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psnet.ahrq.gov/node/764410/psn-pdf
March 02, 2022 - Five strategies for clinicians to advance diagnostic
excellence.
March 2, 2022
Singh H, Connor DM, Dhaliwal G. Five strategies for clinicians to advance diagnostic excellence. BMJ.
2022;376:e068044. doi:10.1136/bmj-2021-068044.
https://psnet.ahrq.gov/issue/five-strategies-clinicians-advance-diagnostic-excellence
…
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psnet.ahrq.gov/node/43882/psn-pdf
February 18, 2015 - Case Studies in Patient Safety: Foundations for Core
Competencies.
February 18, 2015
Johnson JK, Haskell HW, Barach PR. Burlington, MA: Jones and Bartlett Learning; 2015. ISBN:
9781449681548.
https://psnet.ahrq.gov/issue/case-studies-patient-safety-foundations-core-competencies
Patient stories can help illustrate…
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psnet.ahrq.gov/node/60008/psn-pdf
July 09, 2024 - IHI Patient Safety Congress.
July 9, 2024
Institute for Healthcare Improvement. San Diego, CA, March 10-11, 2025.
https://psnet.ahrq.gov/issue/ihi-patient-safety-congress
This annual conference will host pre-session workshops, panels, and presentations covering a variety of
patient safety topics that ali…
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psnet.ahrq.gov/node/72711/psn-pdf
February 03, 2021 - Never Events Analysis of HSIB's National Investigations
Report.
February 3, 2021
Farnborough, UK: Healthcare Safety Investigation Branch; January 2021.
https://psnet.ahrq.gov/issue/never-events-analysis-hsibs-national-investigations-report
Never events provide organizations with motivation to analyze a…
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psnet.ahrq.gov/node/46080/psn-pdf
August 28, 2017 - A growth mindset approach to preparing trainees for
medical error.
August 28, 2017
Klein J, Delany C, Fischer MD, et al. A growth mindset approach to preparing trainees for medical error.
BMJ Qual Saf. 2017;26(9):771-774. doi:10.1136/bmjqs-2016-006416.
https://psnet.ahrq.gov/issue/growth-mindset-approach-preparing…
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psnet.ahrq.gov/node/47416/psn-pdf
January 09, 2019 - Supervision, autonomy, and medical error in the teaching
clinic.
January 9, 2019
Cossman JP, Wang M, Fischer AA. Supervision, autonomy, and medical error in the teaching clinic. J Am
Acad Dermatol. 2018;79(5):981-983. doi:10.1016/j.jaad.2017.12.033.
https://psnet.ahrq.gov/issue/supervision-autonomy-and-medical-err…
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psnet.ahrq.gov/node/848827/psn-pdf
May 10, 2023 - TQIP Mortality Reporting System Case Reports.
May 10, 2023
ACS TQIP Mortality Reporting System Writing Group. J Trauma Acute Care Surg. 2023.
https://psnet.ahrq.gov/issue/tqip-mortality-reporting-system-case-reports
Anonymous case reporting provides opportunities to examine unexpected patient harm instances to
pin…
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psnet.ahrq.gov/perspective/conversation-susan-e-skochelak-md-phd
February 01, 2019 - We have learned that creating such a transparent and just culture does not automatically result from
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www.ahrq.gov/patient-safety/resources/learning-lab/connected-emergency-care-long-desc.html
January 01, 2025 - Connected Emergency Care Patient Safety Learning Lab (CEC PSLL)
Principal Investigator: Jeremiah Hinson, M.D., Ph.D., Johns Hopkins University, Baltimore, MD; formerly Scott Levin, M.S., Ph.D., Johns Hopkins University, Baltimore, MD AHRQ Grant No.: HS26640 Project Period: 09/30/18-12/31/23 Description: Th…
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www.ahrq.gov/hai/tools/mvp/modules/cusp/learn-from-defects-fac-guide.html
February 01, 2017 - Learn From Defects in Care of Mechanically Ventilated Patients: Facilitator Guide
AHRQ Safety Program for Mechanically Ventilated Patients
Slide 1: Learn From Defects in Care of Mechanically Ventilated Patients
Say:
In this module, we will discuss the Learning From Defects tool. It is a very useful proc…
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psnet.ahrq.gov/issue/concept-analysis-systems-thinking
August 20, 2018 - Review
A concept analysis of systems thinking.
