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  1. psnet.ahrq.gov/issue/patient-provider-and-system-factors-contributing-patient-safety-events-during-medical-and
    November 18, 2016 - Study Patient, provider, and system factors contributing to patient safety events during medical and surgical hospitalizations for persons with serious mental illness. Citation Text: McGinty EE, Thompson DA, Pronovost P, et al. Patient, provider, and system factors contributing to patien…
  2. psnet.ahrq.gov/issue/preventability-voluntarily-reported-or-trigger-tool-identified-medication-errors-pediatric
    September 01, 2016 - Study Preventability of voluntarily reported or trigger tool–identified medication errors in a pediatric institution by information technology: a retrospective cohort study. Citation Text: Stultz JS, Nahata MC. Preventability of Voluntarily Reported or Trigger Tool-Identified Medication …
  3. psnet.ahrq.gov/issue/accuracy-practitioner-estimates-probability-diagnosis-and-after-testing
    May 05, 2021 - Study Accuracy of practitioner estimates of probability of diagnosis before and after testing. Citation Text: Morgan DJ, Pineles L, Owczarzak J, et al. Accuracy of practitioner estimates of probability of diagnosis before and after testing. JAMA Intern Med. 2021;181(6):747-755. doi:10.10…
  4. psnet.ahrq.gov/issue/developing-implementing-evaluating-electronic-apparent-cause-analysis-across-health-care
    February 07, 2018 - Study Developing, implementing, evaluating electronic apparent cause analysis across a health care system. Citation Text: Oster CA, Woods E, Mumma J, et al. Developing, implementing, evaluating electronic apparent cause analysis across a health care system. Jt Comm J Qual Patient Saf. 2…
  5. psnet.ahrq.gov/issue/medication-incident-recovery-and-prevention-utilising-australian-community-pharmacy-incident
    July 28, 2021 - Study Medication incident recovery and prevention utilising an Australian community pharmacy incident reporting system: the QUMwatch study. Citation Text: Adie K, Fois RA, McLachlan AJ, et al. Medication incident recovery and prevention utilising an Australian community pharmacy incident…
  6. psnet.ahrq.gov/issue/achieving-national-quality-forums-never-events-prevention-wrong-site-wrong-procedure-and
    September 28, 2010 - Review Achieving the National Quality Forum's "Never Events": prevention of wrong site, wrong procedure, and wrong patient operations. Citation Text: Michaels RK, Makary MA, Dahab Y, et al. Achieving the National Quality Forum's "Never Events": prevention of wrong site, wrong procedure…
  7. psnet.ahrq.gov/issue/development-and-evaluation-patient-safety-interventions-perspectives-operational-safety
    February 26, 2025 - Study Development and evaluation of patient safety interventions: perspectives of operational safety leaders and patient safety organizations. Citation Text: Gomes KM, Handley J, Pruitt ZM, et al. Development and evaluation of patient safety interventions: perspectives of operational saf…
  8. psnet.ahrq.gov/issue/medication-errors-and-processes-reduce-them-care-homes-united-kingdom-scoping-review
    October 28, 2020 - Review Medication errors and processes to reduce them in care homes in the United Kingdom: a scoping review. Citation Text: Irons MW, Auta A, Portlock JC, et al. Medication errors and processes to reduce them in care homes in the United Kingdom: a scoping review. Home Health Care Serv Q.…
  9. psnet.ahrq.gov/issue/defining-estimating-and-communicating-overdiagnosis-cancer-screening
    October 13, 2018 - Commentary Defining, estimating, and communicating overdiagnosis in cancer screening. Citation Text: Davies L, Petitti DB, Martin L, et al. Defining, estimating, and communicating overdiagnosis in cancer screening. Ann Intern Med. 2018;169(1):36-43. doi:10.7326/M18-0694. Copy Citation …
  10. psnet.ahrq.gov/issue/systematic-review-natural-language-processing-classification-tasks-field-incident-reporting
