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psnet.ahrq.gov/issue/multicenter-trial-aviation-style-training-surgical-teams
October 03, 2011 - Study
A multicenter trial of aviation-style training for surgical teams.
Citation Text:
Catchpole K, Dale TJ, Hirst G, et al. A multicenter trial of aviation-style training for surgical teams. J Patient Saf. 2010;6(3):180-6. doi:10.1097/PTS.0b013e3181f100ea.
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psnet.ahrq.gov/issue/reengineering-hospital-discharge-protocol-improve-patient-safety-reduce-costs-and-boost
May 20, 2009 - Commentary
Reengineering hospital discharge: a protocol to improve patient safety, reduce costs, and boost patient satisfaction.
Citation Text:
Clancy CM. Reengineering hospital discharge: a protocol to improve patient safety, reduce costs, and boost patient satisfaction. Am J Med Qual…
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psnet.ahrq.gov/issue/evolution-safety-culture
March 17, 2021 - Commentary
The evolution of a safety culture.
Citation Text:
Patton BS, Donovan KJ. The Evolution of a Safety Culture. Air Med J. 2015;34(5):264-8. doi:10.1016/j.amj.2015.05.012.
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psnet.ahrq.gov/issue/jcaho-patient-safety-event-taxonomy-standardized-terminology-and-classification-schema-near
June 04, 2014 - Commentary
Classic
The JCAHO patient safety event taxonomy: a standardized terminology and classification schema for near misses and adverse events.
Citation Text:
Chang A, Schyve PM, Croteau RJ, et al. The JCAHO patient safety event taxonomy: a standardized t…
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psnet.ahrq.gov/issue/preventing-sentinel-events-caused-family-members
June 14, 2023 - Commentary
Preventing sentinel events caused by family members.
Citation Text:
Wall Y, Kautz DD. Preventing sentinel events caused by family members. Dimens Crit Care Nurs. 2011;30(1):25-7. doi:10.1097/DCC.0b013e3181fd02a0.
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psnet.ahrq.gov/issue/effects-screen-point-care-computer-reminders-processes-and-outcomes-care
September 20, 2011 - Review
The effects of on-screen, point of care computer reminders on processes and outcomes of care.
Citation Text:
Shojania KG, Jennings A, Mayhew A, et al. The effects of on-screen, point of care computer reminders on processes and outcomes of care. Cochrane Database Syst Rev. 2009;(3…
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psnet.ahrq.gov/issue/processes-effective-communication-primary-care
December 21, 2018 - Commentary
Processes for effective communication in primary care.
Citation Text:
Weiner SJ, Barnet B, Cheng TL, et al. Processes for effective communication in primary care. Ann Intern Med. 2005;142(8):709-714.
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psnet.ahrq.gov/issue/monitoring-medication-errors-outpatient-settings
December 31, 2014 - Review
Monitoring for medication errors in outpatient settings.
Citation Text:
Balkrishnan R, Foss CE, Pawaskar M, et al. Monitoring for medication errors in outpatient settings. J Dermatolog Treat. 2009;20(4):229-32. doi:10.1080/09546630802607487.
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psnet.ahrq.gov/issue/novel-tool-organisational-learning-and-its-impact-safety-culture-hospital-dispensary
January 21, 2015 - Study
A novel tool for organisational learning and its impact on safety culture in a hospital dispensary.
Citation Text:
Sujan MA. A novel tool for organisational learning and its impact on safety culture in a hospital dispensary. Reliab Eng Syst Saf. 2012;101:21-34. doi:10.1016/j.ress…
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psnet.ahrq.gov/issue/will-human-factors-restore-faith-gmc
January 12, 2022 - Commentary
Will human factors restore faith in the GMC?
Citation Text:
Morgan L, Benson D, McCulloch P. Will human factors restore faith in the GMC? BMJ. 2019;364:l1037. doi:10.1136/bmj.l1037.
