al. Lessons Learned from a Systems Approach to Engaging Patients
and Families in Patient Safety Transformation. Jt Comm J Qual Patient Saf. 2020;46(3):158-1…
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psnet.ahrq.gov/node/844989/psn-pdf
February 22, 2023 - Defining and enhancing collaboration between
community pharmacists and primary care providers to
improve medication safety.
February 22, 2023
White A, Fulda KG, Blythe R, et al. Defining and enhancing collaboration between community pharmacists
and primary care providers to improve medication safety. Expert Opin D…
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psnet.ahrq.gov/node/73065/psn-pdf
March 24, 2021 - Implementing the clinical occurrence reporting and
learning system: a double-loop learning incident
reporting system in long-term care.
March 24, 2021
Goh HS, Tan V, Chang J, et al. Implementing the clinical occurrence reporting and learning system: a
double-loop learning incident reporting system in long-term car…
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psnet.ahrq.gov/node/73107/psn-pdf
April 07, 2021 - Crisis checklists in emergency medicine: another step
forward for cognitive aids.
April 7, 2021
Chen Y-YK, Arriaga AF. Crisis checklists in emergency medicine: another step forward for cognitive aids.
BMJ Qual Saf. 2021;30(9):689-693. doi:10.1136/bmjqs-2021-013203.
https://psnet.ahrq.gov/issue/crisis-checklists-em…