Citation Text:
Stalter AM, Phillips JM, Ruggiero JS, et al. A Concept Analysis of Systems Thinking. Nurs Forum. 2017;52(4):323-330. doi:10.1111/nuf.12196.
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DOI Google Scholar PubMed BibTeX EndNote X3 XML En…
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psnet.ahrq.gov/issue/moving-patient-safety-ambulatory-settings-and-beyond
October 02, 2019 - Commentary
Moving patient safety into ambulatory settings and beyond.
Citation Text:
Ricciardi R, Shofer M. Moving Patient Safety Into Ambulatory Settings and Beyond. J Nurs Care Qual. 2018;33(3):195-199. doi:10.1097/NCQ.0000000000000329.
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psnet.ahrq.gov/issue/early-warnings-weak-signals-and-learning-healthcare-disasters
February 28, 2024 - Commentary
Early warnings, weak signals and learning from healthcare disasters.
Citation Text:
Macrae C. Early warnings, weak signals and learning from healthcare disasters. BMJ Qual Saf. 2014;23(6):440-5. doi:10.1136/bmjqs-2013-002685.
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DOI Google Scho…
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psnet.ahrq.gov/issue/learning-influenza-vaccine-errors-prepare-covid-19-vaccination-campaigns
June 10, 2018 - Newspaper/Magazine Article
Learning from influenza vaccine errors to prepare for COVID-19 vaccination campaigns.
Citation Text:
Learning from influenza vaccine errors to prepare for COVID-19 vaccination campaigns. ISMP Medication Safety Alert! Acute care edition. November 19, 2020;2…
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psnet.ahrq.gov/issue/building-culture-patient-safety-through-simulation-interprofessional-learning-model
August 21, 2019 - Book/Report
Building a Culture of Patient Safety Through Simulation: An Interprofessional Learning Model.
Citation Text:
Building a Culture of Patient Safety Through Simulation: An Interprofessional Learning Model. Gallo K, Smith LG, eds. New York, NY: Springer Publishing Company; 2015. …
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psnet.ahrq.gov/issue/clinical-risk-management-enhancing-patient-safety-2nd-ed
May 20, 2019 - Book/Report
Classic
Clinical Risk Management. Enhancing Patient Safety. 2nd ed.
Citation Text:
Clinical Risk Management. Enhancing Patient Safety. 2nd ed. Vincent CA, ed. London, UK: BMJ Books; 2001. ISBN: 9780727913920.
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psnet.ahrq.gov/issue/health-care-management-during-covid-19-insights-complexity-science
July 22, 2020 - Commentary
Health care management during Covid-19: insights from complexity science.
Citation Text:
Health care management during Covid-19: insights from complexity science. Begun JW, Jiang HJ. NEJM Catalyst. October 9, 2020.
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psnet.ahrq.gov/issue/nurses-perceptions-multidisciplinary-team-work-acute-health-care
January 06, 2017 - Image/Poster
Nurses' perceptions of multidisciplinary team work in acute health-care.
Citation Text:
Atwal A, Caldwell K. Nurses' perceptions of multidisciplinary team work in acute health-care. Int J Nurs Pract. 2006;12(6):359-65.
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psnet.ahrq.gov/issue/incidents-during-out-hospital-patient-transportation
March 23, 2011 - Study
Incidents during out-of-hospital patient transportation.
Citation Text:
Flabouris A, Runciman WB, Levings B. Incidents during out-of-hospital patient transportation. Anaesth Intensive Care. 2006;34(2):228-236.
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psnet.ahrq.gov/issue/4-actions-reduce-medical-errors-us-hospitals
July 24, 2024 - Newspaper/Magazine Article
4 actions to reduce medical errors in U.S. hospitals.
Citation Text:
4 actions to reduce medical errors in U.S. hospitals. Toussaint JS, Segel KT. Harvard Business Review. April 20, 2022.
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