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psnet.ahrq.gov/node/39173/psn-pdf
November 02, 2014 - Transforming healthcare: a safety imperative.
November 2, 2014
Leape L, Berwick D, Clancy C, et al. Transforming healthcare: a safety imperative. Qual Saf Health Care.
2009;18(6):424-8. doi:10.1136/qshc.2009.036954.
https://psnet.ahrq.gov/issue/transforming-healthcare-safety-imperative
Although significant progres…
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psnet.ahrq.gov/node/47856/psn-pdf
June 02, 2019 - The impact of patient–physician alliance on trust
following an adverse event.
June 2, 2019
Shoemaker K, Smith CP. The impact of patient-physician alliance on trust following an adverse event.
Patient Educ Couns. 2019;102(7):1342-1349. doi:10.1016/j.pec.2019.02.015.
https://psnet.ahrq.gov/issue/impact-patient-physi…
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psnet.ahrq.gov/node/73321/psn-pdf
May 26, 2021 - Support for healthcare professionals after surgical patient
safety incidents: a qualitative descriptive study in 5
teaching hospitals.
May 26, 2021
Serou N, Husband AK, Forrest SP, et al. Support for healthcare professionals after surgical patient safety
incidents: a qualitative descriptive study in 5 teaching hos…
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psnet.ahrq.gov/node/73962/psn-pdf
October 13, 2021 - Building a program of expanded peer support for the
entire health care team: no one left behind.
October 13, 2021
Klatt TE, Sachs JF, Huang C-C, et al. Building a program of expanded peer support for the entire health
care team: no one left behind. Jt Comm J Qual Patient Saf. 2021;47(12):759-767.
doi:10.1016/j.jcj…
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psnet.ahrq.gov/node/865663/psn-pdf
April 24, 2024 - Medication management strategies by community-
dwelling older adults: a multisite qualitative analysis.
April 24, 2024
Jallow F, Stehling E, Sajwani-Merchant Z, et al. Medication management strategies by community-dwelling
older adults: a multisite qualitative analysis. J Patient Saf. 2024;20(3):192-197.
doi:10.10…
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psnet.ahrq.gov/node/46472/psn-pdf
August 20, 2018 - Wide variation and overprescription of opioids after
elective surgery.
August 20, 2018
Thiels CA, Anderson SS, Ubl DS, et al. Wide Variation and Overprescription of Opioids After Elective
Surgery. Ann Surg. 2017;266(4):564-573. doi:10.1097/SLA.0000000000002365.
https://psnet.ahrq.gov/issue/wide-variation-and-overp…
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psnet.ahrq.gov/node/44461/psn-pdf
June 21, 2016 - Outcomes of daytime procedures performed by attending
surgeons after night work.
June 21, 2016
Govindarajan A, Urbach DR, Kumar M, et al. Outcomes of Daytime Procedures Performed by Attending
Surgeons after Night Work. N Engl J Med. 2015;373(9):845-53. doi:10.1056/NEJMsa1415994.
https://psnet.ahrq.gov/issue/outcom…
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psnet.ahrq.gov/node/40394/psn-pdf
January 01, 2019 - Partnership for Patients.
October 6, 2016
Washington, DC: US Department of Health and Human Services.
https://psnet.ahrq.gov/issue/partnership-patients
Launched in 2011, the Partnership for Patients plans to invest approximately $1 billion total in an effort to
decrease preventable harm in United States hospitals.…
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psnet.ahrq.gov/node/74179/psn-pdf
January 01, 2022 - Establishing a multidisciplinary taskforce to improve
anticoagulation safety at a large health system.
December 12, 2021
Attia E, Fuentes A, Vassallo M, et al. Establishing a multidisciplinary taskforce to improve anticoagulation
safety at a large health system. Am J Health Syst Pharm. 2022;79(4):297-305. doi:10.10…
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psnet.ahrq.gov/node/42250/psn-pdf
June 03, 2013 - A long-term follow-up evaluation of electronic health
record prescribing safety.
June 3, 2013
Abramson EL, Malhotra S, Osorio N, et al. A long-term follow-up evaluation of electronic health record
prescribing safety. J Am Med Inform Assoc. 2013;20(e1):e52-8. doi:10.1136/amiajnl-2012-001328.
https://psnet.ahrq.gov/…
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psnet.ahrq.gov/node/39197/psn-pdf
January 06, 2010 - Resident fatigue: is there a patient safety issue?
