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  1. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/842424/psn-pdf
    January 11, 2023 - unsafe-design-infusion-task-reallocation-and-safety-perceptions-us-hospitals Organizational pressures sometimes lead

  2. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/838080/psn-pdf
    September 14, 2022 - This meta-analysis of 26 studies estimated that cognitive reasoning tools can lead to small improvements

  3. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/853244/psn-pdf
    September 06, 2023 - issue/error-traps-pediatric-patient-blood-management-perioperative-period Blood management errors can lead

  4. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/73703/psn-pdf
    September 15, 2021 - expand-evidence-base-about-harms-tests-and-treatments Provider and patient underestimation of harms of tests and treatments may lead

  5. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/47825/psn-pdf
    March 06, 2019 - diagnostic-error-result-drug-laboratory-test-interactions Failure to recognize potential drug–laboratory test interactions can lead

  6. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/837065/psn-pdf
    May 11, 2022 - https://psnet.ahrq.gov/issue/fast-tracking-cardiac-surgery-it-safe Post-operative complications can lead

  7. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/50402/psn-pdf
    October 02, 2019 - emerging-critical Deviations or variations in diagnostic fidelity, including diagnostic errors and delays, can lead

  8. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/838081/psn-pdf
    September 14, 2022 - medication-dosage-calculation-among-nursing-students-does-digital- technology-make-difference Medication dose errors can lead

  9. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/853613/psn-pdf
    September 20, 2023 - battles-burnout-investigating-role-interphysician-conflict-physician-burnout Disruptive behaviors, including experiencing or witnessing coworker conflict, can lead

  10. 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 - August 22, 2018 Did duty hour reform lead to better outcomes among the highest risk patients … April 24, 2018 Does increased schedule flexibility lead to change?

  11. Mistaken Identity | PSNet

    psnet.ahrq.gov/web-mm/mistaken-identity
    December 18, 2014 - In some cases, incorrect identification may lead primarily to provider embarrassment without any patient … On the other hand, many instances of patient identification errors lead to more than embarrassment—such … errors can lead to serious harm or even loss of life. … Patient identification errors occur at least occasionally in virtually every health system, and some lead … Language barriers may lead to misidentification and increase the likelihood of adverse events.

  12. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/36626/psn-pdf
    January 14, 2011 - https://psnet.ahrq.gov/issue/whats-trouble-how-doctors-think The author discusses how heuristics can lead

  13. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/42410/psn-pdf
    July 10, 2013 - doctors-perform-thousands-unnecessary-surgeries This newspaper article explains how unnecessary surgeries may lead

  14. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/37165/psn-pdf
    May 02, 2018 - lack-standard-dosing-methods-contributes-iv-errors This article discusses the myriad dosing methods that can lead

  15. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/42735/psn-pdf
    November 13, 2013 - healthcare-technology-hazards This article summarizes an annual report that spotlights health technologies that may lead

  16. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/43340/psn-pdf
    July 23, 2014 - do-doctors-understand-test-results This magazine article reports how weaknesses in physician understanding of statistics can lead

  17. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/39146/psn-pdf
    December 02, 2009 - This commentary explains how inaccurately estimating patient weight in the emergency department can lead

  18. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/36096/psn-pdf
    September 28, 2010 - how-series-errors-led-recurrent-hypoglycemia This case study illustrates how therapeutic duplication can lead

  19. Effects of resident duty hour reform on surgical and procedural patient safety indicators among hospitalized Veterans Health Administration and Medicare patients. | PSNet

    psnet.ahrq.gov/issue/effects-resident-duty-hour-reform-surgical-and-procedural-patient-safety-indicators-among
    November 26, 2014 - November 26, 2014 Did duty hour reform lead to better outcomes among the highest risk … April 6, 2011 Did duty hour reform lead to better outcomes among the highest risk patients

  20. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/38407/psn-pdf
    February 11, 2009 - science-and-economics-improving-clinical-communication This article presents a case scenario focusing on communication breakdowns that lead
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