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psnet.ahrq.gov/issue/whats-difference-between-hospital-and-bottling-factory
October 08, 2008 - Commentary
What's the difference between a hospital and a bottling factory?
Citation Text:
Morton A, Cornwell J. What's the difference between a hospital and a bottling factory? BMJ. 2009;339(jul20 1). doi:10.1136/bmj.b2727.
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psnet.ahrq.gov/issue/impact-adverse-events-prescribing-warfarin-patients-atrial-fibrillation-matched-pair-analysis
August 15, 2018 - Study
Impact of adverse events on prescribing warfarin in patients with atrial fibrillation: matched pair analysis.
Citation Text:
Choudhry NK, Anderson G, Laupacis A, et al. Impact of adverse events on prescribing warfarin in patients with atrial fibrillation: matched pair analysis. B…
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psnet.ahrq.gov/issue/enhancing-pediatric-perioperative-patient-safety
January 28, 2015 - Commentary
Enhancing pediatric perioperative patient safety.
Citation Text:
Johnson Q, McVey J. Enhancing Pediatric Perioperative Patient Safety. AORN J. 2017;106(5):434-442. doi:10.1016/j.aorn.2017.09.007.
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psnet.ahrq.gov/issue/quality-performance-improvement-teamwork-information-technology-and-protocols
November 03, 2015 - Commentary
Quality: performance improvement, teamwork, information technology and protocols.
Citation Text:
Coleman NE, Pon S. Quality: performance improvement, teamwork, information technology and protocols. Crit Care Clin. 2013;29(2):129-51. doi:10.1016/j.ccc.2012.11.002.
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psnet.ahrq.gov/issue/state-science-evolving-perspectives-human-error
February 22, 2023 - Commentary
State of science: evolving perspectives on ‘human error’.
Citation Text:
Read GJM, Shorrock S, Walker GH, et al. State of science: evolving perspectives on ‘human error’. Ergonomics. 2021;64(9):1091-1114. doi:10.1080/00140139.2021.1953615.
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psnet.ahrq.gov/issue/bearing-witness-ethics-practice-storying-physicians-medical-mistake-narratives
July 17, 2024 - Study
Bearing witness to the ethics of practice: storying physicians' medical mistake narratives.
Citation Text:
Carmack HJ. Bearing witness to the ethics of practice: storying physicians' medical mistake narratives. Health Commun. 2010;25(5):449-58. doi:10.1080/10410236.2010.484876.
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psnet.ahrq.gov/issue/just-culture-its-more-policy
July 05, 2017 - Study
Just culture: it's more than policy.
Citation Text:
Paradiso L, Sweeney N. Just culture: It's more than policy. Nurs Manage. 2019;50(6):38-45. doi:10.1097/01.NUMA.0000558482.07815.ae.
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psnet.ahrq.gov/issue/system-analysis-suboptimal-surgical-experience
March 23, 2011 - Study
A system analysis of a suboptimal surgical experience.
Citation Text:
Lee R, Cooke DL, Richards MR. A system analysis of a suboptimal surgical experience. Patient Saf Surg. 2009;3(1):1. doi:10.1186/1754-9493-3-1.
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psnet.ahrq.gov/issue/using-simulation-improve-patient-safety-dawn-new-era
October 29, 2017 - Commentary
Using simulation to improve patient safety: dawn of a new era.
Citation Text:
Cheng A, Grant V, Auerbach M. Using simulation to improve patient safety: dawn of a new era. JAMA Pediatr. 2015;169(5):419-20. doi:10.1001/jamapediatrics.2014.3817.
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psnet.ahrq.gov/issue/actions-needed-address-employee-misconduct-process-and-ensure-accountability
July 11, 2018 - Book/Report
Actions Needed to Address Employee Misconduct Process and Ensure Accountability.
Citation Text:
Actions Needed to Address Employee Misconduct Process and Ensure Accountability. Washington, DC: United States Government Accountability Office; July 2018. Publication GAO-18-137. …