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  1. Improved obstetric safety through programmatic collaboration. | PSNet

    psnet.ahrq.gov/issue/improved-obstetric-safety-through-programmatic-collaboration
    September 23, 2020 - Commentary Improved obstetric safety through programmatic collaboration. Citation Text: Goffman D, Brodman M, Friedman AJ, et al. Improved obstetric safety through programmatic collaboration. J Healthc Risk Manag. 2014;33(3):14-22. doi:10.1002/jhrm.21131. Copy Citation Format: …

  2. ADVERSE drug events: incidence and risk reduction across the care continuum. | PSNet

    psnet.ahrq.gov/issue/adverse-drug-events-incidence-and-risk-reduction-across-care-continuum
    April 12, 2019 - Image/Poster ADVERSE drug events: incidence and risk reduction across the care continuum. Citation Text: Wanderer JP, Rathmell JP. ADVERSE Drug Events: Incidence & risk reduction across the care continuum. Anesthesiology. 2016;124(1):A23. doi:10.1097/01.anes.0000473722.20007.03. Copy C…

  3. Risk mitigation in large scale systems: lessons from high reliability organizations. | PSNet

    psnet.ahrq.gov/issue/risk-mitigation-large-scale-systems-lessons-high-reliability-organizations
    January 30, 2019 - Commentary Classic Risk mitigation in large scale systems: lessons from high reliability organizations. Citation Text: Risk mitigation in large scale systems: lessons from high reliability organizations. Grabowski M, Roberts K. Calif Manag Rev. 1997;39(4):152-16…

  4. Beyond communication: the role of standardized protocols in a changing health care environment. | PSNet

    psnet.ahrq.gov/issue/beyond-communication-role-standardized-protocols-changing-health-care-environment
    October 12, 2011 - Study Beyond communication: the role of standardized protocols in a changing health care environment. Citation Text: Vardaman JM, Cornell P, Gondo MB, et al. Beyond communication: the role of standardized protocols in a changing health care environment.  Health Care Manage Rev. 2012;37…

  5. How policy makers can smooth the way for communication-and-resolution programs. | PSNet

    psnet.ahrq.gov/issue/how-policy-makers-can-smooth-way-communication-and-resolution-programs
    December 19, 2018 - Commentary How policy makers can smooth the way for communication-and-resolution programs. Citation Text: Sage WM, Gallagher TH, Armstrong S, et al. How policy makers can smooth the way for communication-and- resolution programs. Health Aff (Millwood). 2014;33(1):11-9. doi:10.1377/hlthaf…

  6. Towards high-reliability organising in healthcare: a strategy for building organisational capacity. | PSNet

    psnet.ahrq.gov/issue/towards-high-reliability-organising-healthcare-strategy-building-organisational-capacity
    January 06, 2016 - Commentary Towards high-reliability organising in healthcare: a strategy for building organisational capacity. Citation Text: Aboumatar HJ, Weaver SJ, Rees D, et al. Towards high-reliability organising in healthcare: a strategy for building organisational capacity. BMJ Qual Saf. 2017;26(…

  7. Operating management system for high reliability: leadership, accountability, learning and innovation in healthcare. | PSNet

    psnet.ahrq.gov/issue/operating-management-system-high-reliability-leadership-accountability-learning-and
    July 01, 2016 - Commentary Operating management system for high reliability: leadership, accountability, learning and innovation in healthcare. Citation Text: Day RM, Demski RJ, Pronovost PJ, et al. Operating management system for high reliability: Leadership, accountability, learning and innovation in …

  8. Patient safety: threats and solutions. | PSNet

    psnet.ahrq.gov/issue/patient-safety-threats-and-solutions
    January 19, 2011 - Commentary Patient safety: threats and solutions. Citation Text: McCaughan D, Kaufman G. Patient safety: threats and solutions. Nurs Stand. 2013;27(44):48-55; quiz 56, 58. Copy Citation Format: Google Scholar PubMed BibTeX EndNote X3 XML EndNote 7 XML Endnote tagged PubM…

  9. Clinical decision support in the era of artificial intelligence. | PSNet

    psnet.ahrq.gov/issue/clinical-decision-support-era-artificial-intelligence
    November 06, 2015 - Commentary Classic Clinical decision support in the era of artificial intelligence. Citation Text: Shortliffe EH, Sepúlveda MJ. Clinical Decision Support in the Era of Artificial Intelligence. JAMA. 2018;320(21):2199-2200. doi:10.1001/jama.2018.17163. Copy Cit…

  10. The ethical imperative to think about thinking. | PSNet

    psnet.ahrq.gov/issue/ethical-imperative-think-about-thinking
    June 27, 2018 - Commentary The ethical imperative to think about thinking. Citation Text: Stark M, Fins JJ. The ethical imperative to think about thinking - diagnostics, metacognition, and medical professionalism. Camb Q Healthc Ethics. 2014;23(4):386-96. doi:10.1017/S0963180114000061. Copy Citation …

