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psnet.ahrq.gov/node/44331/psn-pdf
September 09, 2015 - Temporal trends in patient safety in the Netherlands:
reductions in preventable adverse events or the end of
adverse events as a useful metric?
September 9, 2015
Shojania KG, van de Mheen PJM-. Temporal trends in patient safety in the Netherlands: reductions in
preventable adverse events or the end of adverse even…
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psnet.ahrq.gov/node/44767/psn-pdf
January 20, 2016 - "What's psychology got to do with it?" Applying
psychological theory to understanding failures in modern
healthcare settings.
January 20, 2016
Rydon-Grange M. 'What's Psychology got to do with it?' Applying psychological theory to understanding
failures in modern healthcare settings. J Med Ethics. 2015;41(11):880-…
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psnet.ahrq.gov/node/35462/psn-pdf
February 18, 2011 - Effect of the transformation of the Veterans Affairs Health
Care System on the quality of care.
February 18, 2011
Jha AK, Perlin JB, Kizer KW, et al. Effect of the transformation of the Veterans Affairs Health Care System
on the quality of care. N Engl J Med. 2003;348(22):2218-27.
https://psnet.ahrq.gov/issue/effe…
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psnet.ahrq.gov/node/38470/psn-pdf
March 11, 2009 - Quality and strength of patient safety climate on
medical–surgical units.
March 11, 2009
Hughes LC, Chang YK, Mark BA. Quality and strength of patient safety climate on medical-surgical units.
Health Care Manag Rev. 2009;34(1):19-28. doi:10.1097/01.HMR.0000342976.07179.3a.
https://psnet.ahrq.gov/issue/quality-and-…
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psnet.ahrq.gov/node/867229/psn-pdf
January 01, 2025 - Feasibility of prospective error reporting in home
palliative care: a mixed methods study.
December 4, 2024
Kurahashi AM, Kim G, Parry N, et al. Feasibility of prospective error reporting in home palliative care: a
mixed methods study. Palliat Med. 2025;39(1):22-30. doi:10.1177/02692163241288774.
https://psnet.ahr…
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psnet.ahrq.gov/node/47059/psn-pdf
May 16, 2018 - Participating in a multisite study exploring operational
failures encountered by frontline nurses: lessons learned.
May 16, 2018
Melnyk H, Rosenfeld P, Glassman KS. Participating in a Multisite Study Exploring Operational Failures
Encountered by Frontline Nurses: Lessons Learned. J Nurs Adm. 2018;48(4):203-208.
do…
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psnet.ahrq.gov/node/40994/psn-pdf
December 18, 2014 - Implementing medication reconciliation in outpatient
pediatrics.
December 18, 2014
Rappaport DI, Collins B, Koster A, et al. Implementing medication reconciliation in outpatient pediatrics.
Pediatrics. 2011;128(6):e1600-7. doi:10.1542/peds.2011-0993.
https://psnet.ahrq.gov/issue/implementing-medication-reconciliat…
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psnet.ahrq.gov/node/836984/psn-pdf
April 27, 2022 - A 6-year thematic review of reported incidents associated
with cardiopulmonary resuscitation calls in a United
Kingdom hospital.
April 27, 2022
Beed M, Hussain S, Woodier N, et al. A 6-year thematic review of reported incidents associated with
cardiopulmonary resuscitation calls in a United Kingdom hospital. J Pat…
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psnet.ahrq.gov/node/46794/psn-pdf
May 17, 2018 - Implementation of diagnostic pauses in the ambulatory
setting.
May 17, 2018
Huang GC, Kriegel G, Wheaton C, et al. Implementation of diagnostic pauses in the ambulatory setting.
BMJ Qual Saf. 2018;27(6):492-497. doi:10.1136/bmjqs-2017-007192.
https://psnet.ahrq.gov/issue/implementation-diagnostic-pauses-ambulatory…
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psnet.ahrq.gov/node/858164/psn-pdf
December 13, 2023 - Risk-adjusted cumulative sum for early detection of
hospitals with excess perioperative mortality.
