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  1. Detection rates of mild cognitive impairment in primary care for the United States Medicare population. | PSNet

    psnet.ahrq.gov/issue/detection-rates-mild-cognitive-impairment-primary-care-united-states-medicare-population
    February 16, 2022 - Study Detection rates of mild cognitive impairment in primary care for the United States Medicare population. Citation Text: Liu Y, Jun H, Becker A, et al. Detection rates of mild cognitive impairment in primary care for the United States Medicare population. J Prev Alz Dis. 2024;11:7–12…

  2. Society for Maternal-Fetal Medicine Special Statement: cognitive bias and medical error in obstetrics-challenges and opportunities. | PSNet

    psnet.ahrq.gov/issue/society-maternal-fetal-medicine-special-statement-cognitive-bias-and-medical-error-obstetrics
    May 18, 2022 - Organizational Policy/Guidelines Society for Maternal-Fetal Medicine Special Statement: cognitive bias and medical error in obstetrics-challenges and opportunities. Citation Text: Atallah F, Hamm RF, Davidson CM, et al. Society for Maternal-Fetal Medicine Special Statement: Cognitive bia…

  3. Optimizing Medication Management During the Covid-19 Pandemic: Implementation Guide for Post-acute and Long Term Care. | PSNet

    psnet.ahrq.gov/issue/optimizing-medication-management-during-covid-19-pandemic-implementation-guide-post-acute-and
    August 16, 2023 - Study Optimizing Medication Management During the Covid-19 Pandemic: Implementation Guide for Post-acute and Long Term Care. Citation Text: Brandt N, Steinman MA. Optimizing Medication Management During the COVID‐19 Pandemic: An Implementation Guide for Post‐Acute and Long‐Term Care. J A…

  4. The quest to eliminate intrathecal vincristine errors: a 40-year journey. | PSNet

    psnet.ahrq.gov/issue/quest-eliminate-intrathecal-vincristine-errors-40-year-journey
    September 15, 2010 - Commentary The quest to eliminate intrathecal vincristine errors: a 40-year journey. Citation Text: Noble DJ, Donaldson LJ. The quest to eliminate intrathecal vincristine errors: a 40-year journey. Qual Saf Health Care. 2010;19(4):323-326. doi:10.1136/qshc.2008.030874. Copy Citation …

  5. Publication of inspection frameworks: a qualitative study exploring the impact on quality improvement and regulation in three healthcare settings. | PSNet

    psnet.ahrq.gov/issue/publication-inspection-frameworks-qualitative-study-exploring-impact-quality-improvement-and
    August 10, 2022 - Study Publication of inspection frameworks: a qualitative study exploring the impact on quality improvement and regulation in three healthcare settings. Citation Text: Weenink J-W, Wallenburg I, Leistikow I, et al. Publication of inspection frameworks: a qualitative study exploring the i…

  6. Measuring adverse events and levels of harm in pediatric inpatients with the Global Trigger Tool. | PSNet

    psnet.ahrq.gov/issue/measuring-adverse-events-and-levels-harm-pediatric-inpatients-global-trigger-tool
    December 18, 2013 - Study Measuring adverse events and levels of harm in pediatric inpatients with the Global Trigger Tool. Citation Text: Kirkendall E, Kloppenborg E, Papp J, et al. Measuring adverse events and levels of harm in pediatric inpatients with the Global Trigger Tool. Pediatrics. 2012;130(5):e12…

  7. The World Federation of Chiropractic Global Patient Safety Task Force: a call to action. | PSNet

    psnet.ahrq.gov/issue/world-federation-chiropractic-global-patient-safety-task-force-call-action
    December 23, 2020 - Review The World Federation of Chiropractic Global Patient Safety Task Force: a call to action. Citation Text: Coleman BC, Rubinstein SM, Salsbury SA, et al. The World Federation of Chiropractic Global Patient Safety Task Force: a call to action. Chiropr Man Therap. 2024;32(1):15. doi:10…

  8. Root cause analysis of ICU adverse events in the Veterans Health Administration. | PSNet

    psnet.ahrq.gov/issue/root-cause-analysis-icu-adverse-events-veterans-health-administration
    June 23, 2021 - Study Root cause analysis of ICU adverse events in the Veterans Health Administration. Citation Text: Corwin GS, Mills PD, Shanawani H, et al. Root Cause Analysis of ICU Adverse Events in the Veterans Health Administration. Jt Comm J Qual Patient Saf. 2017;43(11):580-590. doi:10.1016/j.j…

  9. Prescribing patterns of heart failure-exacerbating medications following a heart failure hospitalization. | PSNet

    psnet.ahrq.gov/issue/prescribing-patterns-heart-failure-exacerbating-medications-following-heart-failure
    January 26, 2022 - Study Prescribing patterns of heart failure-exacerbating medications following a heart failure hospitalization. Citation Text: Goyal P, Kneifati-Hayek J, Archambault A, et al. Prescribing patterns of heart failure-exacerbating medications following a heart failure hospitalization. JACC H…

  10. Care Deficiencies and Leaders' Inadequate Reviews of a Patient Who Died at the Lt. Col. Luke Weathers, Jr. VA Medical Center in Memphis, Tennessee. | PSNet

    psnet.ahrq.gov/issue/care-deficiencies-and-leaders-inadequate-reviews-patient-who-died-lt-col-luke-weathers-jr-va
    April 10, 2024 - Book/Report Care Deficiencies and Leaders' Inadequate Reviews of a Patient Who Died at the Lt. Col. Luke Weathers, Jr. VA Medical Center in Memphis, Tennessee. Citation Text: Care Deficiencies and Leaders' Inadequate Reviews of a Patient Who Died at the Lt. Col. Luke Weathers, Jr. VA Me…

