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  1. One Toxic Drug Is Not Like Another | PSNet

    psnet.ahrq.gov/web-mm/one-toxic-drug-not-another
    October 02, 2019 - SPOTLIGHT CASE One Toxic Drug Is Not Like Another Citation Text: Holmboe ES. One Toxic Drug Is Not Like Another. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2011. Copy Citation Format: Google Scholar BibTe…

  2. Postdischarge Follow-Up Phone Call | PSNet

    psnet.ahrq.gov/web-mm/postdischarge-follow-phone-call
    May 19, 2021 - SPOTLIGHT CASE Postdischarge Follow-Up Phone Call Citation Text: Mourad M, Rennke S. Postdischarge Follow-Up Phone Call. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2012. Copy Citation Format: Google Schol…

  3. In Conversation With… Tejal K. Gandhi, MD, MPH | PSNet

    psnet.ahrq.gov/perspective/conversation-tejal-k-gandhi-md-mph
    February 26, 2025 - In Conversation With… Tejal K. Gandhi, MD, MPH April 1, 2014  Citation Text: In Conversation With… Tejal K. Gandhi, MD, MPH. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2014. Copy Citatio…

  4. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/837808/psn-pdf
    August 05, 2024 - Recognizing Excellence in Diagnosis: Recommended Practices for Hospitals. August 5, 2024 Washington, DC: Leapfrog Group; July 2024. https://psnet.ahrq.gov/issue/recognizing-excellence-diagnosis-recommended-practices-hospitals Diagnostic safety is beginning to be established as a systemic, rather than solely an ind…

  5. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/836931/psn-pdf
    April 13, 2022 - Quality Special Issue. April 13, 2022 J Med Imaging Radiat Oncol. 2022;66(2):165-309. https://psnet.ahrq.gov/issue/quality-special-issue Improving patient safety related to radiology and radiation oncology is an ongoing priority. This special issue explores themes related to radiology and radiation oncology, inclu…

  6. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/73097/psn-pdf
    March 31, 2011 - The Future of Nursing: Leading Change, Advancing Health. March 31, 2011 Institute of Medicine. Washington, DC: The National Academies Press: 2011. https://psnet.ahrq.gov/issue/future-nursing-leading-change-advancing-health The effective engagement of nursing is key to patient safety and care quality improvement. T…

  7. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/837309/psn-pdf
    June 01, 2022 - Usability and accessibility of publicly available patient safety databases. June 1, 2022 Sheehan JG, Howe JL, Fong A, et al. Usability and accessibility of publicly available patient safety databases. J Patient Saf. 2022;18(6):565-569. doi:10.1097/pts.0000000000001018. https://psnet.ahrq.gov/issue/usability-and-ac…

  8. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/38890/psn-pdf
    December 30, 2014 - Intravenous infusion safety technology: return on investment. December 30, 2014 Danello SH, Maddox RR, Schaack GJ. Intravenous Infusion Safety Technology: Return on Investment. Hosp Pharm. 2010;44(8):680-688. doi:10.1310/hpj4408-680. https://psnet.ahrq.gov/issue/intravenous-infusion-safety-technology-return-invest…

  9. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/35349/psn-pdf
    November 18, 2011 - Leadership Guide to Patient Safety: Resources and Tools for Establishing and Maintaining Patient Safety. November 18, 2011 Botwinick L, Bisognano M, Haraden C. Cambridge, MA: Institute for Healthcare Improvement; 2006. https://psnet.ahrq.gov/issue/leadership-guide-patient-safety-resources-and-tools-establishin…

  10. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/43371/psn-pdf
    June 19, 2019 - Medication Safety Officer's Handbook. June 19, 2019 Larson CM, Saine D, eds. Bethesda, MD: American Society of Health-System Pharmacists; 2013. ISBN: 9781585282104. https://psnet.ahrq.gov/issue/medication-safety-officers-handbook This book provides information about medication errors and quality improvement to gui…

