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psnet.ahrq.gov/node/35737/psn-pdf
July 15, 2010 - Shepherding change: how the market, healthcare
providers, and public policy can deliver quality care for
the 21st century.
July 15, 2010
Kennedy P, Pronovost P. Shepherding change: how the market, healthcare providers, and public policy
can deliver quality care for the 21st century. Crit Care Med. 2006;34(3 Suppl)…
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psnet.ahrq.gov/node/42568/psn-pdf
December 29, 2014 - Hospital readmission and parent perceptions of their
child's hospital discharge.
December 29, 2014
Berry JG, Ziniel SI, Freeman L, et al. Hospital readmission and parent perceptions of their child's hospital
discharge. Int J Qual Health Care. 2013;25(5):573-81. doi:10.1093/intqhc/mzt051.
https://psnet.ahrq.gov/iss…
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psnet.ahrq.gov/node/836719/psn-pdf
March 09, 2022 - Prevalence and factors associated with patient-requested
corrections to the medical record through use of a patient
portal: findings from a national survey.
March 9, 2022
Nguyen OT, Hong Y-R, Alishahi Tabriz A, et al. Prevalence and factors associated with patient-requested
corrections to the medical record throug…
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psnet.ahrq.gov/node/867007/psn-pdf
October 23, 2024 - Development and psychometric analysis of a patient-
reported measure of diagnostic excellence for emergency
and urgent care settings.
October 23, 2024
Gleason KT, Dukhanin V, Peterson SK, et al. Development and psychometric analysis of a patient-reported
measure of diagnostic excellence for emergency and urgent ca…
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psnet.ahrq.gov/node/37446/psn-pdf
January 06, 2017 - How useful are voluntary medication error reports? The
case of warfarin-related medication errors.
January 6, 2017
Zhan C, Smith SR, Keyes MA, et al. How useful are voluntary medication error reports? The case of
warfarin-related medication errors. Jt Comm J Qual Patient Saf. 2008;34(1):36-45.
https://psnet.ahrq.g…
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psnet.ahrq.gov/node/44609/psn-pdf
June 21, 2016 - The missing evidence: a systematic review of patients'
experiences of adverse events in health care.
June 21, 2016
Harrison R, Walton M, Manias E, et al. The missing evidence: a systematic review of patients' experiences
of adverse events in health care. Int J Qual Health Care. 2015;27(6):424-42. doi:10.1093/intqhc…
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psnet.ahrq.gov/node/860380/psn-pdf
January 10, 2024 - Validity of 16 AHRQ Patient Safety Indicators to identify
in-hospital complications: a medical record review across
nine Swiss hospitals.
January 10, 2024
Havranek MM, Rüter F, Bilger S, et al. Validity of 16 AHRQ Patient Safety Indicators to identify in-hospital
complications: a medical record review across nine …
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psnet.ahrq.gov/node/50775/psn-pdf
January 01, 2021 - Content analysis of patient safety incident reports for
older adult patient transfers, handovers, and discharges:
do they serve organizations, staff, or patients?
January 8, 2020
Scott J, Dawson P, Heavey E, et al. Content analysis of patient safety incident reports for older adult
patient transfers, handovers, an…
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psnet.ahrq.gov/node/72566/psn-pdf
January 01, 2021 - Incidence, nature and causes of avoidable significant
harm in primary care in England: retrospective case note
review.
December 16, 2020
Avery AJ, Sheehan C, Bell BG, et al. Incidence, nature and causes of avoidable significant harm in primary
care in England: retrospective case note review. BMJ Qual Saf. 2021;30(…
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psnet.ahrq.gov/issue/shakespeare-was-target-dont-be-borrower-or-lender
May 11, 2022 - Newspaper/Magazine Article
Shakespeare was on target—don't be a borrower or lender.
Save
Save to your library
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June 10, 2018
This piece describes the dangers…
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psnet.ahrq.gov/node/44687/psn-pdf
June 21, 2016 - Free From Harm: Accelerating Patient Safety
Improvement Fifteen Years After To Err Is Human.
