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psnet.ahrq.gov/issue/patient-safety-and-diagnostic-error-tips-your-next-shift
January 15, 2009 - Commentary
Patient safety and diagnostic error: tips for your next shift.
Citation Text:
Sinclair D, Croskerry P. Patient safety and diagnostic error: tips for your next shift. Can Fam Physician. 2010;56(1):28-30.
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psnet.ahrq.gov/issue/dangerous-deception-hiding-evidence-adverse-drug-events
November 09, 2022 - Commentary
Dangerous deception--hiding the evidence of adverse drug events.
Citation Text:
Avorn J. Dangerous deception--hiding the evidence of adverse drug effects. N Engl J Med. 2006;355(21):2169-71.
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psnet.ahrq.gov/issue/observational-assessment-surgical-teamwork-feasibility-study
August 18, 2017 - Study
Observational assessment of surgical teamwork: a feasibility study.
Citation Text:
Undre S, Healey A, Darzi A, et al. Observational assessment of surgical teamwork: a feasibility study. World J Surg. 2006;30(10):1774-83.
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psnet.ahrq.gov/issue/technology-education-and-safety-3
October 11, 2023 - Special or Theme Issue
Technology, Education and Safety.
Citation Text:
Technology, Education and Safety. Harbell MW, ed. Curr Opin Anaesthesiol. 2024;37(6):666-742.
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psnet.ahrq.gov/issue/disclosing-adverse-events-patients
September 23, 2020 - Commentary
Disclosing adverse events to patients.
Citation Text:
Cantor MD, Barach P, Derse A, et al. Disclosing adverse events to patients. Jt Comm J Qual Patient Saf. 2005;31(1):5-12.
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psnet.ahrq.gov/issue/medical-emergency-team-review-literature
March 02, 2011 - Review
Medical emergency team: a review of the literature.
Citation Text:
Barbetti J, Lee G. Medical emergency team: a review of the literature. Nurs Crit Care. 2008;13(2):80-85. doi:10.1111/j.1478-5153.2007.00258.x.
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psnet.ahrq.gov/issue/safety-hospital-stroke-care
December 02, 2020 - Study
The safety of hospital stroke care.
Citation Text:
Holloway RG, Tuttle D, Baird T, et al. The safety of hospital stroke care. Neurology. 2007;68(8):550-555.
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psnet.ahrq.gov/issue/intrahospital-transport-radiology-department-risk-adverse-events-nursing-surveillance
September 04, 2013 - Commentary
Intrahospital transport to the radiology department: risk for adverse events, nursing surveillance, utilization of a MET and practice implications.
Citation Text:
Ott LK, Hoffman LA, Hravnak M. Intrahospital Transport to the Radiology Department: Risk for Adverse Events, Nur…
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psnet.ahrq.gov/issue/factors-influencing-patient-safety-during-postoperative-handover
March 03, 2021 - Review
Factors influencing patient safety during postoperative handover.
Citation Text:
Factors influencing patient safety during postoperative handover. Rose M, Newman SD. AANA J. 2016;84:329-338.
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psnet.ahrq.gov/issue/perinatal-clinical-decision-support-system-documentation-tool-patient-safety
December 12, 2014 - Commentary
Perinatal clinical decision support system: a documentation tool for patient safety.
Citation Text:
Provost C, Gray M. Perinatal clinical decision support system: a documentation tool for patient safety. Nurs Womens Health. 2007;11(4):407-10.
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psnet.ahrq.gov/issue/debriefing-after-critical-incidents-anaesthetic-trainees
June 10, 2020 - Study
Debriefing after critical incidents for anaesthetic trainees.
Citation Text:
Tan H. Debriefing after critical incidents for anaesthetic trainees. Anaesth Intensive Care. 2005;33(6):768-72.
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psnet.ahrq.gov/issue/near-miss-event-analysis-enhances-barcode-medication-administration-process
February 13, 2013 - Newspaper/Magazine Article
Near-miss event analysis enhances the barcode medication administration process.
Citation Text:
Near-miss event analysis enhances the barcode medication administration process. Magee MC; Miller K; Patzek D; Madera C; Michalek C; Shetterly M.
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psnet.ahrq.gov/issue/2004-john-m-eisenberg-patient-safety-and-quality-awards
January 05, 2017 - Special or Theme Issue
The 2004 John M. Eisenberg Patient Safety and Quality Awards.
Citation Text:
The 2004 John M. Eisenberg Patient Safety and Quality Awards. Jt Comm J Qual Saf. 2004;30(12):653-680.
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psnet.ahrq.gov/issue/safe-haven-nurses-report-medication-errors-clarian-and-spectrum-health-systems-prove-it
September 24, 2010 - Commentary
A safe haven for nurses to report medication errors? Clarian and Spectrum Health Systems prove it is possible!
Citation Text:
Paparella S. A Safe Haven for Nurses to Report Medication Errors? Clarian and Spectrum Health Systems Prove It Is Possible!. J Emerg Nurs. 2005;31(4)…
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psnet.ahrq.gov/issue/counting-matters-lessons-root-cause-analysis-retained-surgical-item
January 02, 2017 - Commentary
Counting matters: lessons from the root cause analysis of a retained surgical item.
Citation Text:
Agrawal A. Counting matters: lessons from the root cause analysis of a retained surgical item. Jt Comm J Qual Patient Saf. 2012;38(12):566-574.
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psnet.ahrq.gov/issue/deconstructing-intraoperative-communication-failures
July 25, 2012 - Study
Deconstructing intraoperative communication failures.
Citation Text:
Hu Y-Y, Arriaga AF, Peyre S, et al. Deconstructing intraoperative communication failures. J Surg Res. 2012;177(1):37-42. doi:10.1016/j.jss.2012.04.029.
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www.ahrq.gov/practiceimprovement/systemdesign/leancasestudies/lean-exhibit5-4.html
November 01, 2014 - Improving Care Delivery Through Lean: Implementation Case Studies
Exhibit 5.4. Chronology of Quality Improvement (QI) and Lean at Heights Hospital
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Table of Contents
Improving Care Delivery Through Lean: Implementation Case Studies
Introduction to the Case Studies
Case 1. …
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psnet.ahrq.gov/issue/aftermath-adverse-event-supporting-health-care-professionals-meet-patient-expectations
May 29, 2013 - Review
Aftermath of an adverse event: supporting health care professionals to meet patient expectations through open disclosure.
Citation Text:
Manser T, Staender S. Aftermath of an adverse event: supporting health care professionals to meet patient expectations through open disclosure…
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psnet.ahrq.gov/issue/safe-medication-prescribing-and-monitoring-outpatient-setting
January 06, 2018 - Commentary
Safe medication prescribing and monitoring in the outpatient setting.
Citation Text:
Shojania KG. Safe medication prescribing and monitoring in the outpatient setting. Can Med Assoc J. 2006;174(9). doi:10.1503/cmaj.050984.
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psnet.ahrq.gov/issue/cms-your-mistake-your-problem
November 16, 2022 - Newspaper/Magazine Article
CMS: your mistake, your problem.
Citation Text:
Lubell J. CMS: your mistake, your problem. Eight hospital-acquired conditions won't be paid for. Modern healthcare. 2007;37(33):10-1.
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