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  1. A systematic quantitative assessment of risks associated with poor communication in surgical care. | PSNet

    psnet.ahrq.gov/issue/systematic-quantitative-assessment-risks-associated-poor-communication-surgical-care
    August 11, 2010 - Study A systematic quantitative assessment of risks associated with poor communication in surgical care. Citation Text: Nagpal K, Vats A, Ahmed K, et al. A systematic quantitative assessment of risks associated with poor communication in surgical care. Arch Surg. 2010;145(6):582-8. doi:1…

  2. Application of human error theory in case analysis of wrong procedures. | PSNet

    psnet.ahrq.gov/issue/application-human-error-theory-case-analysis-wrong-procedures
    November 14, 2018 - Study Application of human error theory in case analysis of wrong procedures. Citation Text: Duthie EA. Application of Human Error Theory in Case Analysis of Wrong Procedures. J Patient Saf. 2010;6(2):108-114. doi:10.1097/pts.0b013e3181de47f9. Copy Citation Format: DOI Goo…

  3. Drug Shortages: FDA's Ability to Respond Should Be Strengthened. | PSNet

    psnet.ahrq.gov/issue/drug-shortages-fdas-ability-respond-should-be-strengthened
    April 15, 2009 - Congressional Testimony Drug Shortages: FDA's Ability to Respond Should Be Strengthened. Citation Text: Drug Shortages: FDA's Ability to Respond Should Be Strengthened. Testimony before the Committee on Health, Education, Labor, and Pensions, US Senate. US Government Accountability Offic…

  4. Managing clinical failure: a complex adaptive system perspective. | PSNet

    psnet.ahrq.gov/issue/managing-clinical-failure-complex-adaptive-system-perspective
    August 13, 2014 - Study Managing clinical failure: a complex adaptive system perspective. Citation Text: Matthews JI, Thomas PT. Managing clinical failure: a complex adaptive system perspective. Int J Health Care Qual Assur. 2007;20(3):184-194. doi:10.1108/09526860710743336. Copy Citation Format: …

  5. Hospital patient safety: characteristics of best-performing hospitals. | PSNet

    psnet.ahrq.gov/issue/hospital-patient-safety-characteristics-best-performing-hospitals
    February 03, 2011 - Study Hospital patient safety: characteristics of best-performing hospitals. Citation Text: Longo DR, Hewett JE, Ge B, et al. Hospital patient safety: characteristics of best-performing hospitals. J Healthc Manag. 2007;52(3):188-204; discussion 204-5. Copy Citation Format: …

  6. Case study: preventing surgical complications at Baystate Medical Center. | PSNet

    psnet.ahrq.gov/issue/case-study-preventing-surgical-complications-baystate-medical-center
    May 27, 2011 - Commentary Case study: preventing surgical complications at Baystate Medical Center. Citation Text: Fitzgerald J, Kanter G, Benjamin EM. Case Study: Preventing Surgical Complications at Baystate Medical Center. The Joint Commission Journal on Quality and Patient Safety. 2016;33(11). doi:…

  7. Examining markers of safety in homecare using the international classification for patient safety. | PSNet

    psnet.ahrq.gov/issue/examining-markers-safety-homecare-using-international-classification-patient-safety
    March 02, 2016 - Review Examining markers of safety in homecare using the international classification for patient safety. Citation Text: Macdonald M, Lang A, Storch J, et al. Examining markers of safety in homecare using the international classification for patient safety. BMC Health Serv Res. 2013;13:…

  8. Lessons Learned? Building a Culture of Patient Safety Within the Veterans Health Administration. | PSNet

    psnet.ahrq.gov/issue/lessons-learned-building-culture-patient-safety-within-veterans-health-administration
    November 06, 2019 - Congressional Testimony Lessons Learned? Building a Culture of Patient Safety Within the Veterans Health Administration. Citation Text: Lessons Learned? Building a Culture of Patient Safety Within the Veterans Health Administration. US House of Representatives Committee on Veterans' Affa…

  9. The association of workflow interruptions and hospital doctors' workload: a prospective observational study. | PSNet

    psnet.ahrq.gov/issue/association-workflow-interruptions-and-hospital-doctors-workload-prospective-observational
    March 06, 2013 - Study The association of workflow interruptions and hospital doctors' workload: a prospective observational study. Citation Text: Weigl M, Müller A, Vincent C, et al. The association of workflow interruptions and hospital doctors' workload: a prospective observational study. BMJ Qual Saf…

  10. Cost of medication-related problems at a university hospital. | PSNet

    psnet.ahrq.gov/issue/cost-medication-related-problems-university-hospital
    January 13, 2021 - Study Classic Cost of medication-related problems at a university hospital. Citation Text: Cost of medication-related problems at a university hospital. Schneider PJ; Gift MG; Lee YP; Rothermich EA; Sill BE Copy Citation Save Save to yo…

