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psnet.ahrq.gov/node/40309/psn-pdf
April 22, 2011 - The role of theory in research to develop and evaluate the
implementation of patient safety practices.
April 22, 2011
Foy R, Ovretveit J, Shekelle PG, et al. The role of theory in research to develop and evaluate the
implementation of patient safety practices. BMJ Qual Saf. 2011;20(5):453-9.
doi:10.1136/bmjqs.2010…
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psnet.ahrq.gov/node/39338/psn-pdf
April 30, 2014 - The effect of multidisciplinary care teams on intensive
care unit mortality.
April 30, 2014
Kim MM, Barnato AE, Angus DC, et al. The effect of multidisciplinary care teams on intensive care unit
mortality. Arch Intern Med. 2010;170(4):369-76. doi:10.1001/archinternmed.2009.521.
https://psnet.ahrq.gov/issue/effect-…
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psnet.ahrq.gov/node/49477/psn-pdf
April 01, 2005 - Hold the tPA
April 1, 2005
Fagan SC. Hold the tPA. PSNet [internet]. 2005.
https://psnet.ahrq.gov/web-mm/hold-tpa
The Case
A 74-year-old woman with a history of atrial fibrillation on warfarin therapy came to the emergency
department (ED) 1 hour after the sudden onset of aphasia and right-sided weakness. A non-co…
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psnet.ahrq.gov/node/33796/psn-pdf
January 01, 2016 - In Conversation With… Mark L. Graber, MD
January 1, 2016
In Conversation With… Mark L. Graber, MD. PSNet [internet]. 2016.
https://psnet.ahrq.gov/perspective/conversation-mark-l-graber-md
Editor's note: Dr. Graber is a Senior Fellow at RTI International and Professor Emeritus of Medicine at
the State University o…
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psnet.ahrq.gov/node/40893/psn-pdf
November 02, 2011 - Systematic review of safety checklists for use by medical
care teams in acute hospital settings—limited evidence of
effectiveness.
November 2, 2011
Ko HCH, Turner TJ, Finnigan MA. Systematic review of safety checklists for use by medical care teams in
acute hospital settings--limited evidence of effectiveness. BMC…
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psnet.ahrq.gov/node/40785/psn-pdf
May 04, 2012 - A framework for evaluating the appropriateness of clinical
decision support alerts and responses.
May 4, 2012
McCoy AB, Waitman LR, Lewis JB, et al. A framework for evaluating the appropriateness of clinical
decision support alerts and responses. J Am Med Inform Assoc. 2012;19(3):346-52. doi:10.1136/amiajnl-
2011-…
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psnet.ahrq.gov/node/46110/psn-pdf
January 01, 2019 - Examination of the relationship between management and
clinician perception of patient safety climate and patient
satisfaction.
December 21, 2018
Mazurenko O, Richter J, Kazley AS, et al. Examination of the relationship between management and
clinician perception of patient safety climate and patient satisfaction.…
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psnet.ahrq.gov/node/43063/psn-pdf
May 01, 2015 - More Than 1,000 Preventable Deaths a Day Is Too Many:
The Need to Improve Patient Safety.
May 1, 2015
Hearing Before the Subcommittee on Primary Health and Aging, 113th Cong (July 17, 2014).
https://psnet.ahrq.gov/issue/more-1000-preventable-deaths-day-too-many-need-improve-patient-safety
A group of patient safety…
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psnet.ahrq.gov/node/46932/psn-pdf
April 22, 2018 - Hospital Survey on Patient Safety Culture: 2018 User
Database Report.
April 22, 2018
Famolaro T, Yount N, Hare, R, et al. Rockville, MD: Agency for Healthcare Research and Quality; March
2018. AHRQ Publication No. 18-0025-EF.
https://psnet.ahrq.gov/issue/hospital-survey-patient-safety-culture-2018-user-database-re…
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psnet.ahrq.gov/node/44034/psn-pdf
January 19, 2016 - Surgical checklist implementation project: the impact of
variable WHO checklist compliance on risk-adjusted
clinical outcomes after national implementation: a
longitudinal study.
