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psnet.ahrq.gov/node/73479/psn-pdf
July 07, 2021 - Mitigating the July effect.
July 7, 2021
Wu AW, Vincent CA, Shapiro DW, et al. Mitigating the July effect. J Patient Saf Risk Manag.
2021;26(3):93-96. doi:10.1177/25160435211019142.
https://psnet.ahrq.gov/issue/mitigating-july-effect
The July effect is a phenomenon that presumably results in poor care due to the a…
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psnet.ahrq.gov/node/845079/psn-pdf
February 22, 2023 - Pump up the volume: how to prioritize events and analyze
error data.
February 22, 2023
ISMP Medication Safety Alert! Acute care edition. February 9, 2023;28(3):1-4.
https://psnet.ahrq.gov/issue/pump-volume-how-prioritize-events-and-analyze-error-data
Patient safety event reporting is an established component of a …
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psnet.ahrq.gov/node/36841/psn-pdf
December 31, 2014 - Using medical malpractice closed claims data to reduce
surgical risk and improve patient safety.
December 31, 2014
Manuel BM, Greenwald LM. Using medical malpractice closed claims data to reduce surgical risk and
improve patient safety. Bull Am Coll Surg. 2007;92(3):27-30.
https://psnet.ahrq.gov/issue/using-medica…
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psnet.ahrq.gov/node/855435/psn-pdf
November 15, 2023 - Technology, Education and Safety
November 15, 2023
Arnal-Velasco, D, ed. Curr Opin Anaesthesiol. 2023;36(6):649-705.
https://psnet.ahrq.gov/issue/technology-education-and-safety-2
Adoption of new ideas is necessary to create safety in the perioperative environment. This collection of
reviews illustrates relationsh…
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psnet.ahrq.gov/node/35859/psn-pdf
July 22, 2010 - A multifaceted approach to improve patient safety,
prevent medical errors and resolve the professional
liability crisis.
July 22, 2010
Weinstein L. A multifacited approach to improve patient safety, prevent medical errors and resolve the
professional liability crisis. Am J Obstet Gynecol. 2006;194(4):1160-5; discu…
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psnet.ahrq.gov/node/38269/psn-pdf
October 01, 2024 - Nursing Home Survey on Patient Safety Culture.
October 1, 2024
Rockville, MD: Agency for Healthcare Research and Quality; October 2020.
https://psnet.ahrq.gov/issue/nursing-home-survey-patient-safety-culture
Challenges to establishing and sustaining a safety culture in a nursing home include insufficient staffing
…
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psnet.ahrq.gov/node/34655/psn-pdf
May 21, 2019 - Organizational culture as a source of high reliability.
May 21, 2019
Weick KE. Organizational Culture as a Source of High Reliability. Calif Manage Rev. 2012;29(2):112-127.
doi:10.2307/41165243.
https://psnet.ahrq.gov/issue/organizational-culture-source-high-reliability
The author proposes that, as organizations a…
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psnet.ahrq.gov/node/45750/psn-pdf
February 01, 2017 - Cognitive biases associated with medical decisions: a
systematic review.
February 1, 2017
Saposnik G, Redelmeier DA, Ruff CC, et al. Cognitive biases associated with medical decisions: a
systematic review. BMC Med Inform Decis Mak. 2016;16(1):138.
https://psnet.ahrq.gov/issue/cognitive-biases-associated-medical-de…
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psnet.ahrq.gov/node/73606/psn-pdf
August 18, 2021 - Broadening the concept of patient safety culture through
value-based healthcare.
August 18, 2021
Dombrádi V, Bíró K, Jonitz G, et al. Broadening the concept of patient safety culture through value-based
healthcare. J Health Organ Manag. 2021;35(5):541-549. doi:10.1108/jhom-07-2020-0287.
https://psnet.ahrq.gov/issu…
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psnet.ahrq.gov/node/45994/psn-pdf
January 01, 2019 - Common predictors of nurse-reported quality of care and
patient safety.
December 21, 2018
Stimpfel AW, Djukic M, Brewer CS, et al. Common predictors of nurse-reported quality of care and patient
safety. Health Care Manage Rev. 2019;44(1):57-66. doi:10.1097/HMR.0000000000000155.
https://psnet.ahrq.gov/issue/common-…
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psnet.ahrq.gov/node/45801/psn-pdf
August 03, 2017 - Overcoming diagnostic errors in medical practice.
