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5821. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/50425/psn-pdf
      September 04, 2019 - Why doctors still offer treatments that may not help. September 4, 2019 Frakt A. New York Times. August 26, 2019. https://psnet.ahrq.gov/issue/why-doctors-still-offer-treatments-may-not-help The slow adoption of improvement innovations is a persistent challenge to high-quality and safe patient care. This newspaper…

5822. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/39051/psn-pdf
      November 04, 2009 - On the prospects for a blame-free medical culture. November 4, 2009 Collins ME, Block SD, Arnold RM, et al. On the prospects for a blame-free medical culture. Soc Sci Med. 2009;69(9):1287-90. doi:10.1016/j.socscimed.2009.08.033. https://psnet.ahrq.gov/issue/prospects-blame-free-medical-culture This study found tha…

5823. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/39060/psn-pdf
      October 28, 2009 - Impact of duty-hour restriction on resident inpatient teaching. October 28, 2009 Mazotti LA, Vidyarthi AR, Wachter RM, et al. Impact of duty-hour restriction on resident inpatient teaching. J Hosp Med. 2009;4(8). doi:10.1002/jhm.448. https://psnet.ahrq.gov/issue/impact-duty-hour-restriction-resident-inpatient-teac…

5824. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/42661/psn-pdf
      October 16, 2013 - Utility and assessment of non-technical skills for rapid response systems and medical emergency teams. October 16, 2013 Chalwin RP, Flabouris A. Utility and assessment of non-technical skills for rapid response systems and medical emergency teams. Intern Med J. 2013;43(9):962-9. doi:10.1111/imj.12172. https://psne…

5825. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/47332/psn-pdf
      November 02, 2018 - Interventions for postsurgical opioid prescribing: a systematic review. November 2, 2018 Wick EC, Sehgal NL. A Learning Health System Approach to the Opioid Crisis. JAMA Surg. 2018;153(10):948-954. doi:10.1001/jamasurg.2018.2731. https://psnet.ahrq.gov/issue/interventions-postsurgical-opioid-prescribing-systematic…

5826. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/43220/psn-pdf
      April 03, 2017 - Patient safety teams recognised at BMJ awards. April 3, 2017 Gulland A. Berwick Patient Safety Team: making the NHS a safer place. BMJ. 2014;348(mar28 1). doi:10.1136/bmj.g2404. https://psnet.ahrq.gov/issue/patient-safety-teams-recognised-bmj-awards The Great Ormond Street Hospital Foundation NHS Trust received th…

5827. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/36838/psn-pdf
      April 19, 2011 - A very public failure: lessons for quality improvement in healthcare organisations from the Bristol Royal Infirmary. April 19, 2011 Walshe K, Offen N. A very public failure: lessons for quality improvement in healthcare organisations from the Bristol Royal Infirmary. Qual Health Care. 2001;10(4):250-6. https://psn…

5828. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/74860/psn-pdf
      February 23, 2022 - Is electronic health record safety a paradox? February 23, 2022 Harrington L. Is electronic health record safety a paradox? AACN Adv Crit Care. 2021;32(4):375-380. doi:10.4037/aacnacc2021406. https://psnet.ahrq.gov/issue/electronic-health-record-safety-paradox The usability of health information technology, such a…

5829. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/41425/psn-pdf
      June 19, 2012 - Mortality and morbidity meetings: an untapped resource for improving the governance of patient safety? June 19, 2012 Higginson J, Walters R, Fulop NJ. Mortality and morbidity meetings: an untapped resource for improving the governance of patient safety? BMJ Qual Saf. 2012;21(7):576-585. doi:10.1136/bmjqs-2011-00060…

5830. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/846762/psn-pdf
      March 29, 2023 - Hospital ‘black boxes’ put surgical practices under the microscope. March 29, 2023 Sadick B. Wall Street Journal. March 19, 2023. https://psnet.ahrq.gov/issue/hospital-black-boxes-put-surgical-practices-under-microscope Safety information systems that track action in real time can reveal a trove of data about how …

5831. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/38555/psn-pdf
      April 15, 2009 - Standardized sign-out reduces intern perception of medical errors on the general internal medicine ward. April 15, 2009 Salerno SM, Arnett M, Domanski JP. Standardized sign-out reduces intern perception of medical errors on the general internal medicine ward. Teach Learn Med. 2009;21(2):121-6. doi:10.1080/10401330…

5832. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/48043/psn-pdf
      October 01, 2023 - Health Services Safety Investigations Body. October 1, 2023 Lytchett House, 13 Freeland Park, Wareham Road, Poole, Dorset, BH16 6FA. https://psnet.ahrq.gov/issue/health-services-safety-investigations-body Independent investigations examine system weaknesses in health care to inform improvement, reduce risk, and pr…

5833. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/41420/psn-pdf
      September 26, 2012 - Improving healthcare quality through organisational peer- to-peer assessment: lessons from the nuclear power industry. September 26, 2012 Pronovost P, Hudson DW. Improving healthcare quality through organisational peer-to-peer assessment: lessons from the nuclear power industry. BMJ Qual Saf. 2012;21(10):872-5. h…

5834. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/38854/psn-pdf
      August 12, 2009 - Implementation of resident work hour restrictions is associated with a reduction in mortality and provider- related complications on the surgical service: a concurrent analysis of 14,610 patients. August 12, 2009 Privette AR, Shackford SR, Osler T, et al. Implementation of resident work hour restrictions is associ…

5835. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/47433/psn-pdf
      February 22, 2019 - Impact of nurse peer review on a culture of safety. February 22, 2019 Herrington CR, Hand MW. Impact of Nurse Peer Review on a Culture of Safety. J Nurs Care Qual. 2019;34(2):158-162. doi:10.1097/NCQ.0000000000000361. https://psnet.ahrq.gov/issue/impact-nurse-peer-review-culture-safety This commentary describes an…

5836. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/45581/psn-pdf
      October 19, 2016 - Reducing diagnostic errors. October 19, 2016 Gittlen S. HealthLeaders Media. October 1, 2016. https://psnet.ahrq.gov/issue/reducing-diagnostic-errors-0 The recent recognition of diagnostic error as a blind spot in health care has driven the need to enhance diagnosis. This news article reports how health systems, a…

5837. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/44729/psn-pdf
      January 07, 2016 - The morbidity and mortality meeting: time for a different approach? January 7, 2016 Fraser J. The morbidity and mortality meeting: time for a different approach? Arch Dis Child. 2016;101(1):4- 8. doi:10.1136/archdischild-2015-309536. https://psnet.ahrq.gov/issue/morbidity-and-mortality-meeting-time-different-appro…

5838. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/41802/psn-pdf
      October 31, 2012 - Relationship between high-fidelity simulation and patient safety in prelicensure nursing education: a comprehensive review. October 31, 2012 Blum CA, Parcells DA. Relationship between high-fidelity simulation and patient safety in prelicensure nursing education: a comprehensive review. J Nurs Educ. 2012;51(8):429-…

5839. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/45364/psn-pdf
      September 04, 2016 - A piece of my mind. Changing the narrative. September 4, 2016 Allen-Dicker J. Changing the Narrative. JAMA. 2016;316(3). doi:10.1001/jama.2016.3029. https://psnet.ahrq.gov/issue/piece-my-mind-changing-narrative Storytelling can share knowledge and build community among physicians. However, if clinicians communicat…

5840. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/33835/psn-pdf
      June 01, 2017 - You've learned about the way the politics work. PA: You learn about how science works in society.