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psnet.ahrq.gov/issue/role-patient-safety-culture-causation-unintended-events-hospitals
October 14, 2009 - Study
The role of patient safety culture in the causation of unintended events in hospitals.
Citation Text:
Smits M, Wagner C, Spreeuwenberg P, et al. The role of patient safety culture in the causation of unintended events in hospitals. J Clin Nurs. 2012;21(23-24):3392-401. doi:10.1111…
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psnet.ahrq.gov/issue/canary-measures-among-ahrq-patient-safety-indicators
November 27, 2012 - Study
"Canary measures" among the AHRQ Patient Safety Indicators.
Citation Text:
Yu H, Greenberg MD, Haviland AM, et al. "Canary measures" among the AHRQ patient safety indicators. Am J Med Qual. 2009;24(6):465-73. doi:10.1177/1062860609341585.
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psnet.ahrq.gov/issue/under-mined
October 27, 2010 - Newspaper/Magazine Article
Under-mined.
Citation Text:
Greene J. Under-mined. Hospitals & health networks. 2006;80(12):38-40, 42, 44, 1.
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psnet.ahrq.gov/issue/state-science-human-factors-and-ergonomics-healthcare
April 01, 2015 - Commentary
State of science: human factors and ergonomics in healthcare.
Citation Text:
Hignett S, Carayon P, Buckle P, et al. State of science: human factors and ergonomics in healthcare. Ergonomics. 2013;56(10):1491-503. doi:10.1080/00140139.2013.822932.
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psnet.ahrq.gov/issue/using-survey-incident-reporting-and-learning-practices-improve-organisational-learning-cancer
June 30, 2011 - Study
Using a survey of incident reporting and learning practices to improve organisational learning at a cancer care centre.
Citation Text:
Cooke DL, Dunscombe PB, Lee R. Using a survey of incident reporting and learning practices to improve organisational learning at a cancer care ce…
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psnet.ahrq.gov/issue/diagnosis-reducing-errors-and-improving-quality
October 12, 2022 - Book/Report
Diagnosis: Reducing Errors and Improving Quality.
Citation Text:
Diagnosis: Reducing Errors and Improving Quality. Schiff G. Chapter In: Loscalzo J, Fauci A, Kasper D, et al, eds. Harrison's Principles of Internal Medicine, 21e. New York, NY: McGraw Hill; 2022
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psnet.ahrq.gov/issue/human-factors-healthcare-welcome-progress-still-scratching-surface
June 16, 2021 - Commentary
Human factors in healthcare: welcome progress, but still scratching the surface.
Citation Text:
Waterson P, Catchpole K. Human factors in healthcare: welcome progress, but still scratching the surface. BMJ Qual Saf. 2016;25(7):480-4. doi:10.1136/bmjqs-2015-005074.
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psnet.ahrq.gov/issue/medication-errors-chemotherapy-incidence-types-and-involvement-patients-prevention-review
February 01, 2011 - Review
Medication errors in chemotherapy: incidence, types and involvement of patients in prevention. A review of the literature.
Citation Text:
Schwappach DLB, Wernli M. Medication errors in chemotherapy: incidence, types and involvement of patients in prevention. A review of the lite…
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psnet.ahrq.gov/issue/va-health-care-va-uses-medical-injury-tort-claims-data-assess-veterans-care-should-take
February 10, 2010 - Government Resource
VA Health Care: VA Uses Medical Injury Tort Claims Data to Assess Veterans’ Care, but Should Take Action to Ensure That These Data Are Complete.
Citation Text:
VA Health Care: VA Uses Medical Injury Tort Claims Data to Assess Veterans’ Care, but Should Take Action t…
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psnet.ahrq.gov/issue/identifying-and-understanding-ways-address-impact-racism-patient-safety-health-care-settings
May 21, 2014 - Book/Report
Identifying and Understanding Ways to Address the Impact of Racism on Patient Safety in Health Care Settings.
