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Implementation of a standardized tool for root cause analysis selection. | PSNet

psnet.ahrq.gov/issue/implementation-standardized-tool-root-cause-analysis-selection

November 06, 2024 - Study Implementation of a standardized tool for root cause analysis selection. Citation Text: Wahlstedt E, Levy BE, Scott E, et al. Implementation of a standardized tool for root cause analysis selection. J Patient Saf. 2025;21(2):101-105. doi:10.1097/pts.0000000000001291. Copy Citatio…

Factors influencing the reporting of medication errors and near misses among nurses: a systematic mixed methods review. | PSNet

psnet.ahrq.gov/issue/factors-influencing-reporting-medication-errors-and-near-misses-among-nurses-systematic-mixed

April 23, 2014 - Review Factors influencing the reporting of medication errors and near misses among nurses: a systematic mixed methods review. Citation Text: Braiki R, Douville F, Gagnon M‐P. Factors influencing the reporting of medication errors and near misses among nurses: a systematic mixed methods …

Racial bias among emergency providers: strategies to mitigate its adverse effects. | PSNet

psnet.ahrq.gov/issue/racial-bias-among-emergency-providers-strategies-mitigate-its-adverse-effects

January 12, 2011 - Commentary Racial bias among emergency providers: strategies to mitigate its adverse effects. Citation Text: Brockett-Walker C, Lall M, Evans DD, et al. Racial bias among emergency providers: strategies to mitigate its adverse effects. Adv Emerg Nurs J. 2021;43(2):89-101. doi:10.1097/tme…

Using behavioral insights to strengthen strategies for change. Practical applications for quality improvement in healthcare. | PSNet

psnet.ahrq.gov/issue/using-behavioral-insights-strengthen-strategies-change-practical-applications-quality

April 06, 2022 - Commentary Using behavioral insights to strengthen strategies for change. Practical applications for quality improvement in healthcare. Citation Text: Johansen RLR, Tulloch S. Using behavioral insights to strengthen strategies for change. Practical applications for quality improvement in…

How physicians think: a case-based diagnostic simulation exercise. | PSNet

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August 14, 2019 - Study How physicians think: a case-based diagnostic simulation exercise. Citation Text: Gupta A, Quinn M, Saint S, et al. The variability in how physicians think: a casebased diagnostic simulation exercise. Diagnosis (Berl). 2021;8(2):167-175. doi:10.1515/dx-2020-0010. Copy Citation …

Anticipated consequences of the 2011 duty hours standards: views of internal medicine and surgery program directors. | PSNet

psnet.ahrq.gov/issue/anticipated-consequences-2011-duty-hours-standards-views-internal-medicine-and-surgery

August 22, 2018 - Study Anticipated consequences of the 2011 duty hours standards: views of internal medicine and surgery program directors. Citation Text: Shea JA, Willett LL, Borman KR, et al. Anticipated consequences of the 2011 duty hours standards: views of internal medicine and surgery program dire…

The Economic Measurement of Medical Errors. | PSNet

psnet.ahrq.gov/issue/economic-measurement-medical-errors

March 23, 2022 - Book/Report The Economic Measurement of Medical Errors. Citation Text: The Economic Measurement of Medical Errors. Shreve J, van Den Bos J, Gray T, Halford M, Rustagi K, Ziemkiewicz E. Schaumburg, IL: The Society of Actuaries; 2010. Copy Citation Save Save t…

Redesigning rounds: towards a more purposeful approach to inpatient teaching and learning. | PSNet

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February 02, 2022 - Commentary Redesigning rounds: towards a more purposeful approach to inpatient teaching and learning. Citation Text: Reilly JB, Bennett N, Fosnocht K, et al. Redesigning rounds: towards a more purposeful approach to inpatient teaching and learning. Acad Med. 2015;90(4):450-3. doi:10.1097…

Chief of Residents for Quality Improvement and Patient Safety: a recipe for a new role in graduate medical education. | PSNet

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August 13, 2014 - Commentary Chief of Residents for Quality Improvement and Patient Safety: a recipe for a new role in graduate medical education. Citation Text: Ferraro K, Zernzach R, Maturo S, et al. Chief of Residents for Quality Improvement and Patient Safety: A Recipe for a New Role in Graduate Medic…

Assessing resident and attending error and adverse events in the emergency department. | PSNet

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November 25, 2020 - Study Assessing resident and attending error and adverse events in the emergency department. Citation Text: Adler JL, Gurley K, Rosen CL, et al. Assessing resident and attending error and adverse events in the emergency department. Am J Emerg Med. 2022;54:228-231. doi:10.1016/j.ajem.2022…

Fighting a common enemy: a catalyst to close intractable safety gaps. | PSNet

psnet.ahrq.gov/issue/fighting-common-enemy-catalyst-close-intractable-safety-gaps