June 21, 2016
Boston, MA: National Patient Safety Foundation; 2015.
https://psnet.ahrq.gov/issue/free-harm-accelerating-patient-safety-improvement-fifteen-years-after-err-
human
This report provides an objective assessmen…
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psnet.ahrq.gov/node/44965/psn-pdf
February 15, 2017 - Identification and Prioritization of Health IT Patient Safety
Measures.
February 15, 2017
Washington, DC: National Quality Forum; February 2016.
https://psnet.ahrq.gov/issue/identification-and-prioritization-health-it-patient-safety-measures
Health information technology (IT) has transformed health care and improv…
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psnet.ahrq.gov/node/41496/psn-pdf
December 21, 2014 - Hospital-based medication reconciliation practices: a
systematic review.
December 21, 2014
Mueller SK, Sponsler KC, Kripalani S, et al. Hospital-based medication reconciliation practices: a
systematic review. Arch Intern Med. 2012;172(14):1057-69. doi:10.1001/archinternmed.2012.2246.
https://psnet.ahrq.gov/issue/h…
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psnet.ahrq.gov/node/45907/psn-pdf
December 22, 2017 - Primary care collaboration to improve diagnosis and
screening for colorectal cancer.
December 22, 2017
Schiff G, Bearden T, Hunt LS, et al. Primary Care Collaboration to Improve Diagnosis and Screening for
Colorectal Cancer. Jt Comm J Qual Patient Saf. 2017;43(7):338-350. doi:10.1016/j.jcjq.2017.03.004.
https://ps…
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psnet.ahrq.gov/node/44189/psn-pdf
September 09, 2015 - Variation in printed handoff documents: results and
recommendations from a multicenter needs assessment.
September 9, 2015
Rosenbluth G, Bale JF, Starmer AJ, et al. Variation in printed handoff documents: Results and
recommendations from a multicenter needs assessment. J Hosp Med. 2015;10(8):517-24.
doi:10.1002/jh…
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psnet.ahrq.gov/node/61041/psn-pdf
October 21, 2020 - Improving accuracy of handoff by implementing an
electronic health record-generated tool: an improvement
project in an academic neonatal intensive care unit.
October 21, 2020
Koo JK, Moyer L, Castello MA, et al. Improving accuracy of handoff by implementing an electronic health
record-generated tool: an improvemen…
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psnet.ahrq.gov/perspective/conversation-michael-cohen-rph-ms-scd-hon-0
October 24, 2021 - In Conversation With… Michael Cohen, RPh, MS, ScD (hon)
October 1, 2018
Citation Text:
In Conversation With… Michael Cohen, RPh, MS, ScD (hon). PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. …
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psnet.ahrq.gov/node/49392/psn-pdf
April 01, 2003 - Another Fall
April 1, 2003
Bogardus SG. Another Fall. PSNet [internet]. 2003.
https://psnet.ahrq.gov/web-mm/another-fall
Case Objectives
List risk factors for falls in hospitalized patients
Understand appropriate use of restraints
Identify system issues contributing to falls in hospitalized patients
Case & Comm…
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psnet.ahrq.gov/node/840256/psn-pdf
November 16, 2022 - In Conversation With... Pascale Carayon, PhD and Nicole
Werner, PhD
November 16, 2022
In Conversation With.. Pascale Carayon, PhD and Nicole Werner, PhD. PSNet [internet]. 2022.
https://psnet.ahrq.gov/perspective/conversation-pascale-carayon-phd-and-nicole-werner-phd
Editor’s note: Dr. Pascale Carayon, PhD, is a p…
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psnet.ahrq.gov/node/33826/psn-pdf
February 01, 2017 - In Conversation With… Amy C. Edmondson, PhD, AM
February 1, 2017
In Conversation With… Amy C. Edmondson, PhD, AM. PSNet [internet]. 2017.
https://psnet.ahrq.gov/perspective/conversation-amy-c-edmondson-phd-am
Editor's note: Dr. Edmondson is professor of Leadership and Management at Harvard Business School.
Her la…