August 3, 2017
Bordini BJ, Stephany A, Kliegman RM. Overcoming Diagnostic Errors in Medical Practice. J Pediatr.
2017;185. doi:10.1016/j.jpeds.2017.02.065.
https://psnet.ahrq.gov/issue/overcoming-diagnostic-errors-medical-practice
This commentary describes a progra…
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psnet.ahrq.gov/node/43898/psn-pdf
February 11, 2015 - Special Section on Patient Safety and Quality in
Healthcare.
February 11, 2015
Andersen HB, Lipczak H, Borch-Johnsen K, eds. Cogn Technol Work. 2015;17:1-155.
https://psnet.ahrq.gov/issue/special-section-patient-safety-and-quality-healthcare
Articles in this special issue explore patient safety from a sociotechnic…
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psnet.ahrq.gov/node/39220/psn-pdf
January 13, 2010 - The relationship between physician practice
characteristics and physician adoption of electronic
health records.
January 13, 2010
Bramble JD, Galt KA, Siracuse M, et al. The relationship between physician practice characteristics and
physician adoption of electronic health records. Health Care Manag Rev. 2010;35(1…
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psnet.ahrq.gov/node/46026/psn-pdf
May 03, 2017 - Key principles in quality and safety in radiology.
May 3, 2017
Abujudeh H, Kaewlai R, Shaqdan K, et al. Key Principles in Quality and Safety in Radiology. American
Journal of Roentgenology. 2017;208(3). doi:10.2214/ajr.16.16951.
https://psnet.ahrq.gov/issue/key-principles-quality-and-safety-radiology
This review s…
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psnet.ahrq.gov/node/42727/psn-pdf
November 13, 2013 - Impact of electronic health record systems on information
integrity: quality and safety implications.
November 13, 2013
Bowman S. Impact of electronic health record systems on information integrity: quality and safety
implications. Perspect Health Inf Manag. 2013;10:1c.
https://psnet.ahrq.gov/issue/impact-electron…
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psnet.ahrq.gov/node/50387/psn-pdf
September 25, 2019 - Special Issue on Prescription Drug Misuse.
September 25, 2019
Rickles NM, Fleming ML, Björnsdottir I, eds. Res Social Adm Pharm. 2019;15:907-1056.
https://psnet.ahrq.gov/issue/special-issue-prescription-drug-misuse
This special issue reviews research initiatives exploring persistent challenges associated with the
…
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psnet.ahrq.gov/node/34602/psn-pdf
February 17, 2009 - Disclosure of unanticipated events: the next step in better
communication with patients (part 1 of 3).
February 17, 2009
Chicago, IL; American Society of Healthcare Risk Management: 2003.
https://psnet.ahrq.gov/issue/disclosure-unanticipated-events-next-step-better-communication-patients-part-
1-3
The change in t…
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psnet.ahrq.gov/node/60935/psn-pdf
September 23, 2020 - Resilience from a stakeholder perspective: the role of
next of kin in cancer care.
September 23, 2020
Bergerød IJ, Braut GS, Wiig S. Resilience from a stakeholder perspective: the role of next of kin in cancer
care. J Patient Saf. 2020;16(3):e205-e210. doi:10.1097/pts.0000000000000532.
https://psnet.ahrq.gov/issue…
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psnet.ahrq.gov/node/46341/psn-pdf
August 16, 2017 - In treating sepsis, questions about timing and mandates.
August 16, 2017
Abbasi J. In Treating Sepsis, Questions About Timing and Mandates. JAMA. 2017;318(6):506-508.
doi:10.1001/jama.2017.7997.
https://psnet.ahrq.gov/issue/treating-sepsis-questions-about-timing-and-mandates
Delayed treatment of sepsis can result …
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psnet.ahrq.gov/node/46043/psn-pdf
April 05, 2017 - High-reliability and the I-PASS communication tool.
April 5, 2017
Clements K. High-reliability and the I-PASS communication tool. Nursing Management (Springhouse).
2017;48(3). doi:10.1097/01.numa.0000512897.68425.e5.
https://psnet.ahrq.gov/issue/high-reliability-and-i-pass-communication-tool
High reliability has y…