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psnet.ahrq.gov/node/44294/psn-pdf
October 03, 2017 - You can't understand something you hide: transparency
as a path to improve patient safety.
October 3, 2017
Wachter R, Kaplan GS, Gandhi T, et al. Health Affairs Blog. June 22, 2015.
https://psnet.ahrq.gov/issue/you-cant-understand-something-you-hide-transparency-path-improve-patient-
safety
Transparency is recogn…
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psnet.ahrq.gov/node/33993/psn-pdf
March 02, 2011 - Improving patient care. My right knee.
March 2, 2011
Berwick DM. Improving patient care. My right knee. Ann Intern Med. 2005;142(2):121-5.
https://psnet.ahrq.gov/issue/improving-patient-care-my-right-knee
Dr. Donald Berwick writes this compelling piece as a personal reflection on the current deficiencies in
health…
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psnet.ahrq.gov/node/866555/psn-pdf
August 21, 2024 - Using behavioral insights to strengthen strategies for
change. Practical applications for quality improvement in
healthcare.
August 21, 2024
Johansen RLR, Tulloch S. Using behavioral insights to strengthen strategies for change. Practical
applications for quality improvement in healthcare. J Patient Saf. 2024;20(5…
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psnet.ahrq.gov/node/72702/psn-pdf
February 03, 2021 - Outcomes from Wake Up Safe, the pediatric anesthesia
quality improvement initiative.
February 3, 2021
Haché M, Sun LS, Gadi G, et al. Outcomes from Wake Up Safe, the pediatric anesthesia quality
improvement initiative. Paediatr Anaesth. 2020;30(12):1348-1354. doi:10.1111/pan.14044.
https://psnet.ahrq.gov/issue/out…
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psnet.ahrq.gov/node/46425/psn-pdf
September 13, 2017 - Optimizing Crisis Resource Management to Improve
Patient Safety and Team Performance--A Handbook for
Acute Care Health Professionals.
September 13, 2017
Brindley P, Cardinal P, eds. Ottawa, ON, Canada: Royal College of Physicians and Surgeons of Canada;
2017. ISBN: 9781926588414.
https://psnet.ahrq.gov/issue/opti…
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psnet.ahrq.gov/node/45679/psn-pdf
January 03, 2018 - Global Guidelines on the Prevention of Surgical Site
Infection.
January 3, 2018
Global Guidelines on the Prevention of Surgical Site Infection.
https://psnet.ahrq.gov/issue/global-guidelines-prevention-surgical-site-infection
Efforts to reduce surgical site infections have achieved some success. The World Health O…
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psnet.ahrq.gov/node/46403/psn-pdf
September 06, 2017 - Supplemental Issue: Quality and Safety Education for
Nurses (QSEN) program.
September 6, 2017
Quality and Safety Education for Nurses.
https://psnet.ahrq.gov/issue/supplemental-issue-quality-and-safety-education-nurses-qsen-program
Patient safety and quality improvement competencies are developed through interprof…
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psnet.ahrq.gov/node/43142/psn-pdf
June 15, 2014 - Development and sustainability of an inpatient-to-
outpatient discharge handoff tool: a quality improvement
project.
June 15, 2014
Moy NY, Lee SJ, Chan T, et al. Development and sustainability of an inpatient-to-outpatient discharge
handoff tool: a quality improvement project. Jt Comm J Qual Patient Saf. 2014;40(5…
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psnet.ahrq.gov/node/45227/psn-pdf
January 21, 2017 - Implementing delivery room checklists and
communication standards in a multi-neonatal ICU quality
improvement collaborative.
January 21, 2017
Bennett SC, Finer N, Halamek LP, et al. Implementing Delivery Room Checklists and Communication
Standards in a Multi-Neonatal ICU Quality Improvement Collaborative. Jt Comm …
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psnet.ahrq.gov/node/47979/psn-pdf
May 01, 2019 - Inpatient notes: just what the doctor ordered—checklists
to improve diagnosis.