  11. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/42586/psn-pdf
    September 11, 2013 - A hazard of impatient medicine. September 11, 2013 Gunderman R, Lynch J, Harrell H. The Atlantic. September 3, 2013. https://psnet.ahrq.gov/issue/hazard-impatient-medicine This magazine article reports on the unique tension between efficiency mandates and patient-centered care through the example of a cancer patie…

  12. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/73523/psn-pdf
    July 21, 2021 - TeamSTEPPS Video Toolkit. July 21, 2021 AHA Team Training and Project Firstline. Chicago, IL: American Hospital Association, Center for Disease Control and Prevention; July 2021. https://psnet.ahrq.gov/issue/teamstepps-video-toolkit Problems in communication are common contributors to patient care mistakes. This t…

  13. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/851068/psn-pdf
    June 28, 2023 - Building a Culture of Safety in Health Care. June 28, 2023 Chicago, IL: American Hospital Association: May 2023. https://psnet.ahrq.gov/issue/building-culture-safety-health-care Healthcare-acquired infections (HAIs) are a common complication of hospital care. This report summarizes lessons learned at a series of i…

  14. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/44503/psn-pdf
    November 18, 2024 - Certified Professional in Patient Safety Review Course. November 18, 2024 Institute for Healthcare Improvement. February 5-6, 2025, 12:00-4:00 PM (eastern). https://psnet.ahrq.gov/issue/certified-professional-patient-safety-review-course This online class prepares individuals to apply for the Institute for Healthca…

  15. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/45311/psn-pdf
    May 20, 2019 - The Joint Commission Big Book of Checklists. 2nd Edition. May 20, 2019 Oakbrook Terrance, IL: Joint Commission; 2018. ISBN: 9781635850598. https://psnet.ahrq.gov/issue/joint-commission-big-book-checklists-2nd-edition Checklists are a widely accepted strategy to improve communication and standardize processes to su…

  16. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/865348/psn-pdf
    January 01, 2023 - Learning Health Systems January 1, 2023 Agency for Health Research and Quality. https://psnet.ahrq.gov/issue/learning-health-systems The learning health system model centers on the purposeful, systematic use of internal data and knowledge with external evidence to improve the safety and quality of care. This websi…

  17. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/39182/psn-pdf
    May 22, 2019 - ACOG Committee Opinion No. 447: patient safety in obstetrics and gynecology. May 22, 2019 Improvement AC of O and GCC on PS and Q. ACOG Committee Opinion No. 447: Patient safety in obstetrics and gynecology. Obstet Gynecol. 2009;114(6):1424-7. doi:10.1097/AOG.0b013e3181c6f90e. https://psnet.ahrq.gov/issue/acog-com…

  18. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/45540/psn-pdf
    November 01, 2016 - Performing the wrong procedure. November 1, 2016 Minnier T, Phrampus P, Waddell L. Performing the Wrong Procedure. JAMA. 2016;316(11):1207-1208. doi:10.1001/jama.2016.9134. https://psnet.ahrq.gov/issue/performing-wrong-procedure Describing an incorrect procedure incident which involved placement of a dialysis cath…

  19. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/46553/psn-pdf
    October 25, 2017 - Telehealth. October 25, 2017 Tuckson R, Edmunds M, Hodgkins ML. Telehealth. N Engl J Med. 2017;377(16):1585-1592. doi:10.1056/NEJMsr1503323. https://psnet.ahrq.gov/issue/telehealth Telemedicine can improve patient experience and access to health care. This commentary reviews the current state of telehealth practi…

  20. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/44678/psn-pdf
    July 05, 2017 - Patient Safety Risk Management Playbook. July 5, 2017 Chicago, IL: American Society for Healthcare Risk Management; 2015. https://psnet.ahrq.gov/issue/patient-safety-risk-management-playbook Proactive risk management is an important component to improving the safety of care. Exploring principles of high reliabilit…
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