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  1. The science of safety improvement: learning while doing. | PSNet

    psnet.ahrq.gov/issue/science-safety-improvement-learning-while-doing
    August 04, 2021 - Commentary The science of safety improvement: learning while doing. Citation Text: Clancy CM, Berwick DM. The science of safety improvement: learning while doing. Ann Intern Med. 2011;154(10):699-701. doi:10.7326/0003-4819-154-10-201105170-00013. Copy Citation Format: DOI…

  2. Fl19Dataelemandextractandreport (pdf file)

    hcup-us.ahrq.gov/datainnovations/clinicaldata/FL19dataelemandExtractandReport.pdf
    January 01, 2019 - Orderable Test Interface Code Orderable Test Name Result Interface Code Result Name Specimen Type Result Type Units of Measure Method BLGAS BLOOD GAS ANALYSIS O2HB O2HB SYR N % BLGAS BLOOD GAS ANALYSIS HCO3 HCO3 SYR N mEq/L BLGAS BLOOD GAS ANALYSIS PCO2 PCO2 SYR N mmHg CBC CBC WITH DIFFERENTIAL HCT HEMATOCRI…

  3. A system factors analysis of "line, tube, and drain" incidents in the intensive care unit. | PSNet

    psnet.ahrq.gov/issue/system-factors-analysis-line-tube-and-drain-incidents-intensive-care-unit
    December 15, 2011 - Study A system factors analysis of "line, tube, and drain" incidents in the intensive care unit. Citation Text: Needham DM, Sinopoli DJ, Thompson DA, et al. A system factors analysis of "line, tube, and drain" incidents in the intensive care unit. Crit Care Med. 2005;33(8):1701-1707. …

  4. Common Formats for Patient Safety Data Collection: Diagnostic Safety 0.1. | PSNet

    psnet.ahrq.gov/issue/common-formats-patient-safety-data-collection-diagnostic-safety-01
    May 19, 2021 - Press Release/Announcement Common Formats for Patient Safety Data Collection: Diagnostic Safety 0.1. Citation Text: Common Formats for Patient Safety Data Collection: Diagnostic Safety 0.1. The Agency for Healthcare Research and Quality. Fed Register. 2021;86(103): 29263-29264. Copy …

  5. Restoring trust in VA health care. | PSNet

    psnet.ahrq.gov/issue/restoring-trust-va-health-care
    June 21, 2016 - Commentary Restoring trust in VA health care. Citation Text: Kizer KW, Jha AK. Restoring trust in VA health care. N Engl J Med. 2014;371(4):295-297. doi:10.1056/NEJMp1406852. Copy Citation Format: DOI Google Scholar PubMed BibTeX EndNote X3 XML EndNote 7 XML Endnote tagged …

  6. A web-based tool for the Comprehensive Unit-based Safety Program (CUSP). | PSNet

    psnet.ahrq.gov/issue/web-based-tool-comprehensive-unit-based-safety-program-cusp
    January 02, 2017 - Commentary A web-based tool for the Comprehensive Unit-based Safety Program (CUSP). Citation Text: Pronovost P, King J, Holzmueller CG, et al. A web-based tool for the Comprehensive Unit-based Safety Program (CUSP). Jt Comm J Qual Patient Saf. 2006;32(3):119-29. Copy Citation Forma…

  7. Recent Evidence That Health IT Improves Patient Safety: Issue Brief. | PSNet

    psnet.ahrq.gov/issue/recent-evidence-health-it-improves-patient-safety-issue-brief
    June 29, 2016 - Book/Report Recent Evidence That Health IT Improves Patient Safety: Issue Brief. Citation Text: Recent Evidence That Health IT Improves Patient Safety: Issue Brief. Banger A, Graber ML. Washington, DC: Office of the National Coordinator for Health Information Technology; February 2015. …

  8. Improving America's Hospitals: The Joint Commission's Annual Report on Quality and Safety 2010. | PSNet

    psnet.ahrq.gov/issue/improving-americas-hospitals-joint-commissions-annual-report-quality-and-safety-2010
    November 23, 2016 - Book/Report Improving America's Hospitals: The Joint Commission's Annual Report on Quality and Safety 2010. Citation Text: Improving America's Hospitals: The Joint Commission's Annual Report on Quality and Safety 2010. Oakbrook Terrace, IL: The Joint Commission; September 2010. …

  9. Public reporting of surgical outcomes: surgeons, hospitals, or both? | PSNet

    psnet.ahrq.gov/issue/public-reporting-surgical-outcomes-surgeons-hospitals-or-both
    April 05, 2013 - Commentary Public reporting of surgical outcomes: surgeons, hospitals, or both? Citation Text: Jha AK. Public Reporting of Surgical Outcomes: Surgeons, Hospitals, or Both? JAMA. 2017;318(15):1429-1430. doi:10.1001/jama.2017.13815. Copy Citation Format: DOI Google Scholar Pu…

