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psnet.ahrq.gov/perspective/patient-safety-and-health-information-technology-learning-our-mistakes
July 01, 2012 - Patient Safety and Health Information Technology: Learning from Our Mistakes
Ross Koppel, PhD | July 1, 2012
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Koppel R. Patient Safety and Health Information Technology: Learning f…
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psnet.ahrq.gov/perspective/are-residency-duty-hour-rules-improving-patient-safety
April 01, 2013 - Are Residency Duty Hour Rules Improving Patient Safety?
Kathlyn E. Fletcher, MD, MA; Darcy A. Reed, MD, MPH | April 1, 2013
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Fletcher KE, Reed DA. Are Residency Duty Hour Rules Imp…
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psnet.ahrq.gov/perspective/conversation-david-blumenthal-md-mpp
July 01, 2012 - In Conversation With… David Blumenthal, MD, MPP
July 1, 2012
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In Conversation With… David Blumenthal, MD, MPP. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Service…
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psnet.ahrq.gov/perspective/accreditation-and-regulation-can-they-help-improve-patient-safety
April 01, 2009 - knowing what happened in one is not enough information to understand what the vulnerabilities are in an institution
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psnet.ahrq.gov/perspective/conversation-dr-michelle-schreiber-measuring-patient-safety
December 14, 2022 - In Conversation With... Dr. Michelle Schreiber on Measuring Patient Safety
December 14, 2022
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In Conversation With.. Dr. Michelle Schreiber on Measuring Patient Safety. PSNet [internet]. 2022.In Conversation With... Dr. Michelle …
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psnet.ahrq.gov/perspective/measuring-patient-safety
December 14, 2022 - Measuring Patient Safety
Michelle Schreiber, MD; Cindy Van, MHSA; Sarah E. Mossburg, RN, PhD
| December 14, 2022
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Schreiber M, Van C, Mossburg SE. Measuring Patient Safety. PSN…
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psnet.ahrq.gov/web-mm/overdose-oxygen
August 02, 2023 - Overdose on Oxygen?
Citation Text:
O'Driscoll RB. Overdose on Oxygen?. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2008.
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psnet.ahrq.gov/perspective/balancing-supervision-and-autonomy-ongoing-tension
February 01, 2012 - Balancing Supervision and Autonomy: An Ongoing Tension
C. Jessica Dine, MD, MA; and Jennifer S. Myers, MD | February 1, 2012
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Dine JC, Myers JS. Balancing Supervision and Autonomy:…
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psnet.ahrq.gov/perspective/integrating-multiple-medication-decision-support-systems-how-will-we-make-it-all-work
May 01, 2008 - Integrating Multiple Medication Decision Support Systems: How Will We Make It All Work?
Josh Peterson, MD, MPH | May 1, 2018
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Peterson JF. Integrating Multiple Medication Decision …
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psnet.ahrq.gov/web-mm/stroke-error
February 01, 2016 - SPOTLIGHT CASE
A Stroke of Error
Citation Text:
Barrett KM. A Stroke of Error. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2014.
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psnet.ahrq.gov/node/838220/psn-pdf
September 27, 2019 - Primary Care and Patient Safety: Opportunities at the
Interface
September 28, 2022
O’Malley P, McNellis B, Chew E, et al. Primary Care and Patient Safety: Opportunities at the Interface.
PSNet [internet]. 2022.
https://psnet.ahrq.gov/perspective/primary-care-and-patient-safety-opportunities-interface
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psnet.ahrq.gov/perspective/conversation-withdavid-w-bates-md-msc
May 01, 2018 - In Conversation with…David W. Bates, MD, MSc
May 1, 2008
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In Conversation with…David W. Bates, MD, MSc. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2008…
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psnet.ahrq.gov/node/867656/psn-pdf
February 26, 2025 - In Conversation with Lucy Savitz about Learning Health
Systems for Patient Safety
February 26, 2025
Savitz LA, Sousane Z, Mossburg SE. In Conversation with Lucy Savitz about Learning Health Systems for
Patient Safety. PSNet [internet]. 2025.
https://psnet.ahrq.gov/perspective/conversation-lucy-savitz-about-learnin…
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psnet.ahrq.gov/web-mm/limb-loss-after-vasopressor-use
March 14, 2012 - grafting, and flap reconstruction. 19 The combination of therapies selected is patient and provider/institution-dependent
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psnet.ahrq.gov/node/60328/psn-pdf
May 27, 2020 - Several important policy changes were made at an institution level in response to this fatal event, including
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psnet.ahrq.gov/home
August 04, 2021 - Promoting Patient Safety.
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AHRQ’s Patient Safety Network (PSNet) features a collection of the latest news and resources on patient safety, innovations and toolkits , opportunities for free CME and trainings . The p…
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psnet.ahrq.gov/issue/providing-feedback-following-leadership-walkrounds-associated-better-patient-safety-culture
February 01, 2023 - Study
Classic
Providing feedback following Leadership WalkRounds is associated with better patient safety culture, higher employee engagement and lower burnout.
Citation Text:
Sexton B, Adair KC, Leonard MW, et al. Providing feedback following Leadership WalkRou…
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psnet.ahrq.gov/issue/costs-intravenous-adverse-drug-events-academic-and-nonacademic-intensive-care-units
August 11, 2021 - Study
Costs of intravenous adverse drug events in academic and nonacademic intensive care units.
Citation Text:
Nuckols TK, Paddock SM, Bower AG, et al. Costs of intravenous adverse drug events in academic and nonacademic intensive care units. Med Care. 2009;46(1):17-24. doi:10.1097/m…
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psnet.ahrq.gov/issue/program-prevent-catheter-associated-urinary-tract-infection-acute-care
December 21, 2017 - Study
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A program to prevent catheter-associated urinary tract infection in acute care.
Citation Text:
Saint S, Greene T, Krein SL, et al. A Program to Prevent Catheter-Associated Urinary Tract Infection in Acute Care. New Engl J Med. 2016;374(22):2111-211…
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psnet.ahrq.gov/issue/implementation-hand-hygiene-health-care-facilities-results-who-hand-hygiene-self-assessment
September 09, 2020 - Study
Implementation of hand hygiene in health-care facilities: results from the WHO Hand Hygiene Self-Assessment Framework global survey 2019.
Citation Text:
de Kraker MEA, Tartari E, Tomczyk S, et al. Implementation of hand hygiene in health-care facilities: results from the WHO Hand H…