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Improving patient care. The cognitive psychology of missed diagnoses. | PSNet

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October 03, 2012 - Commentary Improving patient care. The cognitive psychology of missed diagnoses. Citation Text: Redelmeier DA. Improving patient care. The cognitive psychology of missed diagnoses. Ann Intern Med. 2005;142(2):115-120. Copy Citation Format: Google Scholar PubMed BibTeX End…

The interrelationship of isolation precautions and adverse events in an acute care facility. | PSNet

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September 24, 2010 - Study The interrelationship of isolation precautions and adverse events in an acute care facility. Citation Text: Spence MR, McQuaid M. The interrelationship of isolation precautions and adverse events in an acute care facility. Am J Infect Control. 2011;39(2):154-155. doi:10.1016/j.aj…

Utilizing improvement science methods to improve physician compliance with proper hand hygiene. | PSNet

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April 13, 2011 - Study Utilizing improvement science methods to improve physician compliance with proper hand hygiene. Citation Text: White CM, Statile AM, Conway PH, et al. Utilizing improvement science methods to improve physician compliance with proper hand hygiene. Pediatrics. 2012;129(4):e1042-50.…

Improving medication administration safety in a community hospital setting using Lean methodology. | PSNet

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September 23, 2020 - Commentary Improving medication administration safety in a community hospital setting using Lean methodology. Citation Text: Critchley S. Improving medication administration safety in a community hospital setting using Lean methodology. J Nurs Care Qual. 2015;30(4):345-351. doi:10.1097/N…

Using improvement science methods to increase accuracy of surgical consents. | PSNet

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October 05, 2011 - Study Using improvement science methods to increase accuracy of surgical consents. Citation Text: Mercurio P, Ellis AS, Schoettker PJ, et al. Using improvement science methods to increase accuracy of surgical consents. AORN J. 2014;100(1):42-53. doi:10.1016/j.aorn.2013.07.023. Copy Cit…

Diagnostic pitfalls in paediatric ischaemic stroke. | PSNet

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December 14, 2016 - Study Diagnostic pitfalls in paediatric ischaemic stroke. Citation Text: Braun KPJ, Kappelle J, Kirkham FJ, et al. Diagnostic pitfalls in paediatric ischaemic stroke. Dev Med Child Neurol. 2006;48(12):985-90. Copy Citation Format: Google Scholar PubMed BibTeX EndNote X3 X…

Anesthesia workspaces for safe medication practices: design guidelines. | PSNet

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November 29, 2017 - Study Anesthesia workspaces for safe medication practices: design guidelines. Citation Text: MohammadiGorji S, Joseph A, Mihandoust S, et al. Anesthesia workspaces for safe medication practices: design guidelines. HERD. 2024;17(1):64-83. doi:10.1177/19375867231190646. Copy Citation …

The global burden of diagnostic errors in primary care. | PSNet

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May 25, 2022 - Review The global burden of diagnostic errors in primary care. Citation Text: Singh H, Schiff G, Graber ML, et al. The global burden of diagnostic errors in primary care. BMJ Qual Saf. 2017;26(6):484-494. doi:10.1136/bmjqs-2016-005401. Copy Citation Format: DOI Google Schol…

Reducing continuous intravenous medication errors in an intensive care unit. | PSNet

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September 27, 2016 - Commentary Reducing continuous intravenous medication errors in an intensive care unit. Citation Text: OʼByrne N, Kozub EI, Fields W. Reducing Continuous Intravenous Medication Errors in an Intensive Care Unit. J Nurs Care Qual. 2016;31(1):13-16. doi:10.1097/NCQ.0000000000000144. Copy …

What is the NHS Safety Thermometer? | PSNet

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November 02, 2016 - Commentary What is the NHS Safety Thermometer? Citation Text: Power M, Stewart K, Brotherton A. What is the NHS Safety Thermometer? Clin Risk. 2012;18(5):163-169. Copy Citation Format: Google Scholar PubMed BibTeX EndNote X3 XML EndNote 7 XML Endnote tagged PubMedId RIS …

An adverse event trigger tool in dentistry: a new methodology for measuring harm in the dental office. | PSNet