January 19, 2016
Mayer EK, Sevdalis N, Rout S, et al. Surgical Checklist Implementation Project: The Impact of Variable
WHO Checklist C…
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psnet.ahrq.gov/node/39583/psn-pdf
October 30, 2010 - The harm susceptibility model: a method to prioritise
risks identified in patient safety reporting systems.
October 30, 2010
Pham JC, Colantuoni E, Dominici F, et al. The harm susceptibility model: a method to prioritise risks
identified in patient safety reporting systems. Qual Saf Health Care. 2010;19(5):440-5.
…
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psnet.ahrq.gov/node/42118/psn-pdf
March 20, 2013 - Simulation exercises as a patient safety strategy: a
systematic review.
March 20, 2013
Schmidt E, Goldhaber-Fiebert SN, Ho LA, et al. Simulation exercises as a patient safety strategy: a
systematic review. Ann Intern Med. 2013;158(5 Pt 2):426-32. doi:10.7326/0003-4819-158-5-201303051-
00010.
https://psnet.ahrq.go…
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psnet.ahrq.gov/node/42895/psn-pdf
December 18, 2014 - National trends in patient safety for four common
conditions, 2005–2011.
December 18, 2014
Wang Y, Eldridge N, Metersky M, et al. National trends in patient safety for four common conditions, 2005-
2011. N Engl J Med. 2014;370(4):341-51. doi:10.1056/NEJMsa1300991.
https://psnet.ahrq.gov/issue/national-trends-patie…
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psnet.ahrq.gov/node/46774/psn-pdf
April 12, 2019 - Association between handover of anesthesia care and
adverse postoperative outcomes among patients
undergoing major surgery.
April 12, 2019
Jones PM, Cherry RA, Allen BN, et al. Association Between Handover of Anesthesia Care and Adverse
Postoperative Outcomes Among Patients Undergoing Major Surgery. JAMA. 2018;319…
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psnet.ahrq.gov/node/42819/psn-pdf
October 31, 2014 - Implementing a national program to reduce catheter-
associated urinary tract infection: a quality improvement
collaboration of state hospital associations, academic
medical centers, professional societies, and
governmental agencies.
October 31, 2014
Fakih MG, George C, Edson B, et al. Implementing a national prog…
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psnet.ahrq.gov/issue/organizational-and-cultural-changes-providing-safe-patient-care
June 01, 2022 - Study
Organizational and cultural changes for providing safe patient care.
Citation Text:
Odwazny R, Hasler S, Abrams R, et al. Organizational and cultural changes for providing safe patient care. Qual Manag Health Care. 2005;14(3):132-143.
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psnet.ahrq.gov/issue/quality-and-safety-medical-care-what-does-future-hold
September 18, 2019 - Commentary
Quality and safety in medical care: what does the future hold?
Citation Text:
Liang BA, Mackey T. Quality and safety in medical care: what does the future hold? Arch Pathol Lab Med. 2011;135(11):1425-31. doi:10.5858/arpa.2011-0154-OA.
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psnet.ahrq.gov/issue/using-care-bundles-reduce-hospital-mortality-quantitative-survey
April 25, 2018 - Study
Using care bundles to reduce in-hospital mortality: quantitative survey.
Citation Text:
Robb E, Jarman B, Suntharalingam G, et al. Using care bundles to reduce in-hospital mortality: quantitative survey. BMJ. 2010;340:c1234. doi:10.1136/bmj.c1234.
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psnet.ahrq.gov/issue/exploratory-analyses-failure-rescue-measure-evaluation-through-medical-record-review
December 15, 2008 - Study
Exploratory analyses of the "failure to rescue" measure: evaluation through medical record review.
Citation Text:
Talsma AN, Bahl V, Campbell D. Exploratory analyses of the "failure to rescue" measure: evaluation through medical record review. J Nurs Care Qual. 2008;23(3):202-210. …
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psnet.ahrq.gov/issue/assessing-clinical-handover-between-paramedics-and-trauma-team
January 19, 2011 - Study
Assessing clinical handover between paramedics and the trauma team.
Citation Text:
Evans S, Murray A, Patrick I, et al. Assessing clinical handover between paramedics and the trauma team. Injury. 2010;41(5):460-4. doi:10.1016/j.injury.2009.07.065.
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