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psnet.ahrq.gov/node/839325/psn-pdf
November 02, 2022 - Human centered design workshops as a meta-solution to
diagnostic disparities.
November 2, 2022
Wiegand AA, Dukhanin V, Sheikh T, et al. Human centered design workshops as a meta-solution to
diagnostic disparities. Diagnosis (Berl). 2022;9(4):458-467. doi:10.1515/dx-2022-0025.
https://psnet.ahrq.gov/issue/human-cen…
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psnet.ahrq.gov/node/38491/psn-pdf
January 31, 2011 - Diagnostic errors--The next frontier for patient safety.
January 31, 2011
Newman-Toker DE, Pronovost P. Diagnostic errors--the next frontier for patient safety. JAMA.
2009;301(10):1060-2. doi:10.1001/jama.2009.249.
https://psnet.ahrq.gov/issue/diagnostic-errors-next-frontier-patient-safety
Studies from autopsy dat…
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psnet.ahrq.gov/node/838321/psn-pdf
October 12, 2022 - Meeting the Moment: Addressing Barriers and Facilitating
Clinical Adoption of Artificial Intelligence in Medical
Diagnosis.
October 12, 2022
Adler-Milstein J, Aggarwal N, Ahmed M, et al. NAM Perspectives. Washington DC: National Academy of
Medicine; 2022.
https://psnet.ahrq.gov/issue/meeting-moment-addressing-bar…
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psnet.ahrq.gov/node/44370/psn-pdf
November 20, 2015 - Interunit handoffs from emergency department to
inpatient care: a cross-sectional survey of physicians at a
university medical center.
November 20, 2015
Smith CJ, Britigan DH, Lyden E, et al. Interunit handoffs from emergency department to inpatient care: A
cross-sectional survey of physicians at a university medi…
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psnet.ahrq.gov/node/854380/psn-pdf
October 11, 2023 - Associations between hospitalist shift busyness,
diagnostic confidence, and resource utilization: a pilot
study.
October 11, 2023
Gupta AB, Greene MT, Fowler KE, et al. Associations between hospitalist shift busyness, diagnostic
confidence, and resource utilization: a pilot study. J Patient Saf. 2023;19(7):447-452…
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psnet.ahrq.gov/node/853070/psn-pdf
August 30, 2023 - Activating pharmacists to reduce the frequency of
medication-related problems (ACTMed): a stepped wedge
cluster randomised trial.
August 30, 2023
Spinks J, Violette R, Boyle DIR, et al. Activating pharmacists to reduce the frequency of medication?related
problems (ACTMed): a stepped wedge cluster randomised trial.…
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psnet.ahrq.gov/node/39979/psn-pdf
November 03, 2010 - Does simulator-based clinical performance correlate with
actual hospital behavior? The effect of extended work
hours on patient care provided by medical interns.
November 3, 2010
Gordon JA, Alexander EK, Lockley SW, et al. Does Simulator-Based Clinical Performance Correlate With
Actual Hospital Behavior? The Effec…
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psnet.ahrq.gov/node/46690/psn-pdf
December 20, 2017 - Quality, safety, and outcomes in anaesthesia: what's to be
done? An international perspective.
December 20, 2017
Peden CJ, Campbell M, Aggarwal G. Quality, safety, and outcomes in anaesthesia: what's to be done? An
international perspective. Br J Anaesth. 2017;119. doi:10.1093/bja/aex346.
https://psnet.ahrq.gov/is…
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psnet.ahrq.gov/node/34063/psn-pdf
September 18, 2011 - Risk factors for retained instruments and sponges after
surgery.
September 18, 2011
Gawande AA, Studdert DM, Orav J, et al. Risk factors for retained instruments and sponges after surgery.
N Engl J Med. 2003;348(3):229-35.
https://psnet.ahrq.gov/issue/risk-factors-retained-instruments-and-sponges-after-surgery
Th…
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psnet.ahrq.gov/node/40410/psn-pdf
May 11, 2011 - Evaluation of the role of the critical care pharmacist in
identifying and avoiding or minimizing significant
drug–drug interactions in medical intensive care patients.
