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  1. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/50722/psn-pdf
    December 04, 2019 - 20 years later: to err is a leadership failure. December 4, 2019 Castellucci M, Meyer H. Modern Healthcare: November 11, 2019;49:18-22;28-30;32-34. https://psnet.ahrq.gov/issue/20-years-later-err-leadership-failure This special segment shares commentaries and online content that summarize growth and lack of progres…

  2. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/34895/psn-pdf
    February 26, 2009 - The safety of Australian healthcare: 10 years after QAHCS. February 26, 2009 Wilson RML, Van Der Weyden MB. The safety of Australian healthcare: 10 years after QAHCS. Med J Aust. 2005;182(6):260-1. https://psnet.ahrq.gov/issue/safety-australian-healthcare-10-years-after-qahcs The authors reflect on the progress i…

  3. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/851451/psn-pdf
    July 19, 2023 - Issues and complexities in safety culture assessment in healthcare. July 19, 2023 Ellis LA, Falkland E, Hibbert P, et al. Issues and complexities in safety culture assessment in healthcare. Front Public Health. 2023;11:1217542. doi:10.3389/fpubh.2023.1217542. https://psnet.ahrq.gov/issue/issues-and-complexities-sa…

  4. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/40789/psn-pdf
    February 10, 2012 - Routinely recorded patient safety events in primary care: a literature review. February 10, 2012 Tsang C, Majeed A, Aylin PP. Routinely recorded patient safety events in primary care: a literature review. Fam Pract. 2012;29(1):8-15. doi:10.1093/fampra/cmr050. https://psnet.ahrq.gov/issue/routinely-recorded-patient…

  5. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/44135/psn-pdf
    November 06, 2015 - Freedom to Speak Up: A Review of Whistleblowing in the NHS. November 6, 2015 Francis R. London, UK: Department of Health; February 2015. https://psnet.ahrq.gov/issue/freedom-speak-review-whistleblowing-nhs Staff willingness to raise awareness of problems that could affect patient care is an important indicator of …

  6. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/38242/psn-pdf
    November 26, 2008 - Is health care getting safer? November 26, 2008 Vincent CA, Aylin PP, Franklin BD, et al. Is health care getting safer? BMJ. 2008;337:a2426. doi:10.1136/bmj.a2426. https://psnet.ahrq.gov/issue/health-care-getting-safer This commentary reflects on data from the United Kingdom's National Health Service to underscore…

  7. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/41272/psn-pdf
    April 06, 2012 - Closed medical negligence claims can drive patient safety and reduce litigation. April 6, 2012 Pegalis SE, Bal S. Closed medical negligence claims can drive patient safety and reduce litigation. Clin Orthop Relat Res. 2012;470(5):1398-404. doi:10.1007/s11999-012-2308-5. https://psnet.ahrq.gov/issue/closed-medical-…

  8. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/60961/psn-pdf
    September 30, 2020 - Identifying psychiatric diagnostic errors with the Safer Dx Instrument. September 30, 2020 Fletcher TL, Helm A, Vaghani V, et al. Identifying psychiatric diagnostic errors with the Safer Dx Instrument. Int J Qual Health Care. 2020;32(6):405-411. doi:10.1093/intqhc/mzaa066. https://psnet.ahrq.gov/issue/identifying-…

  9. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/42253/psn-pdf
    May 08, 2013 - Using inpatient hospital discharge data to monitor patient safety events. May 8, 2013 Taylor JA, Pandian RS, Mao L, et al. Using inpatient hospital discharge data to monitor patient safety events. J Healthc Risk Manag. 2013;32(4):26-33. doi:10.1002/jhrm.21107. https://psnet.ahrq.gov/issue/using-inpatient-hospital-…

  10. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/37789/psn-pdf
    June 04, 2008 - The cost of nurse-sensitive adverse events. June 4, 2008 Pappas SH. The cost of nurse-sensitive adverse events. J Nurs Adm. 2008;38(5):230-236. doi:10.1097/01.NNA.0000312770.19481.ce. https://psnet.ahrq.gov/issue/cost-nurse-sensitive-adverse-events This study determined that the actual direct cost of an adverse ev…

