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psnet.ahrq.gov/node/843054/psn-pdf
January 25, 2023 - Exploring nursing-sensitive events in home healthcare: a
national multicenter cohort study using a trigger tool.
January 25, 2023
Nilsson L, Lindblad M, Johansson N, et al. Exploring nursing-sensitive events in home healthcare: a
national multicenter cohort study using a trigger tool. Int J Nurs Stud. 2022;138:1044…
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psnet.ahrq.gov/node/850917/psn-pdf
June 21, 2023 - Improving safety outcomes through medical error
reduction via virtual reality-based clinical skills training.
June 21, 2023
Kennedy GAL, Pedram S, Sanzone S. Improving safety outcomes through medical error reduction via
virtual reality-based clinical skills training. Safety Sci. 2023;165:106200. doi:10.1016/j.ssci.…
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psnet.ahrq.gov/node/72568/psn-pdf
January 01, 2021 - Alternatives to opioid education and a prescription drug
monitoring program cumulatively decreased outpatient
opioid prescriptions.
December 16, 2020
Sigal A, Shah A, Onderdonk A, et al. Alternatives to opioid education and a prescription drug monitoring
program cumulatively decreased outpatient opioid prescriptio…
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psnet.ahrq.gov/node/854991/psn-pdf
November 01, 2023 - Assessing biases in medical decisions via clinician and
AI chatbot responses to patient vignettes.
November 1, 2023
Kim J, Cai ZR, Chen ML, et al. Assessing biases in medical decisions via clinician and AI chatbot
responses to patient vignettes. JAMA Netw Open. 2023;6(10):e2338050.
doi:10.1001/jamanetworkopen.2023…
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psnet.ahrq.gov/node/837200/psn-pdf
May 25, 2022 - Analysis of readmissions in a mobile integrated health
transitional care program using root cause analysis and
common cause analysis.
May 25, 2022
Buitrago I, Seidl KL, Gingold DB, et al. Analysis of readmissions in a mobile integrated health transitional
care program using root cause analysis and common cause ana…
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psnet.ahrq.gov/node/41352/psn-pdf
May 09, 2012 - ASHP national survey of pharmacy practice in hospital
settings: dispensing and administration—2011.
May 9, 2012
Pedersen CA, Schneider PJ, Scheckelhoff DJ. ASHP national survey of pharmacy practice in hospital
settings: Dispensing and administration—2011. American Journal of Health-System Pharmacy. 2012;69(9).
doi…
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psnet.ahrq.gov/node/837589/psn-pdf
June 29, 2022 - Monitoring preventable adverse events and near misses:
number and type identified differ depending on method
used.
June 29, 2022
Isaksson S, Schwarz A, Rusner M, et al. Monitoring preventable adverse events and near misses: number
and type identified differ depending on method used. J Patient Saf. 2022;18(4):325-3…
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psnet.ahrq.gov/node/35486/psn-pdf
December 06, 2011 - The poor state of health care quality in the U.S.: is
malpractice liability part of the problem or part of the
solution?
December 6, 2011
Hyman DA, Silver C. The poor state of health care quality in the U.S.: is malpractice liability part of the
problem or part of the solution? Cornell Law Rev. 2005;90(4):893-993.…
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psnet.ahrq.gov/node/73917/psn-pdf
October 06, 2021 - Reporting of health information technology system-
related patient safety incidents: the effects of
organizational justice.
October 6, 2021
Gluschkoff K, Kaihlanen A, Palojoki S, et al. Reporting of health information technology system-related
patient safety incidents: the effects of organizational justice. Safety…
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psnet.ahrq.gov/node/866312/psn-pdf
July 17, 2024 - Development of patient safety measures to identify
inappropriate diagnosis of common infections.
July 17, 2024
White AT, Vaughn VM, Petty LA, et al. Development of patient safety measures to identify inappropriate
diagnosis of common infections. Clin Infect Dis. 2024;78(6):1403-1411. doi:10.1093/cid/ciae044.
https…
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psnet.ahrq.gov/node/866556/psn-pdf
August 21, 2024 - Digital maturity as a predictor of quality and safety
outcomes in US hospitals: cross-sectional observational
study.
