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  1. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/859351/psn-pdf
    January 01, 2024 - Changing the patient safety mindset: can safety cases help? December 20, 2023 Sujan M, Habli I. Changing the patient safety mindset: can safety cases help? BMJ Qual Saf. 2024;33(3):145-148. doi:10.1136/bmjqs-2023-016652. https://psnet.ahrq.gov/issue/changing-patient-safety-mindset-can-safety-cases-help Examinatio…

  2. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/44090/psn-pdf
    November 21, 2016 - Insensible losses: when the medical community forgets the family. November 21, 2016 Elias P. Insensible losses: when the medical community forgets the family. Health Aff (Millwood). 2015;34(4):707-710. doi:10.1377/hlthaff.2014.0536. https://psnet.ahrq.gov/issue/insensible-losses-when-medical-community-forgets-fami…

  3. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/848825/psn-pdf
    May 10, 2023 - Laura Levis' death outside ER has changed hospital signage, lighting in Mass. May 10, 2023 Mullins L, Menard F. WBUR. April 27, 2023. https://psnet.ahrq.gov/issue/laura-levis-death-outside-er-has-changed-hospital-signage-lighting-mass Incomplete information and building design problems can reduce access to care an…

  4. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/38226/psn-pdf
    February 18, 2011 - Critical events in the lives of interns. February 18, 2011 Ackerman A, Graham M, Schmidt H, et al. Critical events in the lives of interns. J Gen Intern Med. 2009;24(1):27-32. doi:10.1007/s11606-008-0769-8. https://psnet.ahrq.gov/issue/critical-events-lives-interns Resident physicians remain at high risk for burno…

  5. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/837213/psn-pdf
    May 25, 2022 - Nurse Vaught sentenced for deadly medical error. May 25, 2022 DePeau-Wilson M. MedPage Today. May 13, 2022.  https://psnet.ahrq.gov/issue/nurse-vaught-sentenced-deadly-medical-error Disciplinary actions against clinicians who err continue despite awareness efforts to inhibit them. This article summarizes…

  6. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/44332/psn-pdf
    July 29, 2015 - Health IT Safety Center Roadmap. July 29, 2015 RTI International. Washington, DC: Office of the National Coordinator for Health Information Technology; July 2015. https://psnet.ahrq.gov/issue/health-it-safety-center-roadmap The Institute of Medicine called for enhanced transparency in the reporting of health IT sa…

  7. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/44457/psn-pdf
    September 29, 2017 - Hospitals slow to adopt patient apology policies. September 29, 2017 Rice S. Hospitals slow to adopt patient apology policies. Modern healthcare. 2015;45(33):16, 29-30. https://psnet.ahrq.gov/issue/hospitals-slow-adopt-patient-apology-policies Communication-and-resolution approaches to medical errors have garnered …

  8. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/37847/psn-pdf
    June 18, 2008 - Effect of the 80-hour work week on resident case coverage. June 18, 2008 Shin S, Britt R, Britt LD. Effect of the 80-hour work week on resident case coverage. J Am Coll Surg. 2008;206(5):798-800; discussion 801-3. doi:10.1016/j.jamcollsurg.2007.12.028. https://psnet.ahrq.gov/issue/effect-80-hour-work-week-resident…

  9. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/859352/psn-pdf
    December 20, 2023 - More hospitals move to confront medical errors head on. December 20, 2023 Gorenstein D. Tradeoffs. November 16, 2023. https://psnet.ahrq.gov/issue/more-hospitals-move-confront-medical-errors-head Amid governmental guidance to improve safety, front-line perspectives remain an important source for insight to make im…

  10. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/850934/psn-pdf
    June 21, 2023 - Are apologies a way to reduce malpractice risks?. June 21, 2023 Sanfilippo JS, Kettering C, Smith SR. Are apologies a way to reduce malpractice risks? Clin Obstet Gynecol. 2023;66(2):293-297. doi:10.1097/grf.0000000000000772. https://psnet.ahrq.gov/issue/are-apologies-way-reduce-malpractice-risks Effective apology…