    October 18, 2018 - Review Emerging Classic A systematic review of natural language processing for classification tasks in the field of incident reporting and adverse event analysis. Citation Text: Young IJB, Luz S, Lone N. A systematic review of natural language processing for cla…
  11. psnet.ahrq.gov/issue/impact-communication-and-patient-hand-tool-sbar-patient-safety-systematic-review
    July 07, 2021 - Review Classic Impact of the communication and patient hand-off tool SBAR on patient safety: a systematic review. Citation Text: Müller M, Jürgens J, Redaèlli M, et al. Impact of the communication and patient hand-off tool SBAR on patient safety: a systematic re…
  12. psnet.ahrq.gov/issue/abusive-supervision-systematic-review-and-fundamental-rethink
    May 18, 2022 - Review Abusive supervision: a systematic review and fundamental rethink. Citation Text: Fischer T, Tian AW, Lee A, et al. Abusive supervision: a systematic review and fundamental rethink. The Leadership Q. 2021;32(6):101540. doi:10.1016/j.leaqua.2021.101540. Copy Citation Format: …
  13. psnet.ahrq.gov/issue/mobile-physician-reporting-clinically-significant-events-novel-way-improve-handoff
    September 14, 2011 - Study Mobile physician reporting of clinically significant events—a novel way to improve handoff communication and supervision of resident on call activities. Citation Text: Nabors C, Peterson SJ, Aronow WS, et al. Mobile physician reporting of clinically significant events-a novel way t…
  14. psnet.ahrq.gov/issue/diagnostic-error-children-presenting-acute-medical-illness-community-hospital
    September 25, 2011 - Study Diagnostic error in children presenting with acute medical illness to a community hospital. Citation Text: Warrick C, Patel P, Hyer W, et al. Diagnostic error in children presenting with acute medical illness to a community hospital. Int J Qual Health Care. 2014;26(5):538-46. doi:1…
  15. psnet.ahrq.gov/issue/linking-patient-safety-culture-quality-ratings-nursing-home-setting
    June 29, 2022 - Study Linking patient safety culture to quality ratings in the nursing home setting. Citation Text: Yount N, Zebrak KA, Famolaro T, et al. Linking Patient Safety Culture to Quality Ratings in the Nursing Home Setting. J Appl Gerontol. 2021;41(1):73-81. doi:10.1177/0733464820969283. Cop…
  16. psnet.ahrq.gov/issue/does-nursing-home-compare-reflect-patient-safety-nursing-homes
    February 10, 2015 - Study Does Nursing Home Compare reflect patient safety in nursing homes? Citation Text: Brauner D, Werner RM, Shippee TP, et al. Does Nursing Home Compare Reflect Patient Safety In Nursing Homes? Health Aff (Millwood). 2018;37(11):1770-1778. doi:10.1377/hlthaff.2018.0721. Copy Citation…
  17. psnet.ahrq.gov/issue/recruitment-hospitals-safety-climate-study-facilitators-and-barriers
    June 16, 2011 - Study Recruitment of hospitals for a safety climate study: facilitators and barriers. Citation Text: Rosen AK, Gaba DM, Meterko M, et al. Recruitment of hospitals for a safety climate study: facilitators and barriers. Jt Comm J Qual Patient Saf. 2008;34(5):275-84. Copy Citation For…
  18. psnet.ahrq.gov/issue/effect-race-and-sex-physicians-recommendations-cardiac-catheterization
    July 15, 2020 - Study The effect of race and sex on physicians' recommendations for cardiac catheterization. Citation Text: Schulman KA, Berlin JA, Harless W, et al. The effect of race and sex on physicians' recommendations for cardiac catheterization. N Engl J Med. 2002;340(8):618-626. doi:10.1056/nejm…
  19. psnet.ahrq.gov/issue/high-fidelity-simulation-based-interdisciplinary-operating-room-team-training-point-care
    September 16, 2009 - Study High-fidelity, simulation-based, interdisciplinary operating room team training at the point of care. Citation Text: Paige JT, Kozmenko V, Yang T, et al. High-fidelity, simulation-based, interdisciplinary operating room team training at the point of care. Surgery. 2009;145(2):138…
  20. Psn-Pdf (pdf file)

    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

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