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psnet.ahrq.gov/node/44854/psn-pdf
March 16, 2016 - Bring back the autopsy.
March 16, 2016
Jauhar S. New York Times. March 3, 2016.
https://psnet.ahrq.gov/issue/bring-back-autopsy
Performance of autopsies, previously considered an essential learning tool for clinicians, has decreased in
recent years due to insufficient funding to cover costs and lack of physician e…
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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…
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psnet.ahrq.gov/node/845075/psn-pdf
February 22, 2023 - Artificial intelligence, patient safety, and achieving the
quintuple aim in anesthesiology.
February 22, 2023
Tan JM, Cannesson MP. APSF Newsletter. 2023;38(2):1,3–4,7.
https://psnet.ahrq.gov/issue/artificial-intelligence-patient-safety-and-achieving-quintuple-aim-anesthesiology
Technological advancement…
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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…
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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…
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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…
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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…
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psnet.ahrq.gov/node/43084/psn-pdf
May 19, 2014 - How can the criminal law support the provision of quality
in healthcare?
May 19, 2014
Yeung K, Horder J. How can the criminal law support the provision of quality in healthcare? BMJ Qual Saf.
2014;23(6):519-24. doi:10.1136/bmjqs-2013-002688.
https://psnet.ahrq.gov/issue/how-can-criminal-law-support-provision-quali…
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psnet.ahrq.gov/node/47244/psn-pdf
August 01, 2018 - The Second Society for Simulation in Healthcare
Research Summit: Beyond Our Boundaries.
August 1, 2018
Simul Healthc. 2018;13(3S suppl 1):S1-S55.
https://psnet.ahrq.gov/issue/second-society-simulation-healthcare-research-summit-beyond-our-boundaries
Simulation strategies can help examine team interaction and care …
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psnet.ahrq.gov/primer/discharge-planning-and-transitions-care
June 15, 2024 - Discharge Planning and Transitions of Care
Citation Text:
Bajorek SA, McElroy V. Discharge Planning and Transitions of Care. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2020.
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psnet.ahrq.gov/issue/preventable-adverse-drug-events-descriptive-epidemiology
October 17, 2012 - Study
Preventable adverse drug events: descriptive epidemiology.
Citation Text:
Woo SA, Cragg A, Wickham ME, et al. Preventable adverse drug events: Descriptive epidemiology. Br J Clin Pharmacol. 2020;86(2):291-302. doi:10.1111/bcp.14139.
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psnet.ahrq.gov/issue/what-role-individual-accountability-patient-safety-multi-site-ethnographic-study
June 16, 2021 - Study
What is the role of individual accountability in patient safety? A multi-site ethnographic study.
Citation Text:
Aveling E-L, Parker M, Dixon-Woods M. What is the role of individual accountability in patient safety? A multi-site ethnographic study. Sociol Health Illn. 2016;38(2):21…
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psnet.ahrq.gov/issue/interprofessional-clinical-event-debriefing-does-it-make-difference-attitudes-emergency
April 06, 2022 - Study
Interprofessional clinical event debriefing-does it make a difference? Attitudes of emergency department care providers to INFO clinical event debriefings.
Citation Text:
Rose SC, Ashari NA, Davies JM, et al. Interprofessional clinical event debriefing-does it make a difference? At…
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psnet.ahrq.gov/issue/development-instrument-measure-seniors-patient-safety-health-beliefs-seniors-empowerment-and
February 15, 2011 - Study
Development of an instrument to measure seniors' patient safety health beliefs: the Seniors Empowerment and Advocacy in Patient Safety (SEAPS) survey.
Citation Text:
Elder NC, Regan SL, Pallerla H, et al. Development of an instrument to measure seniors’ patient safety health beli…
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psnet.ahrq.gov/issue/examining-patient-safety-events-using-behaviour-change-wheel-cross-sectional-analysis
September 20, 2012 - Study
Examining patient safety events using the behaviour change wheel: a cross-sectional analysis.
Citation Text:
Somerville M, Cassidy C, MacPhee S, et al. Examining patient safety events using the behaviour change wheel: a cross-sectional analysis. Jt Comm J Qual Patient Saf. 2025;51(…
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psnet.ahrq.gov/issue/patient-safety-executive-hospital-management-wards-qualitative-study-identifying-factors
March 08, 2023 - Study
Patient safety from executive hospital management to wards: a qualitative study identifying factors influencing implementation.
Citation Text:
Conner T, Unsworth J, Machin A. Patient safety from executive hospital management to wards: a qualitative study identifying factors influen…
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psnet.ahrq.gov/issue/impact-agency-healthcare-research-and-qualitys-safety-program-perinatal-care
April 04, 2018 - Study
Impact of the Agency for Healthcare Research and Quality's Safety Program for Perinatal Care.
Citation Text:
Kahwati LC, Sorensen A, Teixeira-Poit S, et al. Impact of the Agency for Healthcare Research and Quality's Safety Program for Perinatal Care. Jt Comm J Qual Patient Saf. 201…
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psnet.ahrq.gov/issue/what-are-unintended-patient-safety-consequences-healthcare-technologies-qualitative-study
February 26, 2020 - Study
What are the unintended patient safety consequences of healthcare technologies? A qualitative study among patients, carers and healthcare providers.
Citation Text:
Abdelaziz S, Garfield S, Neves AL, et al. What are the unintended patient safety consequences of healthcare technologi…
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psnet.ahrq.gov/issue/instruments-and-warning-signs-identifying-and-evaluating-frequency-adverse-events
July 20, 2022 - Review
Instruments and warning signs for identifying and evaluating the frequency of adverse events in intermediate and long-term care centres: a narrative systematic review.
Citation Text:
Malgrat-Caballero S, Kannukene A, Orrego C. Instruments and warning signs for identifying and eva…
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psnet.ahrq.gov/issue/chatgpt-can-you-help-me-save-my-childs-life-diagnostic-accuracy-and-supportive-capabilities
February 01, 2023 - Study
"ChatGPT, can you help me save my child's life?" - Diagnostic accuracy and supportive capabilities to lay rescuers by ChatGPT in prehospital basic life support and paediatric advanced life support cases - an in-silico analysis.
Citation Text:
Bushuven S, Bentele M, Bentele S, et al…