June 30, 2021 - Commentary Fighting a common enemy: a catalyst to close intractable safety gaps. Citation Text: Singh H, Sittig DF, Gandhi TK. Fighting a common enemy: a catalyst to close intractable safety gaps. BMJ Qual Saf. 2021;30(2):141-145. doi:10.1136/bmjqs-2020-011390. Copy Citation Format…

Hospital- and system-wide interventions for health care-associated infections: a systematic review. | PSNet

psnet.ahrq.gov/issue/hospital-and-system-wide-interventions-health-care-associated-infections-systematic-review

January 12, 2022 - Review Hospital- and system-wide interventions for health care-associated infections: a systematic review. Citation Text: Maurer NR, Hogan TH, Walker DM. Hospital- and system-wide interventions for health care-associated infections: a systematic review. Med Care Res Rev. 2021;78(6):643-6…

Quality improvement in ambulatory surgery centers: a major national effort aimed at reducing infections and other surgical complications. | PSNet

psnet.ahrq.gov/issue/quality-improvement-ambulatory-surgery-centers-major-national-effort-aimed-reducing

September 23, 2020 - Study Quality improvement in ambulatory surgery centers: a major national effort aimed at reducing infections and other surgical complications. Citation Text: Davis KK, Mahishi V, Singal R, et al. Quality Improvement in Ambulatory Surgery Centers: A Major National Effort Aimed at Reducin…

Automatable algorithms to identify nonmedical opioid use using electronic data: a systematic review. | PSNet

psnet.ahrq.gov/issue/automatable-algorithms-identify-nonmedical-opioid-use-using-electronic-data-systematic-review

July 27, 2016 - Review Automatable algorithms to identify nonmedical opioid use using electronic data: a systematic review. Citation Text: Canan C, Polinski JM, Alexander C, et al. Automatable algorithms to identify nonmedical opioid use using electronic data: a systematic review. J Am Med Inform Assoc.…

African American COVID-19 mortality: a sentinel event. | PSNet

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November 16, 2022 - Commentary Emerging Classic African American COVID-19 mortality: a sentinel event. Citation Text: Ferdinand KC, Nasser SA. African American COVID-19 mortality: a sentinel event. J Am Coll Cardiol. 2020;75(21):2746-2748. doi:10.1016/j.jacc.2020.04.040. Copy Cit…

Electronic alerts to prevent venous thromboembolism among hospitalized patients. | PSNet

psnet.ahrq.gov/issue/electronic-alerts-prevent-venous-thromboembolism-among-hospitalized-patients

October 19, 2022 - Study Classic Electronic alerts to prevent venous thromboembolism among hospitalized patients. Citation Text: Kucher N, Koo S, Quiroz R, et al. Electronic alerts to prevent venous thromboembolism among hospitalized patients. N Engl J Med. 2005;352(10):969-77. …

The COVID-19 pandemic: resilient organisational response to a low-chance, high-impact event. | PSNet

psnet.ahrq.gov/issue/covid-19-pandemic-resilient-organisational-response-low-chance-high-impact-event

October 07, 2020 - Commentary The COVID-19 pandemic: resilient organisational response to a low-chance, high-impact event. Citation Text: Lloyd-Smith MK. The COVID-19 pandemic: resilient organisational response to a low-chance, high-impact event. BMJ Leader. 2020;4:109-112. doi:10.1136/leader-2020-000245. …

A study of error reporting by nurses: the significant impact of nursing team dynamics. | PSNet

psnet.ahrq.gov/issue/study-error-reporting-nurses-significant-impact-nursing-team-dynamics

April 12, 2014 - Study A study of error reporting by nurses: the significant impact of nursing team dynamics. Citation Text: Munn LT, Lynn MR, Knafl GJ, et al. A study of error reporting by nurses: the significant impact of nursing team dynamics. J Res Nurs. 2023;28(5):354-364. doi:10.1177/17449871231194…

Assessing adverse events after chiropractic care at a chiropractic teaching clinic: an active-surveillance pilot study. | PSNet

psnet.ahrq.gov/issue/assessing-adverse-events-after-chiropractic-care-chiropractic-teaching-clinic-active

December 23, 2020 - Study Assessing adverse events after chiropractic care at a chiropractic teaching clinic: an active-surveillance pilot study. Citation Text: Pohlman KA, Funabashi M, Ndetan H, et al. Assessing adverse events after chiropractic care at a chiropractic teaching clinic: an active-surveillanc…

Moving toward improved teamwork in cancer care: the role of psychological safety in team communication. | PSNet

psnet.ahrq.gov/issue/moving-toward-improved-teamwork-cancer-care-role-psychological-safety-team-communication

October 19, 2012 - Review Moving toward improved teamwork in cancer care: the role of psychological safety in team communication. Citation Text: Jain AK, Fennell ML, Chagpar AB, et al. Moving Toward Improved Teamwork in Cancer Care: The Role of Psychological Safety in Team Communication. J Oncol Pract. 201…

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