  11. A novel approach for assessing bias during team-based clinical decision-making. | PSNet

    psnet.ahrq.gov/issue/novel-approach-assessing-bias-during-team-based-clinical-decision-making
    April 10, 2024 - Study A novel approach for assessing bias during team-based clinical decision-making. Citation Text: Pool N, Hebdon M, de Groot E, et al. A novel approach for assessing bias during team-based clinical decision-making. Front in Public Health. 2023;11:1014773. doi:10.3389/fpubh.2023.101477…

  12. Evaluating a patient safety learning laboratory to create an interdisciplinary ecosystem for health care innovation. | PSNet

    psnet.ahrq.gov/issue/evaluating-patient-safety-learning-laboratory-create-interdisciplinary-ecosystem-health-care
    December 21, 2022 - Study Evaluating a patient safety learning laboratory to create an interdisciplinary ecosystem for health care innovation. Citation Text: Atkinson MK, Benneyan JC, Bambury EA, et al. Evaluating a patient safety learning laboratory to create an interdisciplinary ecosystem for health care …

  13. Emergency department monitor alarms rarely change clinical management: an observational study. | PSNet

    psnet.ahrq.gov/issue/emergency-department-monitor-alarms-rarely-change-clinical-management-observational-study
    September 30, 2020 - Study Emergency department monitor alarms rarely change clinical management: an observational study. Citation Text: Fleischman W, Ciliberto B, Rozanski N, et al. Emergency department monitor alarms rarely change clinical management: an observational study. Am J Emerg Med. 2020;38(6):1072…

  14. How to make medication error reporting systems work—factors associated with their successful development and implementation. | PSNet

    psnet.ahrq.gov/issue/how-make-medication-error-reporting-systems-work-factors-associated-their-successful
    December 05, 2012 - Study How to make medication error reporting systems work—factors associated with their successful development and implementation. Citation Text: Holmström A-R, Laaksonen R, Airaksinen M. How to make medication error reporting systems work--Factors associated with their successful develo…

  15. Direct oral anticoagulant-related medication incidents and pharmacists' interventions in hospital in-patients: evaluation using Reason's accident causation theory. | PSNet

    psnet.ahrq.gov/issue/direct-oral-anticoagulant-related-medication-incidents-and-pharmacists-interventions-hospital
    January 12, 2022 - Study Direct oral anticoagulant-related medication incidents and pharmacists' interventions in hospital in-patients: evaluation using Reason's accident causation theory. Citation Text: Haque H, Alrowily A, Jalal Z, et al. Direct oral anticoagulant-related medication incidents and pharmac…

  16. Standardizing medication reconciliation in a pediatric emergency department. | PSNet

    psnet.ahrq.gov/issue/standardizing-medication-reconciliation-pediatric-emergency-department
    March 10, 2019 - Study Standardizing medication reconciliation in a pediatric emergency department. Citation Text: Sheth S, Bialostozky M, Hollenbach K, et al. Standardizing medication reconciliation in a pediatric emergency department. Pediatrics. 2024;153(2):e2023061964. doi:10.1542/peds.2023-061964. …

  17. Development of a research agenda to identify evidence-based strategies to improve physician wellness and reduce burnout. | PSNet

    psnet.ahrq.gov/issue/development-research-agenda-identify-evidence-based-strategies-improve-physician-wellness-and
    June 01, 2022 - Commentary Development of a research agenda to identify evidence-based strategies to improve physician wellness and reduce burnout. Citation Text: Dyrbye LN, Trockel M, Frank E, et al. Development of a Research Agenda to Identify Evidence-Based Strategies to Improve Physician Wellness an…

  18. Sustaining and spreading the reduction of adverse drug events in a multicenter collaborative. | PSNet

    psnet.ahrq.gov/issue/sustaining-and-spreading-reduction-adverse-drug-events-multicenter-collaborative
    November 16, 2022 - Study Sustaining and spreading the reduction of adverse drug events in a multicenter collaborative. Citation Text: Tham E, Calmes HM, Poppy A, et al. Sustaining and spreading the reduction of adverse drug events in a multicenter collaborative. Pediatrics. 2011;128(2):e438-45. doi:10.1542…

  19. Perceptions of U.S. and U.K. incident reporting systems: a scoping review. | PSNet

    psnet.ahrq.gov/issue/perceptions-us-and-uk-incident-reporting-systems-scoping-review
    January 19, 2022 - Review Perceptions of U.S. and U.K. incident reporting systems: a scoping review. Citation Text: Gampetro PJ, Nickum A, Schultz CM. Perceptions of U.S. and U.K. incident reporting systems: a scoping review. J Patient Saf. 2024;20(5):360-365. doi:10.1097/pts.0000000000001231. Copy Citat…

  20. Health care provider factors associated with patient-reported adverse events and harm. | PSNet

    psnet.ahrq.gov/issue/health-care-provider-factors-associated-patient-reported-adverse-events-and-harm
    June 19, 2019 - Study Health care provider factors associated with patient-reported adverse events and harm. Citation Text: Giardina TD, Royse KE, Khanna A, et al. Health care provider factors associated with patient-reported adverse events and harm. Jt Comm J Qual Patient Saf. 2020;46(5):282-290. doi:…
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