May 11, 2011
Rivkin A, Yin H. Evaluation of the role of the critical care pharmacist in identifying and avoiding or
minimizing significant drug-dru…
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psnet.ahrq.gov/node/73313/psn-pdf
May 26, 2021 - Maintaining maternal-newborn safety during the COVID-
19 pandemic.
May 26, 2021
Patrick NA, Johnson TS. Maintaining maternal-newborn safety during the COVID-19 pandemic. Nurs
Womens Health. 2021;25(3):212-220. doi:10.1016/j.nwh.2021.03.003.
https://psnet.ahrq.gov/issue/maintaining-maternal-newborn-safety-during-co…
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psnet.ahrq.gov/node/44741/psn-pdf
January 20, 2016 - System hazards in managing laboratory test requests and
results in primary care: medical protection database
analysis and conceptual model.
January 20, 2016
Bowie P, Price J, Hepworth N, et al. System hazards in managing laboratory test requests and results in
primary care: medical protection database analysis and…
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psnet.ahrq.gov/node/35540/psn-pdf
August 05, 2009 - Lost in translation: challenges and opportunities in
physician-to-physician communication during patient
handoffs.
August 5, 2009
Solet DJ, Norvell M, Rutan GH, et al. Lost in translation: challenges and opportunities in physician-to-
physician communication during patient handoffs. Acad Med. 2005;80(12):1094-9.
…
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psnet.ahrq.gov/node/74705/psn-pdf
January 26, 2022 - 20 years after To Err Is Human: a bibliometric analysis of
‘the IOM report’s’ impact on research on patient safety.
January 26, 2022
St.Pierre M, Grawe P, Bergström J, et al. 20 years after To Err Is Human: a bibliometric analysis of ‘the
IOM report’s’ impact on research on patient safety. Safety Sci. 2021;147:1055…
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psnet.ahrq.gov/node/74205/psn-pdf
January 01, 2022 - Communicating certainty in pathology reports:
interpretation differences among staff pathologists,
clinicians, and residents in a multicenter study.
December 22, 2021
Gibson BA, McKinnon E, Bentley RC, et al. Communicating certainty in pathology reports: interpretation
differences among staff pathologists, clinici…
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psnet.ahrq.gov/node/47554/psn-pdf
November 07, 2018 - Diagnostic Excellence Initiative.
November 7, 2018
Gordon and Betty Moore Foundation.
https://psnet.ahrq.gov/issue/diagnostic-excellence-improving-experience-and-outcomes-patient-care
Missed or delayed diagnoses lead to delays in care and significant preventable harm for patients. Despite
an increasing focus on di…
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psnet.ahrq.gov/node/39030/psn-pdf
October 21, 2009 - Misleading one detail: a preventable mode of diagnostic
error?
October 21, 2009
Arzy S, Brezis M, Khoury S, et al. Misleading one detail: a preventable mode of diagnostic error? J Eval
Clin Pract. 2009;15(5):804-6. doi:10.1111/j.1365-2753.2008.01098.x.
https://psnet.ahrq.gov/issue/misleading-one-detail-preventable…
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psnet.ahrq.gov/node/867222/psn-pdf
December 04, 2024 - How many is too many? Using cognitive load theory to
determine the maximum safe number of inpatient
consultations for trainees.
December 4, 2024
Brondfield S, Blum AM, Mason JM, et al. How many is too many? Using cognitive load theory to determine
the maximum safe number of inpatient consultations for trainees. Ac…
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psnet.ahrq.gov/node/837036/psn-pdf
May 04, 2022 - Engaging patients in the use of real-time electronic
clinical data to improve the safety and reliability of their
own care.
May 4, 2022
Schnock KO, Roulier S, Butler J, et al. Engaging patients in the use of real-time electronic clinical data to
improve the safety and reliability of their own care. J Patient Saf. …
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psnet.ahrq.gov/node/865723/psn-pdf
June 18, 2024 - Using AHRQ’s SOPS Hospital Survey and Workplace
Safety Item Set: Experiences From a State Hospital
Association.
June 18, 2024
Agency for Healthcare Research and Quality. May 23, 2024.
https://psnet.ahrq.gov/issue/using-ahrqs-sops-hospital-survey-and-workplace-safety-item-set-experiences-
state-hospital
An unders…