August 21, 2024
Snowdon A, Hussein A, Danforth M, et al. Digital maturity as a predictor of quality and safety outcomes in
US hospitals: cross-sectional observational study. J Med Internet Res. 2024…
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psnet.ahrq.gov/node/842765/psn-pdf
January 18, 2023 - Patient identification of diagnostic safety blindspots and
participation in "good catches" through shared visit
notes.
January 18, 2023
Bell SK, Bourgeois FC, Dong J, et al. Patient identification of diagnostic safety blindspots and participation
in "good catches" through shared visit notes. Milbank Q. 2022;100(4)…
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psnet.ahrq.gov/node/73315/psn-pdf
May 26, 2021 - What contributes to diagnostic error or delay? A
qualitative exploration across diverse acute care settings
in the United States.
May 26, 2021
Barwise A, Leppin A, Dong Y, et al. What contributes to diagnostic error or delay? A qualitative exploration
across diverse acute care settings in the United States. J Pati…
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psnet.ahrq.gov/node/73288/psn-pdf
May 19, 2021 - 2020 Pennsylvania Patient Safety Reporting: an analysis
of serious events and incidents from the nation’s largest
event reporting database.
May 19, 2021
Kepner S, Jones RM. 2020 Pennsylvania Patient Safety Reporting: an analysis of serious events and
incidents from the nation’s largest event reporting database. Pa…
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psnet.ahrq.gov/node/60316/psn-pdf
January 01, 2021 - Hospital-acquired Conditions Reduction Program, patient
safety, and Magnet designation in the United States.
May 13, 2020
Hamadi H, Borkar SR, DHA LRM, et al. Hospital-acquired Conditions Reduction Program, patient safety,
and Magnet designation in the United States. J Patient Saf. 2021;17(8):e1814-e1820.
doi:10.1…
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psnet.ahrq.gov/node/37040/psn-pdf
April 11, 2011 - The host hospital 24-hour underreferral rate: an
automated measure of call-center safety.
April 11, 2011
Hirsh DA, Simon HK, Massey R, et al. The host hospital 24-hour underreferral rate: an automated measure
of call-center safety. Pediatrics. 2007;119(6):1139-1144.
https://psnet.ahrq.gov/issue/host-hospital-24-ho…
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psnet.ahrq.gov/node/73368/psn-pdf
June 09, 2021 - Influence of gender, profession, and managerial function
on clinicians' perceptions of patient safety culture: a
cross-national cross-sectional study.
June 9, 2021
Gambashidze N, Hammer A, Wagner A, et al. Influence of gender, profession, and managerial function on
clinicians' perceptions of patient safety culture…
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digital.ahrq.gov/health-it-tools-and-resources/evaluation-resources/workflow-assessment-health-it-toolkit/all-workflow-tools/time-value-map
January 01, 2023 - Time Value Map
Also Known As
Value-Added Time Analysis
Description
Time value maps provide a visual representation of time in a process, demonstrating whether the time is value-added (VA) or non-value-added (NVA).
Uses
To visually portray value-added and non-value-added time in a…
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psnet.ahrq.gov/node/73242/psn-pdf
May 12, 2021 - Strategies to prevent missed nursing care: an
international qualitative study based upon a positive
deviance approach.
May 12, 2021
Longhini J, Papastavrou E, Efstathiou G, et al. Strategies to prevent missed nursing care: an international
qualitative study based upon a positive deviance approach. J Nurs Manag. 20…
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psnet.ahrq.gov/node/60319/psn-pdf
May 13, 2020 - Predictors of nursing home nurses' willingness to report
medication near-misses.
May 13, 2020
Farag A, Vogelsmeier A, Knox K, et al. Predictors of nursing home nurses' willingness to report medication
near-misses. J Gerontol Nurs. 2020;46(4):21-30. doi:10.3928/00989134-20200303-03.
https://psnet.ahrq.gov/issue/pre…