Citation Text:
Identifying and Understanding Ways to Address the Impact of Racism on Patient Safety in Health Care Settings. Schulson LB, Thomas AD, Tsuei J, et al.&n…
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psnet.ahrq.gov/issue/cognitive-errors-and-logistical-breakdowns-contributing-missed-and-delayed-diagnoses-breast
March 02, 2011 - Study
Cognitive errors and logistical breakdowns contributing to missed and delayed diagnoses of breast and colorectal cancers: a process analysis of closed malpractice claims.
Citation Text:
Poon EG, Kachalia A, Puopolo AL, et al. Cognitive errors and logistical breakdowns contributin…
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psnet.ahrq.gov/issue/improving-self-reporting-adverse-drug-events-west-virginia-hospital
March 10, 2011 - Study
Improving self-reporting of adverse drug events in a West Virginia hospital.
Citation Text:
Schade CP, Hannah K, Ruddick P, et al. Improving self-reporting of adverse drug events in a West Virginia hospital. Am J Med Qual. 2006;21(5):335-41.
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psnet.ahrq.gov/issue/auto-identification-technology-and-its-impact-patient-safety-operating-room-future
June 22, 2009 - Commentary
Auto identification technology and its impact on patient safety in the operating room of the future.
Citation Text:
Egan MT, Sandberg WS. Auto identification technology and its impact on patient safety in the Operating Room of the Future. Surg Innov. 2007;14(1):41-50; discus…
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psnet.ahrq.gov/issue/how-deal-disruptive-physician-behavior
December 02, 2020 - Commentary
How to "DEAL" with disruptive physician behavior.
Citation Text:
Junga Z, Tritsch A, Singla M. How to “DEAL” With disruptive physician behavior. Gastroenterology. 2019;157(6):1469-1472. doi:10.1053/j.gastro.2019.10.021.
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psnet.ahrq.gov/issue/frequency-type-and-clinical-importance-medication-history-errors-admission-hospital
September 23, 2020 - Review
Frequency, type and clinical importance of medication history errors at admission to hospital: a systematic review.
Citation Text:
Tam VC. Frequency, type and clinical importance of medication history errors at admission to hospital: a systematic review. Can Med Assoc J. 2005;17…
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psnet.ahrq.gov/issue/piece-my-mind-patient-you-least-want-see
August 14, 2024 - Commentary
A piece of my mind. The patient you least want to see.
Citation Text:
Chen JH. A PIECE OF MY MIND. The Patient You Least Want to See. JAMA. 2016;315(16):1701-2. doi:10.1001/jama.2016.0221.
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psnet.ahrq.gov/issue/cognitive-forcing-tool-mitigate-cognitive-bias-randomised-control-trial
November 07, 2018 - Study
A cognitive forcing tool to mitigate cognitive bias—a randomised control trial.
Citation Text:
O'Sullivan ED, Schofield SJ. A cognitive forcing tool to mitigate cognitive bias - a randomised control trial. BMC Med Educ. 2019;19(1):12. doi:10.1186/s12909-018-1444-3.
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psnet.ahrq.gov/issue/survey-results-smart-pump-data-analytics-pump-metrics-should-be-monitored-improve-safety
August 08, 2018 - Newspaper/Magazine Article
Survey results: smart pump data analytics pump metrics that should be monitored to improve safety.
Citation Text:
Survey results: smart pump data analytics pump metrics that should be monitored to improve safety. ISMP Medication Safety Alert! Acute care edition…
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psnet.ahrq.gov/issue/evaluation-causes-and-frequency-medication-errors-during-information-technology-downtime
October 03, 2011 - Study
Evaluation of causes and frequency of medication errors during information technology downtime.
Citation Text:
Hanuscak TL, Szeinbach SL, Seoane-Vazquez E, et al. Evaluation of causes and frequency of medication errors during information technology downtime. Am J Health Syst Pharm…
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psnet.ahrq.gov/issue/medication-error-alerts-warfarin-orders-detected-bar-code-assisted-medication-administration
July 03, 2014 - Study
Medication-error alerts for warfarin orders detected by a bar-code-assisted medication administration system.
Citation Text:
FitzHenry F, Doran J, Lobo B, et al. Medication-error alerts for warfarin orders detected by a bar-code-assisted medication administration system. Am J Hea…