May 1, 2019
Gupta A, Graber ML. Web Exclusive. Annals for Hospitalists Inpatient Notes - Just What the Doctor
Ordered-Checklists to Improve Diagnosis. Ann Intern Med. 2019;170(8):HO2-HO3. doi:10.7326/M19-0829.
https://psnet.ahrq.gov/iss…
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psnet.ahrq.gov/node/46222/psn-pdf
June 21, 2017 - Enhanced time out: an improved communication process.
June 21, 2017
Nelson PE. Enhanced Time Out: An Improved Communication Process. AORN J. 2017;105(6):564-570.
doi:10.1016/j.aorn.2017.03.014.
https://psnet.ahrq.gov/issue/enhanced-time-out-improved-communication-process
The Universal Protocol requires hospitals t…
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psnet.ahrq.gov/perspective/conversation-christie-allen-about-maternal-safety-and-perinatal-mental-health
March 29, 2023 - Improvements in data access and availability would enable providers to identify when screening and follow-up
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psnet.ahrq.gov/issue/challenges-and-opportunities-improving-patient-safety-through-human-factors-and-systems
September 11, 2019 - Commentary
Emerging Classic
Challenges and opportunities for improving patient safety through human factors and systems engineering.
Citation Text:
Carayon P, Wooldridge A, Hose B-Z, et al. Challenges And Opportunities For Improving Patient Safety Through Human …
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psnet.ahrq.gov/issue/new-diagnostic-team
July 19, 2023 - Commentary
The new diagnostic team.
Citation Text:
Graber ML, Rusz D, Jones ML, et al. The new diagnostic team. Diagnosis (Berl). 2017;4(4):225-238. doi:10.1515/dx-2017-0022.
Copy Citation
Format:
DOI Google Scholar PubMed BibTeX EndNote X3 XML EndNote 7 XML Endnote tagged …
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psnet.ahrq.gov/issue/wrong-patient
December 23, 2008 - Commentary
Classic
The wrong patient.
Citation Text:
Chassin MR, Becher EC. The wrong patient. Ann Intern Med. 2002;136(11):826-833.
Copy Citation
Format:
Google Scholar PubMed BibTeX EndNote X3 XML EndNote 7 XML Endnote tagged PubMedId RIS
…
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psnet.ahrq.gov/issue/digital-doctor-hope-hype-and-harm-dawn-medicines-computer-age
January 09, 2018 - Book/Report
Classic
The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine's Computer Age.
Citation Text:
The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine's Computer Age. Wachter R. New York, NY: McGraw-Hill; 2015. ISBN: 9780071849463. …
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psnet.ahrq.gov/issue/differential-diagnosis-checklists-reduce-diagnostic-error-differentially-randomised
September 23, 2020 - Study
Differential diagnosis checklists reduce diagnostic error differentially: a randomised experiment.
Citation Text:
Kämmer JE, Schauber SK, Hautz SC, et al. Differential diagnosis checklists reduce diagnostic error differentially: a randomised experiment. Med Educ. 2021;55(10):1172-1…
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psnet.ahrq.gov/issue/effective-followership-standardized-algorithm-resolve-clinical-conflicts-and-improve-teamwork
March 13, 2013 - Commentary
Effective followership: a standardized algorithm to resolve clinical conflicts and improve teamwork.
Citation Text:
Sculli GL, Fore AM, Sine DM, et al. Effective followership: A standardized algorithm to resolve clinical conflicts and improve teamwork. J Healthc Risk Manag. 20…
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psnet.ahrq.gov/issue/journey-toward-high-reliability-comprehensive-safety-program-improve-quality-care-and-safety
September 19, 2017 - Study
Journey toward high reliability: a comprehensive safety program to improve quality of care and safety culture in a large, multisite radiation oncology department.
Citation Text:
Woodhouse KD, Volz E, Maity A, et al. Journey Toward High Reliability: A Comprehensive Safety Program to…
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psnet.ahrq.gov/issue/using-artificial-intelligence-improve-primary-care-patients-and-clinicians
March 02, 2022 - Commentary
Using artificial intelligence to improve primary care for patients and clinicians.
Citation Text:
Sarkar U, Bates DW. Using artificial intelligence to improve primary care for patients and clinicians. JAMA Intern Med. 2024;184(4):343-344. doi:10.1001/jamainternmed.2023.7965.
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