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psnet.ahrq.gov/issue/towards-high-reliability-organising-healthcare-strategy-building-organisational-capacity
January 06, 2016 - Commentary
Towards high-reliability organising in healthcare: a strategy for building organisational capacity.
Citation Text:
Aboumatar HJ, Weaver SJ, Rees D, et al. Towards high-reliability organising in healthcare: a strategy for building organisational capacity. BMJ Qual Saf. 2017;26(…
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psnet.ahrq.gov/issue/applying-lean-sigma-solutions-mistake-proof-chemotherapy-preparation-process
September 02, 2015 - Commentary
Applying Lean Sigma solutions to mistake-proof the chemotherapy preparation process.
Citation Text:
Aboumatar HJ, Winner L, Davis RO, et al. Applying Lean Sigma solutions to mistake-proof the chemotherapy preparation process. Jt Comm J Qual Patient Saf. 2010;36(2):79-86.
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psnet.ahrq.gov/issue/surgeon-information-transfer-and-communication-factors-affecting-quality-and-efficiency
December 21, 2014 - Study
Surgeon information transfer and communication: factors affecting quality and efficiency of inpatient care.
Citation Text:
Williams RG, Silverman R, Schwind C, et al. Surgeon information transfer and communication: factors affecting quality and efficiency of inpatient care. Ann S…
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psnet.ahrq.gov/issue/ethical-considerations-development-flexibility-duty-hour-requirements-surgical-trainees-trial
June 21, 2017 - Commentary
Ethical considerations in the development of the Flexibility in Duty Hour Requirements for Surgical Trainees trial.
Citation Text:
Minami CA, Odell DD, Bilimoria KY. Ethical Considerations in the Development of the Flexibility in Duty Hour Requirements for Surgical Trainees Tr…
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psnet.ahrq.gov/perspective/patient-advocacy-patient-safety-have-things-changed
June 01, 2014 - Patient Advocacy in Patient Safety: Have Things Changed?
Helen Haskell, MA | June 1, 2014
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Citation Text:
Haskell H. Patient Advocacy in Patient Safety: Have Things Changed?. PSNet [internet]. Ro…
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psnet.ahrq.gov/issue/strategies-enhance-adoption-ventilator-associated-pneumonia-prevention-interventions
July 10, 2017 - Review
Strategies to enhance adoption of ventilator-associated pneumonia prevention interventions: a systematic literature review.
Citation Text:
Goutier JM, Holzmueller CG, Edwards KC, et al. Strategies to enhance adoption of ventilator-associated pneumonia prevention interventions: a s…
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psnet.ahrq.gov/issue/horus-meets-nightingale-modern-age-how-nursing-communicates-pharmacy-hcit-era
July 10, 2008 - Study
Horus meets Nightingale in the modern age: how nursing communicates with pharmacy in HCIT era.
Citation Text:
Armstrong I, Cox MA. Horus meets Nightingale in the modern age: How nursing communicates with pharmacy in HCIT era. Stud Health Technol Inform. 2006;122:585-6.
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psnet.ahrq.gov/issue/improving-quality-health-care-whats-taking-so-long
April 06, 2016 - Commentary
Classic
Improving the quality of health care: what's taking so long?
Citation Text:
Chassin MR. Improving The Quality Of Health Care: What’s Taking So Long? Health Aff. 2013;32(10):1761-1765. doi:10.1377/hlthaff.2013.0809.
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psnet.ahrq.gov/node/49831/psn-pdf
June 01, 2018 - Chest Pain in a Rural Hospital
June 1, 2018
MacKinney CA, Mohr NM. Chest Pain in a Rural Hospital. PSNet [internet]. 2018.
https://psnet.ahrq.gov/web-mm/chest-pain-rural-hospital
Case Objectives
Recognize that a significant proportion of the Unites States population receives care in rural safety
net emergency dep…
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psnet.ahrq.gov/perspective/are-we-getting-better-measuring-patient-safety
November 10, 2015 - Are We Getting Better at Measuring Patient Safety?
Amy K. Rosen, PhD | November 1, 2010
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Citation Text:
Rosen AK. Are We Getting Better at Measuring Patient Safety?. PSNet [internet]. Rockville (MD): Agency for Healthcare R…
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psnet.ahrq.gov/web-mm/double-trouble
August 01, 2012 - SPOTLIGHT CASE
Double Trouble
Citation Text:
Gurwitz JH. Double Trouble. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2005.
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Google Scholar BibTeX EndNote X3 XML EndNote 7 XML Endnote t…
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psnet.ahrq.gov/web-mm/dont-wait-collect-accurate-weight-case-subtherapeutic-insulin-therapy
July 01, 2008 - Lastly, some dual EHR institutions have policies requiring that providers consult both EHRs for patient
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psnet.ahrq.gov/issue/assessing-and-improving-safety-culture-throughout-academic-medical-centre-prospective-cohort
January 02, 2017 - Study
Assessing and improving safety culture throughout an academic medical centre: a prospective cohort study.
Citation Text:
Paine LA, Rosenstein BJ, Sexton B, et al. Assessing and improving safety culture throughout an academic medical centre: a prospective cohort study. Qual Saf He…
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psnet.ahrq.gov/issue/multidisciplinary-approaches-reducing-error-and-risk-patient-care-setting
January 05, 2017 - Study
Classic
Multidisciplinary approaches to reducing error and risk in a patient care setting.
Citation Text:
Connor M, Ponte PR, Conway JB. Multidisciplinary approaches to reducing error and risk in a patient care setting. Crit Care Nurs Clin North Am. 2002…
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psnet.ahrq.gov/issue/medication-errors-involving-oral-chemotherapy
January 06, 2017 - Study
Medication errors involving oral chemotherapy.
Citation Text:
Weingart SN, Toro J, Spencer J, et al. Medication errors involving oral chemotherapy. Cancer. 2010;116(10):2455-2464. doi:10.1002/cncr.25027.
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psnet.ahrq.gov/web-mm/physical-diagnosis-lost-art
January 17, 2018 - Photograph reprinted with permission of The Alan Mason Chesney Medical Archives of The Johns Hopkins Medical Institutions
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psnet.ahrq.gov/node/49801/psn-pdf
August 01, 2017 - Most institutions participate in national outcomes registries to benchmark performance and target
improvement
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psnet.ahrq.gov/web-mm/multifactorial-medication-mishap
September 01, 2016 - Proactive risk assessment tools, such as failure mode and effects analysis (FMEA), will help institutions
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psnet.ahrq.gov/web-mm/another-fall
June 01, 2010 - Many institutions may face financial or personnel constraints that make implementation of fall prevention
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psnet.ahrq.gov/perspective/patient-engagement-and-patient-safety
February 01, 2013 - Patient Engagement and Patient Safety
Saul N. Weingart, MD, PhD | February 1, 2013
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Citation Text:
Weingart SN. Patient Engagement and Patient Safety. PSNet [internet]. Rockville (MD): Agency fo…