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461. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/866521/psn-pdf
     August 14, 2024 - High reliability in a safety net hospital leading to operational excellence. August 14, 2024 Didion L, Whitfield C, Bishop P, et al. High reliability in a safety net hospital leading to operational excellence. J Patient Saf. 2024;20(5):375-380. doi:10.1097/pts.0000000000001236. https://psnet.ahrq.gov/issue/high-re…

462. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/60191/psn-pdf
     April 01, 2020 - Unprofessional Behavior Leads to Complications. April 1, 2020 Unprofessional Behavior Leads to Complications. JN Learning. 2020. https://psnet.ahrq.gov/issue/unprofessional-behavior-leads-complications Disruptive behavior is a recognized deterrent to safe communication, sharing of concerns and teamwork. This educa…

463. PSNet Curated Library (pdf file)
     psnet.ahrq.gov/print/pdf/node/867659
     July 10, 2024 - PSNet Curated Library AHRQ: Agency for Healthcare Research and Quality Rapid Response Systems Curated Library Primers Rapid Response Systems UC Davis PSNet Editorial Team | September, 15 2024 Rapid response teams represent an intuitively simple concept: when a patient demonstrates signs of imminent clinical de…

464. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/60566/psn-pdf
     June 03, 2020 - Fear of Covid-19 leads other patients to decline critical treatment. June 3, 2020 Hafner K. Fear of Covid-19 leads other patients to decline critical treatment. New York Times. 2020;May 25. https://psnet.ahrq.gov/issue/fear-covid-19-leads-other-patients-decline-critical-treatment The uncertainties surrounding cor…

465. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/852284/psn-pdf
     August 09, 2023 - ‘Medical errors are the third leading cause of death’ and other statistics you should question. August 9, 2023 Jaklevic MC. HealthJournalism.org. July 27, 2023. https://psnet.ahrq.gov/issue/medical-errors-are-third-leading-cause-death-and-other-statistics-you-should- question Published rates of medical errors con…

466. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/40262/psn-pdf
     March 02, 2011 - Leading clinical handover improvement: a change strategy to implement best practices in the acute care setting. March 2, 2011 Clarke CM, Persaud DD. Leading Clinical Handover Improvement. J Patient Saf. 2011;7(1):11-18. doi:10.1097/pts.0b013e31820c98a8. https://psnet.ahrq.gov/issue/leading-clinical-handover-impro…

467. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/38937/psn-pdf
     September 23, 2009 - Cascade iatrogenesis: factors leading to the development of adverse events in hospitalized older adults. September 23, 2009 Thornlow D, Anderson RA, Oddone E. Cascade iatrogenesis: factors leading to the development of adverse events in hospitalized older adults. Int J Nurs Stud. 2009;46(11):1528-1535. doi:10.1016…

468. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/36799/psn-pdf
     November 28, 2016 - The evolving role of health educators in advancing patient safety: forging partnerships and leading change. November 28, 2016 Mercurio A. The evolving role of health educators in advancing patient safety: forging partnerships and leading change. Health Promot Pract. 2007;8(2):119-27. https://psnet.ahrq.gov/issue/e…

469. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/50423/psn-pdf
     September 04, 2019 - When a vital sign leads a country astray—the opioid epidemic. September 4, 2019 Chidgey BA, McGinigle KL, McNaull PP. When a Vital Sign Leads a Country Astray—The Opioid Epidemic. JAMA Surg. 2019;154(11):987-988. doi:10.1001/jamasurg.2019.2104. https://psnet.ahrq.gov/issue/when-vital-sign-leads-country-astray-opio…

470. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/37201/psn-pdf
     October 06, 2011 - Mistaken identity of skin cleansing solution leading to extensive chemical burns in an extremely preterm infant. October 6, 2011 Mannan K, Chow P, Lissauer T, et al. Mistaken identity of skin cleansing solution leading to extensive chemical burns in an extremely preterm infant. Acta Paediatr. 2007;96(10):1536-7. h…

471. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/40242/psn-pdf
     February 23, 2011 - An anesthesiology department leads culture change at a hospital system level to improve quality and patient safety. February 23, 2011 Fleischut PM, Evans AS, Faggiani SL, et al. An anesthesiology department leads culture change at a hospital system level to improve quality and patient safety. Anesthesiol Clin. 201…

472. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/34960/psn-pdf
     June 22, 2009 - Making hospital care safer and better: the structure- process connection leading to adverse events. June 22, 2009 El-Jardali F, Lagacé M. Making hospital care safer and better: the structure-process connection leading to adverse events. Healthc Q. 2005;8(2):40-8. https://psnet.ahrq.gov/issue/making-hospital-care-s…

473. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/851656/psn-pdf
     July 26, 2023 - Investigation of urology intraoperative events leading to root cause analysis at national VA medical centers. July 26, 2023 Peard LM, Teplitsky S, Annabathula A, et al. Can J Urol. 2023;30(2):11467-11472. https://psnet.ahrq.gov/issue/investigation-urology-intraoperative-events-leading-root-cause-analysis- national…

474. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/37517/psn-pdf
     August 25, 2009 - How health care complexity leads to cooperation and affects the autonomy of health care professionals. August 25, 2009 Molleman E, Broekhuis M, Stoffels R, et al. How health care complexity leads to cooperation and affects the autonomy of health care professionals. Health Care Anal. 2008;16(4):329-341. doi:10.1007/…

475. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/40070/psn-pdf
     December 08, 2010 - Epidural pump programming error leading to inadvertent 10-fold dosing error during epidural labor analgesia with ropivacaine. December 8, 2010 Thyen AB, McAllister RK, Councilman LM. Epidural Pump Programming Error Leading to Inadvertent 10- Fold Dosing Error During Epidural Labor Analgesia With Ropivacaine. J Pat…

476. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/39521/psn-pdf
     May 12, 2010 - Confusion about epinephrine dosing leading to iatrogenic overdose: a life-threatening problem with a potential solution. May 12, 2010 Kanwar M, Irvin CB, Frank JJ, et al. Confusion about epinephrine dosing leading to iatrogenic overdose: a life-threatening problem with a potential solution. Ann Emerg Med. 2010;55(…

477. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/43075/psn-pdf
     August 02, 2015 - National estimates of insulin-related hypoglycemia and errors leading to emergency department visits and hospitalizations. August 2, 2015 Geller AI, Shehab N, Lovegrove MC, et al. National estimates of insulin-related hypoglycemia and errors leading to emergency department visits and hospitalizations. JAMA Intern …

478. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/43863/psn-pdf
     July 16, 2015 - Learning through simulated independent practice leads to better future performance in a simulated crisis than learning through simulated supervised practice. July 16, 2015 Goldberg A, Silverman E, Samuelson S, et al. Learning through simulated independent practice leads to better future performance in a simulated …

479. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/36813/psn-pdf
     March 24, 2011 - Ambulatory care adverse events and preventable adverse events leading to a hospital admission. March 24, 2011 Woods D, Thomas EJ, Holl JL, et al. Ambulatory care adverse events and preventable adverse events leading to a hospital admission. Qual Saf Health Care. 2007;16(2):127-131. https://psnet.ahrq.gov/issue/amb…

480. Sources of KID Data and State-Specific Restrictions 2003
     hcup-us.ahrq.gov/db/nation/kid/kid_2003_stspecific_restr.jsp
     January 01, 2000 - Sources of KID Data and State-Specific Restrictions 2003 An official website of the Department of Health & Human Services Search All AHRQ Websites Careers Contact Us Espanol FAQs…