January 6, 2010
Mitchell CD, Mooty CR, Dunn EL, et al. Resident fatigue: is there a patient safety issue? Am J Surg.
2009;198(6):811-6. doi:10.1016/j.amjsurg.2009.04.028.
https://psnet.ahrq.gov/issue/resident-fatigue-there-patient-safety-issue
Regulations limiting…
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psnet.ahrq.gov/node/842763/psn-pdf
January 18, 2023 - Implementation of peer messengers to deliver feedback:
an observational study to promote professionalism in
nursing.
January 18, 2023
Baldwin CA, Hanrahan K, Edmonds SW, et al. Implementation of peer messengers to deliver feedback: an
observational study to promote professionalism in nursing. Jt Comm J Qual Patien…
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psnet.ahrq.gov/node/36003/psn-pdf
March 28, 2011 - The "To Err Is Human Report" and the patient safety
literature.
March 28, 2011
Stelfox HT, Palmisani S, Scurlock C, et al. The "To Err is Human" report and the patient safety literature.
Qual Saf Health Care. 2006;15(3):174-8.
https://psnet.ahrq.gov/issue/err-human-report-and-patient-safety-literature
This study …
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psnet.ahrq.gov/node/40119/psn-pdf
January 05, 2011 - Effects of learning climate and registered nurse staffing
on medication errors.
January 5, 2011
Chang YK, Mark BA. Effects of Learning Climate and Registered Nurse Staffing on Medication Errors. Nurs
Res. 2010;60(1). doi:10.1097/nnr.0b013e3181ff73cc.
https://psnet.ahrq.gov/issue/effects-learning-climate-and-regist…
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psnet.ahrq.gov/node/72627/psn-pdf
January 13, 2021 - Creating a framework to integrate residency program and
medical center approaches to quality improvement and
patient safety training
January 13, 2021
Chen A, Wolpaw BJ, Vande Vusse LK, et al. Creating a framework to integrate residency program and
medical center approaches to quality improvement and patient safety…
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psnet.ahrq.gov/node/40441/psn-pdf
July 02, 2014 - A novel approach to increase residents' involvement in
reporting adverse events.
July 2, 2014
Scott DR, Weimer M, English C, et al. A novel approach to increase residents' involvement in reporting
adverse events. Acad Med. 2011;86(6):742-746. doi:10.1097/ACM.0b013e318217e12a.
https://psnet.ahrq.gov/issue/novel-app…
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psnet.ahrq.gov/node/37471/psn-pdf
February 17, 2011 - Delayed time to defibrillation after in-hospital cardiac
arrest.
February 17, 2011
Chan PS, Krumholz HM, Nichol G, et al. Delayed time to defibrillation after in-hospital cardiac arrest. N
Engl J Med. 2008;358(1):9-17. doi:10.1056/NEJMoa0706467.
https://psnet.ahrq.gov/issue/delayed-time-defibrillation-after-hospit…
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psnet.ahrq.gov/node/44552/psn-pdf
June 21, 2016 - Reducing diagnostic errors—why now?
June 21, 2016
Khullar D, Jha AK, Jena AB. Reducing diagnostic errors--why now? N Engl J Med. 2015;373(26):2491-
2493. doi:10.1056/NEJMp1508044.
https://psnet.ahrq.gov/issue/reducing-diagnostic-errors-why-now
Diagnostic error has recently garnered attention as a patient safety pr…
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psnet.ahrq.gov/node/853429/psn-pdf
September 13, 2023 - Multifaceted intervention to improve patient safety
incident reporting in intensive care units.
September 13, 2023
Griffeth EM, Gajic O, Schueler N, et al. Multifaceted intervention to improve patient safety incident reporting
in intensive care units. J Patient Saf. 2023;19(7):422-428. doi:10.1097/pts.0000000000001…
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psnet.ahrq.gov/node/844769/psn-pdf
January 01, 2020 - Failure to administer recommended chemotherapy:
acceptable variation or cancer care quality blind spot?
September 18, 2019
Ellis RJ, Schlick CJR, Feinglass J, et al. Failure to administer recommended chemotherapy: acceptable
variation or cancer care quality blind spot? BMJ Qual Saf. 2020;29(2):103-112. doi:10.1136/…