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psnet.ahrq.gov/issue/leapfrog-safety-grades-california-hospitals-data-analysis
November 16, 2022 - Study
Leapfrog safety grades in California hospitals: a data analysis.
Citation Text:
Razick D, Amani N, Ali L, et al. Leapfrog safety grades in California hospitals: a data analysis. Am J Med Qual. 2024;39(5):251-255. doi:10.1097/jmq.0000000000000200.
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psnet.ahrq.gov/issue/partners-our-care-patient-safety-patient-perspective
December 04, 2016 - Study
Partners in our care: patient safety from a patient perspective.
Citation Text:
Hovey RB, Morck A, Nettleton S, et al. Partners in our care: patient safety from a patient perspective. Qual Saf Health Care. 2010;19(6):e59. doi:10.1136/qshc.2008.030908.
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psnet.ahrq.gov/issue/predicting-self-intercepted-medication-ordering-errors-using-machine-learning
May 13, 2020 - Study
Predicting self-intercepted medication ordering errors using machine learning.
Citation Text:
King CR, Abraham J, Fritz BA, et al. Predicting self-intercepted medication ordering errors using machine learning. PLoS One. 2021;16(7):e0254358. doi:10.1371/journal.pone.0254358.
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psnet.ahrq.gov/issue/pharmacist-led-educational-interventions-provided-healthcare-providers-reduce-medication
October 14, 2020 - Study
Pharmacist-led educational interventions provided to healthcare providers to reduce medication errors: a systematic review and meta-analysis.
Citation Text:
Jaam M, Naseralallah LM, Hussain TA, et al. Pharmacist-led educational interventions provided to healthcare providers to redu…
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psnet.ahrq.gov/issue/body-evidence-do-autopsy-findings-impact-medical-malpractice-claim-outcomes
August 19, 2020 - Study
Body of evidence: do autopsy findings impact medical malpractice claim outcomes?
Citation Text:
Gartland RM, Myers LC, Iorgulescu JB, et al. Body of evidence: do autopsy findings impact medical malpractice claim outcomes? J Patient Saf. 2020;17(8):576-582. doi:10.1097/pts.000000000…
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psnet.ahrq.gov/issue/communication-relating-family-members-involvement-and-understandings-about-patients
June 16, 2021 - Study
Communication relating to family members' involvement and understandings about patients' medication management in hospital.
Citation Text:
Manias E. Communication relating to family members' involvement and understandings about patients' medication management in hospital. Health Ex…
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psnet.ahrq.gov/issue/automated-communication-tools-and-computer-based-medication-reconciliation-decrease-hospital
September 23, 2020 - Study
Automated communication tools and computer-based medication reconciliation to decrease hospital discharge medication errors.
Citation Text:
Smith KJ, Handler S, Kapoor WN, et al. Automated Communication Tools and Computer-Based Medication Reconciliation to Decrease Hospital Dischar…
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psnet.ahrq.gov/issue/leveraging-safety-event-management-system-improve-organizational-learning-and-safety-culture
August 01, 2018 - Study
Leveraging a safety event management system to improve organizational learning and safety culture.
Citation Text:
Dawson R, Saulnier T, Campbell A, et al. Leveraging a safety event management system to improve organizational learning and safety culture. Hosp Pediatr. 2022;12(4):407…
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psnet.ahrq.gov/issue/reducing-drug-prescription-errors-and-adverse-drug-events-application-probabilistic-machine
March 12, 2025 - Study
Reducing drug prescription errors and adverse drug events by application of a probabilistic, machine-learning based clinical decision support system in an inpatient setting.
Citation Text:
Segal G, Segev A, Brom A, et al. Reducing drug prescription errors and adverse drug events by…
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psnet.ahrq.gov/issue/impact-computerised-physician-order-entry-and-clinical-decision-support-pharmacist-physician
August 24, 2016 - Study
The impact of computerised physician order entry and clinical decision support on pharmacist–physician communication in the hospital setting: a qualitative study.
