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psnet.ahrq.gov/issue/11-medicine-mistakes-avoid
March 20, 2024 - Newspaper/Magazine Article
11 medicine mistakes to avoid.
Citation Text:
Crouch M. 11 medicine mistakes to avoid. AARP. August 06, 2024;
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www.ahrq.gov/hai/tools/ambulatory-surgery/sections/sustainability/training-tools/tool.html
June 01, 2017 - Sustainability Tool - Sustainability Module
Background: This tool can be used to identify sustainability issues in planning and implementing your improvement efforts.
How to use this tool: The Implementation Team leader (or individual designated by the leader) should complete this checklist.
Us…
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psnet.ahrq.gov/issue/reduction-pediatric-identification-band-errors-quality-collaborative
March 14, 2022 - Study
Reduction in pediatric identification band errors: a quality collaborative.
Citation Text:
Phillips SC, Saysana M, Worley S, et al. Reduction in pediatric identification band errors: a quality collaborative. Pediatrics. 2012;129(6):e1587-93. doi:10.1542/peds.2011-1911.
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psnet.ahrq.gov/issue/guideline-prevention-unintentionally-retained-surgical-items
August 01, 2018 - Commentary
Guideline for Prevention of Unintentionally Retained Surgical Items.
Citation Text:
Croke L. Guideline for prevention of unintentionally retained surgical items. AORN J. 2021;114(6):4-6. doi:10.1002/aorn.13579.
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www.ahrq.gov/sites/default/files/wysiwyg/pqmp/toolkits/healthplan-key-drive-diagram.pdf
June 02, 2025 - Transcranial Doppler Screening for Children with Sickle Cell Anemia: Health Plan - Key Driver Diagram
Transcranial Doppler Screening for Children with Sickle Cell Anemia
Health Plan - Key Driver Diagram
Key Drivers
Strateg…
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psnet.ahrq.gov/issue/impact-transparency-patient-safety-and-liability
March 02, 2011 - Commentary
The impact of transparency on patient safety and liability.
Citation Text:
Griffen D. The impact of transparency on patient safety and liability. Bull Am Coll Surg. 2008;93(3):19-23.
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psnet.ahrq.gov/issue/human-factors-and-error-prevention-emergency-medicine
October 03, 2011 - Commentary
Human factors and error prevention in emergency medicine.
Citation Text:
Bleetman A, Sanusi S, Dale T, et al. Human factors and error prevention in emergency medicine. Emerg Med J. 2012;29(5):389-93. doi:10.1136/emj.2010.107698.
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psnet.ahrq.gov/issue/organizational-silence-and-hidden-threats-patient-safety
September 27, 2010 - Commentary
Organizational silence and hidden threats to patient safety.
Citation Text:
Henriksen K, Dayton E. Organizational Silence and Hidden Threats to Patient Safety. Health Serv Res. 2006;41(4p2). doi:10.1111/j.1475-6773.2006.00564.x.
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psnet.ahrq.gov/issue/preventing-complications-central-venous-catheterization
September 02, 2015 - Review
Preventing complications of central venous catheterization.
Citation Text:
McGee DC, Gould MK. Preventing complications of central venous catheterization. N Engl J Med. 2003;348(12):1123-33.
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psnet.ahrq.gov/issue/top-penn-state-health-surgeon-warned-leaders-about-transplant-problems-months-shutdown-then
July 18, 2018 - Newspaper/Magazine Article
Top Penn State Health surgeon warned leaders about transplant problems months before shutdown. Then he was let go.
Citation Text:
Top Penn State Health surgeon warned leaders about transplant problems months before shutdown. Then he was let go. Massey W, Keith …
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psnet.ahrq.gov/issue/medical-emergency-team-review-literature
March 02, 2011 - Review
Medical emergency team: a review of the literature.
Citation Text:
Barbetti J, Lee G. Medical emergency team: a review of the literature. Nurs Crit Care. 2008;13(2):80-85. doi:10.1111/j.1478-5153.2007.00258.x.
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psnet.ahrq.gov/issue/safety-hospital-stroke-care
December 02, 2020 - Study
The safety of hospital stroke care.
Citation Text:
Holloway RG, Tuttle D, Baird T, et al. The safety of hospital stroke care. Neurology. 2007;68(8):550-555.
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psnet.ahrq.gov/issue/diagnostic-error-untapped-potential-improving-patient-safety
March 02, 2016 - Commentary
Diagnostic error: untapped potential for improving patient safety?
Citation Text:
Groszkruger D. Diagnostic error: untapped potential for improving patient safety? J Healthc Risk Manag. 2014;34(1):38-43. doi:10.1002/jhrm.21149.
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psnet.ahrq.gov/issue/intrahospital-transport-radiology-department-risk-adverse-events-nursing-surveillance
September 04, 2013 - Commentary
Intrahospital transport to the radiology department: risk for adverse events, nursing surveillance, utilization of a MET and practice implications.
Citation Text:
Ott LK, Hoffman LA, Hravnak M. Intrahospital Transport to the Radiology Department: Risk for Adverse Events, Nur…
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psnet.ahrq.gov/issue/leapfrog-groups-cpoe-standard-and-evaluation-tool
November 17, 2009 - Newspaper/Magazine Article
The Leapfrog Group's CPOE standard and evaluation tool.
Citation Text:
The Leapfrog Group's CPOE standard and evaluation tool. Metzger JB, Welebob E, Turisco F, et al. Patient Saf Qual Healthc. July/August 2008;5:22-25.
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psnet.ahrq.gov/issue/student-perceptions-clinical-quality-and-safety
September 01, 2021 - Study
Student perceptions of clinical quality and safety.
Citation Text:
Swamy L, Badke C, Suguness A, et al. Student Perceptions of Clinical Quality and Safety. Am J Med Qual. 2016;31(6):601.
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psnet.ahrq.gov/issue/factors-influencing-patient-safety-during-postoperative-handover
March 03, 2021 - Review
Factors influencing patient safety during postoperative handover.
Citation Text:
Factors influencing patient safety during postoperative handover. Rose M, Newman SD. AANA J. 2016;84:329-338.
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psnet.ahrq.gov/issue/medical-errors-malpractice-and-defensive-medicine-ill-fated-triad
July 06, 2022 - Review
Medical errors, malpractice, and defensive medicine: an ill-fated triad.
Citation Text:
Berlin L. Medical errors, malpractice, and defensive medicine: an ill-fated triad. Diagnosis (Berl). 2017;4(3):133-139. doi:10.1515/dx-2017-0007.
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psnet.ahrq.gov/issue/disclosing-unanticipated-outcomes-patients-art-and-practice
July 14, 2010 - Commentary
Disclosing unanticipated outcomes to patients: the art and practice.
Citation Text:
Disclosing unanticipated outcomes to patients: the art and practice. Gallagher TH; Denham CR; Leape LL; Amori G; Levinson W.
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psnet.ahrq.gov/issue/helsinki-declaration-patient-safety-anaesthesiology
December 19, 2014 - Commentary
The Helsinki Declaration on Patient Safety in Anaesthesiology.
Citation Text:
Mellin-Olsen J, Staender S, Whitaker DK, et al. The Helsinki Declaration on Patient Safety in Anaesthesiology. Eur J Anaesthesiol. 2010;27(7):592-597. doi:10.1097/EJA.0b013e32833b1adf.
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