  11. Associations between negative patient safety climate and infection prevention practices. | PSNet

    psnet.ahrq.gov/issue/associations-between-negative-patient-safety-climate-and-infection-prevention-practices
    May 10, 2023 - Study Associations between negative patient safety climate and infection prevention practices. Citation Text: Johnson CT, Hessels AJ. Associations between negative patient safety climate and infection prevention practices. Am J Infect Control. 2024;52(9):1102-1104. doi:10.1016/j.ajic.202…

  12. Another surgeon's error: must you tell the patient? | PSNet

    psnet.ahrq.gov/issue/another-surgeons-error-must-you-tell-patient
    October 02, 2013 - Commentary Another surgeon's error: must you tell the patient? Citation Text: Moffatt-Bruce SD, Denlinger CE, Sade RM. Another surgeon's error: must you tell the patient? Ann Thorac Surg. 2014;98(2):396-401. doi:10.1016/j.athoracsur.2014.04.073. Copy Citation Format: DOI Go…

  13. Understanding patient safety and quality outcome data. | PSNet

    psnet.ahrq.gov/issue/understanding-patient-safety-and-quality-outcome-data
    July 19, 2023 - Commentary Understanding patient safety and quality outcome data. Citation Text: Easter K, Tamburri LM. Understanding Patient Safety and Quality Outcome Data. Crit Care Nurse. 2018;38(6):58-66. doi:10.4037/ccn2018979. Copy Citation Format: DOI Google Scholar PubMed BibTeX E…

  14. Association between license status and medication errors. | PSNet

    psnet.ahrq.gov/issue/association-between-license-status-and-medication-errors
    June 18, 2014 - Study Association between license status and medication errors. Citation Text: Conroy S. Association between licence status and medication errors. Arch Dis Child. 2011;96(3):305-6. doi:10.1136/adc.2010.191940. Copy Citation Format: DOI Google Scholar PubMed BibTeX EndNote…

  15. Health-care professionals' views about safety in maternity services: a qualitative study. | PSNet

    psnet.ahrq.gov/issue/health-care-professionals-views-about-safety-maternity-services-qualitative-study
    June 10, 2020 - Study Health-care professionals' views about safety in maternity services: a qualitative study. Citation Text: Smith AHK, Dixon AL, Page LA. Health-care professionals' views about safety in maternity services: a qualitative study. Midwifery. 2009;25(1):21-31. doi:10.1016/j.midw.2008.11…

  16. Teaching quality improvement. | PSNet

    psnet.ahrq.gov/issue/teaching-quality-improvement
    July 19, 2023 - Commentary Teaching quality improvement. Citation Text: Murray ME, Douglas S, Girdley D, et al. Teaching quality improvement. J Nurs Educ. 2010;49(8):466-9. doi:10.3928/01484834-20100430-09. Copy Citation Format: DOI Google Scholar PubMed BibTeX EndNote X3 XML EndNote 7 …

  17. Chronology of medication errors by nurses: accumulation of stresses and PTSD symptoms. | PSNet

    psnet.ahrq.gov/issue/chronology-medication-errors-nurses-accumulation-stresses-and-ptsd-symptoms
    September 23, 2020 - Study Chronology of medication errors by nurses: accumulation of stresses and PTSD symptoms. Citation Text: Rassin M, Kanti T, Silner D. Chronology of medication errors by nurses: accumulation of stresses and PTSD symptoms. Issues Ment Health Nurs. 2005;26(8):873-86. Copy Citation …

  18. Using a quantitative risk register to promote learning from a patient safety reporting system. | PSNet

    psnet.ahrq.gov/issue/using-quantitative-risk-register-promote-learning-patient-safety-reporting-system
    September 24, 2010 - Study Using a quantitative risk register to promote learning from a patient safety reporting system. Citation Text: Mansfield JG, Caplan RA, Campos JS, et al. Using a quantitative risk register to promote learning from a patient safety reporting system. Jt Comm J Qual Patient Saf. 2015;4…

  19. The federal government's oversight of CT safety: regulatory possibilities. | PSNet

    psnet.ahrq.gov/issue/federal-governments-oversight-ct-safety-regulatory-possibilities
    February 13, 2019 - Commentary The federal government's oversight of CT safety: regulatory possibilities. Citation Text: Harvey B, Pandharipande P. The federal government's oversight of CT safety: regulatory possibilities. Radiology. 2012;262(2):391-8. doi:10.1148/radiol.11111032. Copy Citation Form…

  20. Leveraging consistent communication tools and organizational values to promote accountability among health care providers. | PSNet

    psnet.ahrq.gov/issue/leveraging-consistent-communication-tools-and-organizational-values-promote-accountability
    January 18, 2023 - Commentary Leveraging consistent communication tools and organizational values to promote accountability among health care providers. Citation Text: Baldwin CA, Krumm AM. Leveraging consistent communication tools and organizational values to promote accountability among health care provi…
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