December 13, 2023
Chen VW, Chidi AP, Dong Y, et al. Risk-adjusted cumulative sum for early detection of hospitals with
excess perioperative mortality. JAMA Surg. 2023;158(11):1176. doi:10.1001/jamasurg.2023.3673.
htt…
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psnet.ahrq.gov/node/44776/psn-pdf
April 15, 2016 - Best practices for chemotherapy administration in
pediatric oncology: quality and safety process
improvements (2015).
April 15, 2016
Looper K, Winchester K, Robinson D, et al. Best Practices for Chemotherapy Administration in Pediatric
Oncology: Quality and Safety Process Improvements (2015). J Pediatr Oncol Nurs.…
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psnet.ahrq.gov/node/44552/psn-pdf
June 21, 2016 - Reducing diagnostic errors—why now?
June 21, 2016
Khullar D, Jha AK, Jena AB. Reducing diagnostic errors--why now? N Engl J Med. 2015;373(26):2491-
2493. doi:10.1056/NEJMp1508044.
https://psnet.ahrq.gov/issue/reducing-diagnostic-errors-why-now
Diagnostic error has recently garnered attention as a patient safety pr…
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psnet.ahrq.gov/node/37334/psn-pdf
February 01, 2011 - A framework for health care organizations to develop and
evaluate a safety scorecard.
February 1, 2011
Pronovost P, Berenholtz SM, Needham DM. A framework for health care organizations to develop and
evaluate a safety scorecard. JAMA. 2007;298(17):2063-5.
https://psnet.ahrq.gov/issue/framework-health-care-organiza…
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psnet.ahrq.gov/node/47537/psn-pdf
November 14, 2018 - Developing a learning health system: insights from a
qualitative process evaluation of a pharmacist-led
electronic audit and feedback intervention to improve
medication safety in primary care.
November 14, 2018
Jeffries M, Keers RN, Phipps D, et al. Developing a learning health system: Insights from a qualitative
…
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psnet.ahrq.gov/node/47962/psn-pdf
May 01, 2019 - Understanding the clinical implications of resident
involvement in uncommon operations.
May 1, 2019
Dasani SS, Simmons KD, Wirtalla CJ, et al. Understanding the Clinical Implications of Resident
Involvement in Uncommon Operations. J Surg Educ. 2019;76(5):1319-1328.
doi:10.1016/j.jsurg.2019.03.011.
https://psnet.a…
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psnet.ahrq.gov/node/45964/psn-pdf
March 22, 2017 - What is known: examining the empirical literature in
resident work hours using 30 influential articles.
March 22, 2017
Philibert I. What Is Known: Examining the Empirical Literature in Resident Work Hours Using 30 Influential
Articles. J Grad Med Educ. 2016;8(5):795-805. doi:10.4300/JGME-D-16-00642.1.
https://psne…
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psnet.ahrq.gov/node/866636/psn-pdf
January 01, 2025 - Hospital commitments to address diagnostic errors: an
assessment of 95 US hospitals.
September 4, 2024
Campione Russo A, Tilly J?L, Kaufman L, et al. Hospital commitments to address diagnostic errors: an
assessment of 95 US hospitals. J Hosp Med. 2025;20(2):120-134. doi:10.1002/jhm.13485.
https://psnet.ahrq.gov/is…
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psnet.ahrq.gov/node/47867/psn-pdf
June 19, 2019 - Increasing compliance of safe medication administration
in pediatric anesthesia by use of a standardized checklist.
June 19, 2019
Kanjia MK, Adler AC, Buck D, et al. Increasing compliance of safe medication administration in pediatric
anesthesia by use of a standardized checklist. Paediatr Anaesth. 2019;29(3):258-2…
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psnet.ahrq.gov/node/857455/psn-pdf
January 01, 2024 - Addressing veteran health-related social needs: how
Joint Commission standards accelerated integration and
expansion of tools and services in the Veterans Health
Administration.
December 6, 2023
List JM, Russell LE, Hausmann LRM, et al. Addressing veteran health-related social needs: how Joint
Commission standard…
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psnet.ahrq.gov/node/72748/psn-pdf
February 17, 2021 - The Collective Leadership for Safety Culture (Co-Lead)
team intervention to promote teamwork and patient
safety.
February 17, 2021
De Brún A, Anjara S, Cunningham U, et al. The Collective Leadership for Safety Culture (Co-Lead) team
intervention to promote teamwork and patient safety. Int J Environ Res Public Heal…