  11. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/43305/psn-pdf
    July 02, 2014 - Why don't nurses consistently take patient respiratory rates? July 2, 2014 Ansell H, Meyer A, Thompson S. Why don't nurses consistently take patient respiratory rates? Br J Nurs. 2014;23(8):414-8. https://psnet.ahrq.gov/issue/why-dont-nurses-consistently-take-patient-respiratory-rates Basic nursing care, such as …

  12. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/36638/psn-pdf
    January 14, 2011 - Health care work environments, employee satisfaction, and patient safety: care provider perspectives. January 14, 2011 Rathert C, May DR. Health care work environments, employee satisfaction, and patient safety: care provider perspectives. Health Care Manage Rev. 2007;32(1):2-11. https://psnet.ahrq.gov/issue/healt…

  13. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/43010/psn-pdf
    March 19, 2014 - Why pediatricians fail to diagnose hypertension: a multicenter survey. March 19, 2014 Bijlsma MW, Blufpand HN, Kaspers GJL, et al. Why pediatricians fail to diagnose hypertension: a multicenter survey. J Pediatr. 2014;164(1):173-177.e7. doi:10.1016/j.jpeds.2013.08.066. https://psnet.ahrq.gov/issue/why-pediatrician…

  14. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/863224/psn-pdf
    February 28, 2024 - Special Section: IEA Health Care 2021. February 28, 2024 Hum Factors. 2024;66(3):633-769. https://psnet.ahrq.gov/issue/special-section-iea-health-care-2021 The ergonomics community has an established interest in medical error reduction. The 2021 International Ergonomics Association conference examined applications…

  15. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/43489/psn-pdf
    September 03, 2014 - Did hospital engagement networks actually improve care? September 3, 2014 Pronovost P, Jha AK. Did hospital engagement networks actually improve care? N Engl J Med. 2014;371(8):691-693. doi:10.1056/NEJMp1405800. https://psnet.ahrq.gov/issue/did-hospital-engagement-networks-actually-improve-care In this commentary,…

  16. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/39532/psn-pdf
    June 27, 2011 - Compliance to technical guidelines for radiotherapy treatment in relation to patient safety. June 27, 2011 Simons PAM, Houben RMA, Backes HH, et al. Compliance to technical guidelines for radiotherapy treatment in relation to patient safety. Int J Qual Health Care. 2010;22(3):187-193. doi:10.1093/intqhc/mzq020. h…

  17. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/50534/psn-pdf
    October 16, 2019 - Strategies to reduce diagnostic errors: a systematic review October 16, 2019 Abimanyi-Ochom J, Mudiyanselage SB, Catchpool M, et al. Strategies to reduce diagnostic errors: a systematic review. BMC Med Inform Decis Mak. 2019;19(1):174. doi:10.1186/s12911-019-0901-1. https://psnet.ahrq.gov/issue/strategies-reduce-d…

  18. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/36004/psn-pdf
    March 28, 2011 - Opportunities for performance improvement in relation to medication administration during pediatric stabilization. March 28, 2011 Morgan N. Opportunities for performance improvement in relation to medication administration during pediatric stabilization. Quality and Safety in Health Care. 2006;15(3). doi:10.1136/qs…

  19. Personalized outcomes for hip and knee replacement: the patients point of view. | Digital Healthcare Research

    digital.ahrq.gov/ahrq-funded-projects/optimizing-value-patient-reported-outcome-measures-improving-care-delivery/citation/personalized
    January 01, 2023 - Personalized outcomes for hip and knee replacement: the patients point of view. Citation Whitebird RR, Solberg LI, Ziegenfuss JY, Asche SE, Norton CK, Swiontkowski MF, Dehmer SP, Grossman ES. Personalized outcomes for hip and knee replacement: the patients point of view. J Patient Rep Outcomes. 2021 N…

  20. Is the promise of PROMs being realized? Implementation experience in a large orthopedic practice. | Digital Healthcare Research

    digital.ahrq.gov/ahrq-funded-projects/optimizing-value-patient-reported-outcome-measures-improving-care-delivery/citation/promise
    January 01, 2023 - Is the promise of PROMs being realized? Implementation experience in a large orthopedic practice. Citation Ziegenfuss JY, Grossman ES, Solberg LI, Chrenka EA, Werner A, Asche SE, Norton CK, Nelson A, Reams M, Whitebird RR. Is the promise of PROMs being realized? Implementation experience in a large or…
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