  11. Hospital performance trends on national quality measures and the association with Joint Commission accreditation. | PSNet

    psnet.ahrq.gov/issue/hospital-performance-trends-national-quality-measures-and-association-joint-commission
    September 20, 2011 - Study Hospital performance trends on national quality measures and the association with Joint Commission accreditation. Citation Text: Schmaltz SP, Williams SC, Chassin MR, et al. Hospital performance trends on national quality measures and the association with joint commission accre…

  12. Quality improvement and patient care checklists in intrahospital transfers involving pediatric surgery patients. | PSNet

    psnet.ahrq.gov/issue/quality-improvement-and-patient-care-checklists-intrahospital-transfers-involving-pediatric
    September 23, 2020 - Study Quality improvement and patient care checklists in intrahospital transfers involving pediatric surgery patients. Citation Text: Nakayama DK, Lester SS, Rich DR, et al. Quality improvement and patient care checklists in intrahospital transfers involving pediatric surgery patients.…

  13. The ongoing quality improvement journey: next stop, high reliability. | PSNet

    psnet.ahrq.gov/issue/ongoing-quality-improvement-journey-next-stop-high-reliability
    January 23, 2012 - Commentary The ongoing quality improvement journey: next stop, high reliability. Citation Text: Chassin MR, Loeb JM. The ongoing quality improvement journey: next stop, high reliability. Health Aff (Millwood). 2011;30(4):559-68. doi:10.1377/hlthaff.2011.0076. Copy Citation Format…

  14. Safety-I, Safety-II and resilience engineering. | PSNet

    psnet.ahrq.gov/issue/safety-i-safety-ii-and-resilience-engineering
    December 16, 2015 - Commentary Safety-I, Safety-II and resilience engineering. Citation Text: Patterson M, Deutsch ES. Safety-I, Safety-II and resilience engineering. Curr Probl Pediatr Adolesc Health Care. 2015;45(12):382-389. doi:10.1016/j.cppeds.2015.10.001. Copy Citation Format: DOI Google…

  15. Aiming higher to enhance professionalism: beyond accreditation and certification. | PSNet

    psnet.ahrq.gov/issue/aiming-higher-enhance-professionalism-beyond-accreditation-and-certification
    February 03, 2011 - Commentary Aiming higher to enhance professionalism: beyond accreditation and certification. Citation Text: Chassin MR, Baker DW. Aiming higher to enhance professionalism: beyond accreditation and certification. JAMA. 2015;313(18):1795-6. doi:10.1001/jama.2015.3818. Copy Citation F…

  16. Diagnosing overdiagnosis: conceptual challenges and suggested solutions. | PSNet

    psnet.ahrq.gov/issue/diagnosing-overdiagnosis-conceptual-challenges-and-suggested-solutions
    September 20, 2023 - Commentary Diagnosing overdiagnosis: conceptual challenges and suggested solutions. Citation Text: Hofmann B. Diagnosing overdiagnosis: conceptual challenges and suggested solutions. Eur J Epidemiol. 2014;29(9):599-604. doi:10.1007/s10654-014-9920-5. Copy Citation Format: D…

  17. The effect of drug concentration expression on epinephrine dosing errors: a randomized trial. | PSNet

    psnet.ahrq.gov/issue/effect-drug-concentration-expression-epinephrine-dosing-errors-randomized-trial
    August 27, 2008 - Study The effect of drug concentration expression on epinephrine dosing errors: a randomized trial. Citation Text: Wheeler DW, Carter JJ, Murray LJ, et al. The effect of drug concentration expression on epinephrine dosing errors: a randomized trial. Ann Intern Med. 2008;148(1):11-4. …

  18. A pause in pediatrics: implementation of a pediatric diagnostic time-out. | PSNet

    psnet.ahrq.gov/issue/pause-pediatrics-implementation-pediatric-diagnostic-time-out
    April 20, 2022 - Study A pause in pediatrics: implementation of a pediatric diagnostic time-out. Citation Text: Yale SC, Cohen SS, Kliegman RM, et al. A pause in pediatrics: implementation of a pediatric diagnostic time-out. Diagnosis (Berl). 2022;9(3):348-351. doi:10.1515/dx-2022-0010. Copy Citation …

  19. Revealing Disparities: Health Care Workers’ Observations of Discrimination Against Patients. | PSNet

    psnet.ahrq.gov/issue/revealing-disparities-health-care-workers-observations-discrimination-against-patients
    April 12, 2006 - Book/Report Revealing Disparities: Health Care Workers’ Observations of Discrimination Against Patients. Citation Text: Revealing Disparities: Health Care Workers’ Observations of Discrimination Against Patients. Fernandez H, Ayo-Vaughan M, Zephyrin LC, et al. New York, NY: The Commonwea…

  20. Utilizing improvement science methods to improve physician compliance with proper hand hygiene. | PSNet

    psnet.ahrq.gov/issue/utilizing-improvement-science-methods-improve-physician-compliance-proper-hand-hygiene
    April 13, 2011 - Study Utilizing improvement science methods to improve physician compliance with proper hand hygiene. Citation Text: White CM, Statile AM, Conway PH, et al. Utilizing improvement science methods to improve physician compliance with proper hand hygiene. Pediatrics. 2012;129(4):e1042-50.…
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