  10. Early warnings, weak signals and learning from healthcare disasters. | PSNet

    psnet.ahrq.gov/issue/early-warnings-weak-signals-and-learning-healthcare-disasters
    February 28, 2024 - Commentary Early warnings, weak signals and learning from healthcare disasters. Citation Text: Macrae C. Early warnings, weak signals and learning from healthcare disasters. BMJ Qual Saf. 2014;23(6):440-5. doi:10.1136/bmjqs-2013-002685. Copy Citation Format: DOI Google Scho…

  11. Medication Overload: America's Other Drug Problem. | PSNet

    psnet.ahrq.gov/issue/medication-overload-americas-other-drug-problem
    April 01, 2020 - Book/Report Medication Overload: America's Other Drug Problem. Citation Text: Medication Overload: America's Other Drug Problem. Brownlee S; Garber J. Brookline, MA: Lown Institute; 2019. Copy Citation Save Save to your library Print Download PDF …

  12. Overconfidence as a cause of diagnostic error in medicine. | PSNet

    psnet.ahrq.gov/issue/overconfidence-cause-diagnostic-error-medicine
    July 30, 2014 - Review Overconfidence as a cause of diagnostic error in medicine. Citation Text: Berner ES, Graber ML. Overconfidence as a cause of diagnostic error in medicine. Am J Med. 2008;121(5 Suppl):S2-S23. doi:10.1016/j.amjmed.2008.01.001. Copy Citation Format: DOI Google Scholar…

  13. Errors in diagnosis of spinal epidural abscesses in the era of electronic health records. | PSNet

    psnet.ahrq.gov/issue/errors-diagnosis-spinal-epidural-abscesses-era-electronic-health-records
    April 24, 2018 - Study Errors in diagnosis of spinal epidural abscesses in the era of electronic health records. Citation Text: Bhise V, Meyer AND, Singh H, et al. Errors in Diagnosis of Spinal Epidural Abscesses in the Era of Electronic Health Records. Am J Med. 2017;130(8). doi:10.1016/j.amjmed.2017.03…

  14. Improving America's Hospitals: The Joint Commission's Annual Report on Quality and Safety 2009. | PSNet

    psnet.ahrq.gov/issue/improving-americas-hospitals-joint-commissions-annual-report-quality-and-safety-2009
    September 21, 2011 - Book/Report Improving America's Hospitals: The Joint Commission's Annual Report on Quality and Safety 2009. Citation Text: Improving America's Hospitals: The Joint Commission's Annual Report on Quality and Safety 2009. Oakbrook Terrace, IL: The Joint Commission; January 2010. Cop…

  15. Examples of Medical Device Misconnections. | PSNet

    psnet.ahrq.gov/issue/examples-medical-device-misconnections
    March 04, 2015 - Multi-use Website Examples of Medical Device Misconnections. Citation Text: Examples of Medical Device Misconnections. Food and Drug Administration. February 23. 2023. Copy Citation Save Save to your library Print Download PDF Share Faceboo…

  16. Safety lessons from the NIH Clinical Center. | PSNet

    psnet.ahrq.gov/issue/safety-lessons-nih-clinical-center
    April 10, 2024 - Commentary Safety lessons from the NIH Clinical Center. Citation Text: Gandhi TK. Safety Lessons from the NIH Clinical Center. N Engl J Med. 2016;375(18):1705-1707. Copy Citation Format: Google Scholar PubMed BibTeX EndNote X3 XML EndNote 7 XML Endnote tagged PubMedId RIS …

  17. Why empathy may be the best risk management strategy. | PSNet

    psnet.ahrq.gov/issue/why-empathy-may-be-best-risk-management-strategy
    August 09, 2017 - Newspaper/Magazine Article Why empathy may be the best risk management strategy. Citation Text: Hertz BT. Why empathy may be the best risk management strategy. Medical economics. 2015;92(3):40-4. Copy Citation Format: Google Scholar PubMed BibTeX EndNote X3 XML EndNote 7 XM…

  18. Doctors are more dangerous than gun owners: a rejoinder to error counting. | PSNet

    psnet.ahrq.gov/issue/doctors-are-more-dangerous-gun-owners-rejoinder-error-counting
    June 24, 2020 - Commentary Doctors are more dangerous than gun owners: a rejoinder to error counting. Citation Text: Dekker SWA. Doctors are more dangerous than gun owners: a rejoinder to error counting. Hum Factors. 2007;49(2):177-84. Copy Citation Format: Google Scholar PubMed BibTeX E…

  19. Second victim support programs for healthcare organizations. | PSNet

    psnet.ahrq.gov/issue/second-victim-support-programs-healthcare-organizations
    August 12, 2020 - Review Second victim support programs for healthcare organizations. Citation Text: Stone M. Second victim support programs for healthcare organizations. Nurs Manage. 2020;51(6):38-45. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML EndNote 7 XML Endnote tagged Pu…

  20. Unreported errors in the intensive care unit: a case study of the way we work. | PSNet

    psnet.ahrq.gov/issue/unreported-errors-intensive-care-unit-case-study-way-we-work
    December 12, 2012 - Commentary Unreported errors in the intensive care unit: a case study of the way we work. Citation Text: Henneman EA. Unreported errors in the intensive care unit: a case study of the way we work. Crit Care Nurse. 2007;27(5):27-34; quiz 35. Copy Citation Format: Google Sc…
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