Citation Text:
Pontefract SK, Coleman JJ, Vallance HK, et al. The impact of computerised physician order entry and clin…
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psnet.ahrq.gov/issue/reduce-likelihood-patient-harm-associated-use-anticoagulant-therapy-commentary
November 07, 2018 - Commentary
Reduce the likelihood of patient harm associated with the use of anticoagulant therapy: commentary from the Anticoagulation Forum on the Updated Joint Commission NPSG.03.05.01 Elements of Performance
Citation Text:
Dager WE, Ansell J, Barnes GD, et al. “Reduce the Likelihood o…
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psnet.ahrq.gov/issue/real-time-automated-paging-and-decision-support-critical-laboratory-abnormalities
April 30, 2014 - Study
Real-time automated paging and decision support for critical laboratory abnormalities.
Citation Text:
Etchells E, Adhikari NKJ, Wu RC, et al. Real-time automated paging and decision support for critical laboratory abnormalities. BMJ Qual Saf. 2011;20(11):924-30. doi:10.1136/bmjqs…
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psnet.ahrq.gov/issue/handoff-strategies-settings-high-consequences-failure-lessons-health-care-operations
March 14, 2018 - Study
Classic
Handoff strategies in settings with high consequences for failure: lessons for health care operations.
Citation Text:
Patterson ES. Handoff strategies in settings with high consequences for failure: lessons for health care operations. Int J Qual …
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psnet.ahrq.gov/issue/covid-19-pandemic-resilient-organisational-response-low-chance-high-impact-event
October 07, 2020 - Commentary
The COVID-19 pandemic: resilient organisational response to a low-chance, high-impact event.
Citation Text:
Lloyd-Smith MK. The COVID-19 pandemic: resilient organisational response to a low-chance, high-impact event. BMJ Leader. 2020;4:109-112. doi:10.1136/leader-2020-000245. …
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psnet.ahrq.gov/issue/meitheal-pharmaceuticals-inc-issues-voluntary-nationwide-recall-cisatracurium-besylate
February 03, 2021 - Press Release/Announcement
Meitheal Pharmaceuticals, Inc. issues voluntary nationwide recall of Cisatracurium Besylate Injection, USP 10mg per 5mL due to mislabeling.
Citation Text:
Meitheal Pharmaceuticals, Inc. issues voluntary nationwide recall of Cisatracurium Besylate Injection, USP…
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psnet.ahrq.gov/issue/study-error-reporting-nurses-significant-impact-nursing-team-dynamics
April 12, 2014 - Study
A study of error reporting by nurses: the significant impact of nursing team dynamics.
Citation Text:
Munn LT, Lynn MR, Knafl GJ, et al. A study of error reporting by nurses: the significant impact of nursing team dynamics. J Res Nurs. 2023;28(5):354-364. doi:10.1177/17449871231194…
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psnet.ahrq.gov/issue/transition-planning-senior-surgeon-guidance-and-recommendations-society-surgical-chairs
August 14, 2019 - Commentary
Transition planning for the senior surgeon: guidance and recommendations from the Society of Surgical Chairs.
Citation Text:
Rosengart TK, Doherty G, Higgins R, et al. Transition Planning for the Senior Surgeon: Guidance and Recommendations From the Society of Surgical Chairs.…
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psnet.ahrq.gov/issue/assessing-adverse-events-after-chiropractic-care-chiropractic-teaching-clinic-active
December 23, 2020 - Study
Assessing adverse events after chiropractic care at a chiropractic teaching clinic: an active-surveillance pilot study.
Citation Text:
Pohlman KA, Funabashi M, Ndetan H, et al. Assessing adverse events after chiropractic care at a chiropractic teaching clinic: an active-surveillanc…
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psnet.ahrq.gov/issue/moving-toward-improved-teamwork-cancer-care-role-psychological-safety-team-communication
October 19, 2012 - Review
Moving toward improved teamwork in cancer care: the role of psychological safety in team communication.
Citation Text:
Jain AK, Fennell ML, Chagpar AB, et al. Moving Toward Improved Teamwork in Cancer Care: The Role of Psychological Safety in Team Communication. J Oncol Pract. 201…
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psnet.ahrq.gov/node/49630/psn-pdf
July 01, 2011 - doctor at the time of discharge, or immediately faxed a
discharge summary or letter to convey the last measured … Effect of a simple two-step warfarin dosing algorithm on
anticoagulant control as measured by time in