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July 09, 2014 - Study An adverse event trigger tool in dentistry: a new methodology for measuring harm in the dental office. Citation Text: Kalenderian E, Walji MF, Tavares A, et al. An adverse event trigger tool in dentistry: a new methodology for measuring harm in the dental office. J Am Dent Assoc.…

Reducing diagnostic error through medical home-based primary care reform. | PSNet

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July 15, 2015 - Commentary Reducing diagnostic error through medical home-based primary care reform. Citation Text: Singh H, Graber ML. Reducing diagnostic error through medical home-based primary care reform. JAMA. 2010;304(4):463-4. doi:10.1001/jama.2010.1035. Copy Citation Format: DOI G…

Simulation to Improve Patient Safety: Getting Started. | PSNet

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June 26, 2024 - Book/Report Simulation to Improve Patient Safety: Getting Started. Citation Text: Deutsch ES, Bajaj K. Simulation To Improve Patient Safety: Getting Started. Rockville, MD: Agency for Healthcare Research and Quality; July 2024. Publication No. 24-0055. Copy Citation Format: …

Voluntarily reported emergency department errors. | PSNet

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June 20, 2011 - Study Voluntarily reported emergency department errors. Citation Text: Henneman PL, Blank FSJ, Smithline HA, et al. Voluntarily Reported Emergency Department Errors. J Patient Saf. 2008;1(3):126-132. doi:10.1097/01.jps.0000175694.39559.12. Copy Citation Format: DOI Google…

Hiding in plain sight—resurrecting the power of inspecting the patient. | PSNet

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September 16, 2020 - Commentary Hiding in plain sight—resurrecting the power of inspecting the patient. Citation Text: Gupta S, Saint S, Detsky AS. Hiding in Plain Sight-Resurrecting the Power of Inspecting the Patient. JAMA Intern Med. 2017;177(6):757-758. doi:10.1001/jamainternmed.2017.0634. Copy Citatio…

The clinical transformation of Ascension Health: eliminating all preventable injuries and deaths. | PSNet

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January 05, 2017 - Commentary The clinical transformation of Ascension Health: eliminating all preventable injuries and deaths. Citation Text: Pryor DB, Tolchin SF, Hendrich A, et al. The clinical transformation of Ascension Health: eliminating all preventable injuries and deaths. Jt Comm J Qual Patient Sa…

The nature of adverse events in dentistry. | PSNet

psnet.ahrq.gov/issue/nature-adverse-events-dentistry

November 01, 2023 - Study The nature of adverse events in dentistry. Citation Text: Tokede B, Yansane A, Walji MF, et al. The nature of adverse events in dentistry. J Patient Saf. 2024;20(7):454-460. doi:10.1097/pts.0000000000001255. Copy Citation Format: DOI Google Scholar BibTeX EndNote X3 X…

Increasing physician reporting of diagnostic learning opportunities. | PSNet

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March 23, 2022 - Study Increasing physician reporting of diagnostic learning opportunities. Citation Text: Marshall TL, Ipsaro AJ, Le M, et al. Increasing physician reporting of diagnostic learning opportunities. Pediatrics. 2021;147(1):e20192400. doi:10.1542/peds.2019-2400. Copy Citation Format: …

FDA advises health care professionals and patients about insulin pen packaging and dispensing. | PSNet

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June 22, 2011 - Press Release/Announcement FDA advises health care professionals and patients about insulin pen packaging and dispensing. Citation Text: FDA advises health care professionals and patients about insulin pen packaging and dispensing. MedWatch Safety Alert. Silver Spring, MD: US Food and Dr…

Teaching novice clinicians how to reduce diagnostic waste and errors by applying the Toyota Production System. | PSNet

psnet.ahrq.gov/issue/teaching-novice-clinicians-how-reduce-diagnostic-waste-and-errors-applying-toyota-production

June 19, 2019 - Commentary Teaching novice clinicians how to reduce diagnostic waste and errors by applying the Toyota Production System. Citation Text: Radhakrishnan NS, Singh H, Southwick FS. Teaching novice clinicians how to reduce diagnostic waste and errors by applying the Toyota Production System.…

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