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psnet.ahrq.gov/issue/disclosure-adverse-events-pediatrics
April 21, 2021 - Organizational Policy/Guidelines
Disclosure of adverse events in pediatrics.
Citation Text:
Disclosure of adverse events in pediatrics. McDonnell WM; Altman RL; Bondi SA et al for the Committee on Medical Liability and Risk Management; Council on Quality Improvement and Patient Safety. P…
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psnet.ahrq.gov/issue/learning-and-mindfulness-improving-perioperative-patient-safety
January 12, 2022 - Commentary
Learning and mindfulness: improving perioperative patient safety.
Citation Text:
Graling PR, Sanchez JA. Learning and mindfulness: improving perioperative patient safety. AORN J. 2017;105(3):317-321. doi:10.1016/j.aorn.2017.01.006.
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psnet.ahrq.gov/issue/using-good-catches-promote-just-culture-and-perioperative-patient-safety
July 18, 2018 - Commentary
Using good catches to promote a just culture and perioperative patient safety.
Citation Text:
Monahan JJ. Using Good Catches to Promote a Just Culture and Perioperative Patient Safety. AORN J. 2018;108(5):548-552. doi:10.1002/aorn.12394.
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psnet.ahrq.gov/issue/disclosing-harmful-medical-errors-patients
July 10, 2008 - Review
Disclosing harmful medical errors to patients.
Citation Text:
Gallagher TH, Studdert DM, Levinson W. Disclosing harmful medical errors to patients. N Engl J Med. 2007;356(26):2713-9.
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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/medication-errors-anaesthesia-and-critical-care
January 18, 2011 - Review
Medication errors in anaesthesia and critical care.
Citation Text:
Wheeler SJ, Wheeler DW. Medication errors in anaesthesia and critical care. Anaesthesia. 2005;60(3):257-73.
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psnet.ahrq.gov/issue/path-safety-benefits-2005-patient-safety-and-quality-improvement-act
June 03, 2015 - Commentary
Path to safety: benefits of the 2005 Patient Safety and Quality Improvement Act.
Citation Text:
McBride D, Greening A, Redmond D. Path to safety: benefits of the 2005 Patient Safety and Quality Improvement Act. Healthc Financ Manage. 2006;60(6):84-8.
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psnet.ahrq.gov/node/73630/psn-pdf
August 25, 2021 - Towards safer healthcare: qualitative insights from a
process view of organisational learning from failure.
August 25, 2021
Monazam Tabrizi N, Masri F. Towards safer healthcare: qualitative insights from a process view of
organisational learning from failure. BMJ Open. 2021;11(8):e048036. doi:10.1136/bmjopen-2020-0…
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psnet.ahrq.gov/node/34713/psn-pdf
February 18, 2011 - The nature of adverse events in hospitalized patients.
Results of the Harvard Medical Practice Study II.
February 18, 2011
Leape L, Brennan TA, Laird N, et al. The nature of adverse events in hospitalized patients. Results of the
Harvard Medical Practice Study II. N Engl J Med. 1991;324(6):377-84.
https://psnet.ah…
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psnet.ahrq.gov/node/38100/psn-pdf
July 02, 2009 - Surgical team behaviors and patient outcomes.
July 2, 2009
Mazzocco K, Petitti DB, Fong KT, et al. Surgical team behaviors and patient outcomes. Am J Surg.
2009;197(5):678-85. doi:10.1016/j.amjsurg.2008.03.002.
https://psnet.ahrq.gov/issue/surgical-team-behaviors-and-patient-outcomes
Direct observation of teamwork…
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psnet.ahrq.gov/node/60297/psn-pdf
January 01, 2021 - A call for the application of patient safety culture in
medical humanitarian action: a literature review.
May 6, 2020
Biquet J-M, Schopper D, Sprumont D, et al. A call for the application of patient safety culture in medical
humanitarian action: a literature review. J Patient Saf. 2021;17(8):e1732-e1737.
doi:10.10…
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psnet.ahrq.gov/node/48178/psn-pdf
January 01, 2020 - ACR guidance document on MR safe practices: updates
and critical information 2019.
August 14, 2019
ACR Committee on MR Safety, Greenberg TD, Hoff MN, Gilk TB, et al. J Magn Reson Imaging.
2020;51(2):331-338.
https://psnet.ahrq.gov/issue/acr-guidance-document-mr-safe-practices-updates-and-critical-inform…
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psnet.ahrq.gov/node/39105/psn-pdf
November 18, 2009 - Predictors of successful implementation of preoperative
briefings and postoperative debriefings after medical
team training.
November 18, 2009
Paull DE, Mazzia L, Izu BS, et al. Predictors of successful implementation of preoperative briefings and
postoperative debriefings after medical team training. Am J Surg. 2…
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psnet.ahrq.gov/node/837730/psn-pdf
January 01, 2023 - Factors influencing medication errors in the prehospital
paramedic environment: a mixed method systematic
review.
July 28, 2022
Walker D, Moloney C, SueSee B, et al. Factors influencing medication errors in the prehospital paramedic
environment: a mixed method systematic review. Prehosp Emerg Care. 2023;27(5):669-…
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psnet.ahrq.gov/node/47250/psn-pdf
September 26, 2018 - Hospital-acquired infections under pay-for-performance
systems: an administrative perspective on management
and change.
September 26, 2018
Vokes RA, Bearman G, Bazzoli GJ. Hospital-Acquired Infections Under Pay-for-Performance Systems: an
Administrative Perspective on Management and Change. Curr Infect Dis Rep. 20…
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psnet.ahrq.gov/node/42964/psn-pdf
May 10, 2014 - What is learning? A review of the safety literature to
define learning from incidents, accidents and disasters.
May 10, 2014
Drupsteen L, Guldenmund FW. What Is Learning? A Review of the Safety Literature to Define Learning
from Incidents, Accidents and Disasters. J Contingencies Crisis Manage. 2014;22(2):81-96.
d…
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psnet.ahrq.gov/node/47374/psn-pdf
April 07, 2019 - Developing a conceptual framework for patient safety
culture in emergency department: a review of the
literature.
April 7, 2019
Alshyyab MA, FitzGerald G, Dingle K, et al. Developing a conceptual framework for patient safety culture in
emergency department: A review of the literature. Int J Health Plann Manage. 20…
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psnet.ahrq.gov/node/61118/psn-pdf
January 01, 2021 - Bracing for the storm: one health care system's planning
for the COVID-19 surge.
November 11, 2020
Kim CS, Meo N, Little D, et al. Bracing for the storm: one health care system's planning for the COVID-19
surge. Jt Comm J Qual Patient Saf. 2021;47(1):60-68. doi:10.1016/j.jcjq.2020.09.007.
https://psnet.ahrq.gov/is…
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psnet.ahrq.gov/node/45445/psn-pdf
September 27, 2016 - Using Kotter's change model for implementing bedside
handoff: a quality improvement project.
September 27, 2016
Small A, Gist D, Souza D, et al. Using Kotter's Change Model for Implementing Bedside Handoff: A Quality
Improvement Project. J Nurs Care Qual. 2016;31(4):304-9. doi:10.1097/NCQ.0000000000000212.
https:/…
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psnet.ahrq.gov/node/39462/psn-pdf
April 21, 2010 - Comparing safety climate in naval aviation and hospitals:
implications for improving patient safety.
April 21, 2010
Singer SJ, Rosen AK, Zhao S, et al. Comparing safety climate in naval aviation and hospitals: implications
for improving patient safety. Health Care Manag Rev. 2010;35(2):134-146.
doi:10.1097/HMR.0b0…