  11. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/45209/psn-pdf
    June 29, 2016 - Raising awareness of cognitive biases during diagnostic reasoning. June 29, 2016 van Geene K, de Groot E, Erkelens C, et al. Raising awareness of cognitive biases during diagnostic reasoning. Perspect Med Educ. 2016;5(3):182-5. doi:10.1007/s40037-016-0274-4. https://psnet.ahrq.gov/issue/raising-awareness-cognitive…

  12. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/46462/psn-pdf
    April 11, 2018 - Speaking up: an ethical action exercise. April 11, 2018 Dwyer J, Faber-Langendoen K. Speaking Up: An Ethical Action Exercise. Acad Med. 2018;93(4):602-605. doi:10.1097/ACM.0000000000002047. https://psnet.ahrq.gov/issue/speaking-ethical-action-exercise Speaking up about concerns is a cornerstone to safety improveme…

  13. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/44359/psn-pdf
    January 06, 2016 - What happens when healthcare innovations collide? January 6, 2016 Pendharkar SR, Woiceshyn J, da Silveira GJC, et al. What happens when healthcare innovations collide? BMJ Qual Saf. 2016;25(1):9-13. doi:10.1136/bmjqs-2015-004441. https://psnet.ahrq.gov/issue/what-happens-when-healthcare-innovations-collide Innovat…

  14. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/74276/psn-pdf
    January 19, 2022 - Guideline for Prevention of Unintentionally Retained Surgical Items. January 19, 2022 Croke L. Guideline for prevention of unintentionally retained surgical items. AORN J. 2021;114(6):4-6. doi:10.1002/aorn.13579. https://psnet.ahrq.gov/issue/guideline-prevention-unintentionally-retained-surgical-items Retained su…

  15. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/47142/psn-pdf
    June 13, 2018 - Managing health IT risks: reflections and recommendations. June 13, 2018 Sujan M. Managing health IT risks: reflections and recommendations. J Innov Health Inform. 2018;25(1):952. doi:10.14236/jhi.v25i1.952. https://psnet.ahrq.gov/issue/managing-health-it-risks-reflections-and-recommendations Health information t…

  16. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/866445/psn-pdf
    August 07, 2024 - Diagnosis in the Era of Digital Health and Artificial Intelligence: A Workshop. August 7, 2024 Diagnosis in the Era of Digital Health and Artificial Intelligence: A Workshop. https://psnet.ahrq.gov/issue/diagnosis-era-digital-health-and-artificial-intelligence-workshop Digital health is emerging as a primary techn…

  17. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/47792/psn-pdf
    May 01, 2019 - New evidence on stemming low-value prescribing. May 1, 2019 Sacarny A, Barnett ML, Agrawal S. NEJM Catalyst. April 10, 2019. https://psnet.ahrq.gov/issue/new-evidence-stemming-low-value-prescribing Overprescribing contributes to polypharmacy, antibiotic resistance, and opioid misuse. This commentary discusses stra…

  18. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/35415/psn-pdf
    December 21, 2008 - Acting Locally: Working in Clinical Microsystems CD- ROM. December 21, 2008 Oakbrook Terrance, IL: Joint Commission Resources; 2005. ISBN 9780866889865. https://psnet.ahrq.gov/issue/acting-locally-working-clinical-microsystems-cd-rom This resource represents a collection of special articles published in the Joint …

  19. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/847550/psn-pdf
    April 12, 2023 - What's changed 1 year after RaDonda Vaught's conviction? April 12, 2023 Bean M, Carbajal E. Becker's Hospital Review. March 29, 2023. https://psnet.ahrq.gov/issue/whats-changed-1-year-after-radonda-vaughts-conviction The RaDonda Vaught conviction reverberated throughout health care and marked weaknesses in systems…

  20. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/36835/psn-pdf
    July 08, 2008 - Predicting future staffing needs at teaching hospitals: use of an analytical program with multiple variables. July 8, 2008 Mitchell CC, Ashley SW, Zinner MJ, et al. Predicting future staffing needs at teaching hospitals: use of an analytical program with multiple variables. Arch Surg. 2007;142(4):329-34. https://p…
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