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psnet.ahrq.gov/web-mm/finding-fault-default-alert
August 28, 2024 - Finding Fault With the Default Alert
Citation Text:
Baysari M. Finding Fault With the Default Alert. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2013.
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psnet.ahrq.gov/issue/evaluation-information-transfer-through-continuum-surgical-care-feasibility-study
December 21, 2014 - Study
An evaluation of information transfer through the continuum of surgical care: a feasibility study.
Citation Text:
Nagpal K, Vats A, Ahmed K, et al. An evaluation of information transfer through the continuum of surgical care: a feasibility study. Ann Surg. 2010;252(2):402-7. doi:1…
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psnet.ahrq.gov/issue/adopting-electronic-medical-records-primary-care-lessons-learned-health-information-systems
January 07, 2015 - Review
Adopting electronic medical records in primary care: lessons learned from health information systems implementation experience in seven countries.
Citation Text:
Ludwick DA, Doucette J. Adopting electronic medical records in primary care: lessons learned from health information …
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psnet.ahrq.gov/issue/using-information-technology-improve-quality-and-safety-emergency-care
July 13, 2010 - Commentary
Using information technology to improve the quality and safety of emergency care.
Citation Text:
Handel DA, Wears RL, Nathanson LA, et al. Using Information Technology to Improve the Quality and Safety of Emergency Care. Academic Emergency Medicine. 2011;18(6). doi:10.1111/j…
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psnet.ahrq.gov/node/33571/psn-pdf
March 15, 2025 - Reporting Patient Safety Events
March 15, 2025
Reporting Patient Safety Events. PSNet [internet]. 2019.
https://psnet.ahrq.gov/primer/reporting-patient-safety-events
PSNet primers are regularly reviewed and updated by the UC Davis PSNet Editorial Team to ensure that
they reflect current research and practice in th…
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psnet.ahrq.gov/innovation/project-boost-increases-patient-understanding-treatment-and-follow-care
February 26, 2025 - Project BOOST Increases Patient Understanding of Treatment and Follow-up Care
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May 26, 2021
Innovation
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psnet.ahrq.gov/issue/information-exchange-among-physicians-caring-same-patient-community
March 28, 2011 - Study
Classic
Information exchange among physicians caring for the same patient in the community.
Citation Text:
van Walraven C, Taljaard M, Bell CM, et al. Information exchange among physicians caring for the same patient in the community. CMAJ. 2008;179(10):…
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psnet.ahrq.gov/issue/speaking-and-sharing-information-improves-trainee-neonatal-resuscitations
April 08, 2011 - Study
Speaking up and sharing information improves trainee neonatal resuscitations.
Citation Text:
Katakam LI, Trickey AW, Thomas EJ. Speaking up and sharing information improves trainee neonatal resuscitations. J Patient Saf. 2012;8(4):202-9. doi:10.1097/PTS.0b013e3182699b4f.
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psnet.ahrq.gov/issue/adverse-events-hospitals-public-disclosure-information-about-events
August 01, 2012 - Book/Report
Adverse Events in Hospitals: Public Disclosure of Information About Events.
Citation Text:
Adverse Events in Hospitals: Public Disclosure of Information About Events. Wright S. Washington, DC: US Department of Health and Human Services, Office of the Inspector General; Ja…
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psnet.ahrq.gov/node/867746/psn-pdf
March 12, 2025 - Medical large language models are vulnerable to data-
poisoning attacks.
March 12, 2025
Alber DA, Yang Z, Alyakin A, et al. Medical large language models are vulnerable to data-poisoning
attacks. Nat Med. 2025;31(2):618-626. doi:10.1038/s41591-024-03445-1.
https://psnet.ahrq.gov/issue/medical-large-language-models…
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psnet.ahrq.gov/issue/improving-safety-health-information-technology-requires-shared-responsibility-it-time-we-all
August 20, 2014 - Commentary
Improving the safety of health information technology requires shared responsibility: it is time we all step up.
Citation Text:
Sittig DF, Belmont E, Singh H. Improving the safety of health information technology requires shared responsibility: It is time we all step up. Healt…
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psnet.ahrq.gov/issue/medication-safety-and-knowledge-based-functions-stepwise-approach-against-information
December 22, 2008 - Study
Medication safety and knowledge-based functions: a stepwise approach against information overload.
Citation Text:
Patapovas A, Dormann H, Sedlmayr B, et al. Medication safety and knowledge-based functions: a stepwise approach against information overload. Br J Clin Pharmacol. 2013…
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psnet.ahrq.gov/node/47738/psn-pdf
February 06, 2019 - ISMP Guidelines for Safe Electronic Communication of
Medication Information.
February 6, 2019
Horsham, PA: Institute for Safe Medication Practices; January 2019.
https://psnet.ahrq.gov/issue/ismp-guidelines-safe-electronic-communication-medication-information
Inaccurate or incomplete data in electronic health reco…
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psnet.ahrq.gov/issue/more-algorithms-analysis-safety-events-involving-ml-enabled-medical-devices-reported-fda
May 01, 2019 - Study
More than algorithms: an analysis of safety events involving ML-enabled medical devices reported to the FDA.
Citation Text:
Lyell D, Wang Y, Coiera E, et al. More than algorithms: an analysis of safety events involving ML-enabled medical devices reported to the FDA. J Am Med Inform…
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psnet.ahrq.gov/primer/handoffs
October 18, 2023 - Handoffs
Citation Text:
Handoffs and Signouts. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2019.
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psnet.ahrq.gov/issue/hardwiring-patient-blood-management-harnessing-information-technology-optimize-transfusion
September 20, 2012 - Review
Hardwiring patient blood management: harnessing information technology to optimize transfusion practice.
Citation Text:
Dunbar NM, Szczepiorkowski ZM. Hardwiring patient blood management: harnessing information technology to optimize transfusion practice. Curr Opin Hematol. 2014;2…
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psnet.ahrq.gov/web-mm/e-prescribing-e-error
February 03, 2021 - SPOTLIGHT CASE
E-prescribing: E for error?
Citation Text:
Ashton EW. E-prescribing: E for error?. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2012.
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psnet.ahrq.gov/innovation/care-managers-use-software-aided-medication-review-protocol-frail-community-dwelling
September 13, 2023 - Care Managers Use Software-Aided Medication Review Protocol for Frail, Community-Dwelling Seniors, Leading to More Appropriate Medication Use
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March 31…
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psnet.ahrq.gov/issue/older-patients-understanding-emergency-department-discharge-information-and-its-relationship
October 10, 2012 - Study
Older patients' understanding of emergency department discharge information and its relationship with adverse outcomes.
Citation Text:
Hastings SN, Barrett A, Weinberger M, et al. Older Patients' Understanding of Emergency Department Discharge Information and Its Relationship Wit…
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psnet.ahrq.gov/issue/two-decades-err-human-assessment-progress-and-emerging-priorities-patient-safety
January 16, 2019 - Commentary
Classic
Two decades since To Err Is Human: an assessment of progress and emerging priorities in patient safety.
Citation Text:
Bates DW, Singh H. Two Decades Since To Err Is Human: An Assessment Of Progress And Emerging Priorities In Patient Safety. H…