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psnet.ahrq.gov/issue/information-gaps-newborn-care-and-their-potential-harm
September 14, 2022 - Study
Information gaps in newborn care and their potential for harm.
Citation Text:
Kumar P, Biswas A, Iyengar H, et al. Information gaps in newborn care and their potential for harm. Jt Comm J Qual Patient Saf. 2015;41(5):228-233.
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psnet.ahrq.gov/issue/demonstration-project-impact-safety-culture-infection-control-practices-hemodialysis
May 01, 2024 - Journal Article
A demonstration project on the impact of safety culture on infection control practices in hemodialysis
Citation Text:
Millson T, Hackbarth D, Bernard HL. A demonstration project on the impact of safety culture on infection control practices in hemodialysis. Am J Infect Co…
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psnet.ahrq.gov/issue/safety-emergency-medicine
November 21, 2021 - Review
The safety of emergency medicine.
Citation Text:
Ramlakhan S, Qayyum H, Burke D, et al. The safety of emergency medicine. Emerg Med J. 2016;33(4):293-9. doi:10.1136/emermed-2014-204564.
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psnet.ahrq.gov/issue/quality-improvement-universal-protocol-use-office-based-gastrointestinal-procedure-units
November 16, 2022 - Commentary
Quality improvement: Universal Protocol use in office-based gastrointestinal procedure units.
Citation Text:
Hardee LK. Quality improvement: universal protocol use in office-based gastrointestinal procedure units. Gastroenterol Nurs. 2012;35(6):380-2. doi:10.1097/SGA.0b013e3…
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psnet.ahrq.gov/issue/what-extent-do-pediatricians-accept-computer-based-dosing-suggestions
May 27, 2011 - Study
To what extent do pediatricians accept computer-based dosing suggestions?
Citation Text:
Killelea BK, Kaushal R, Cooper M, et al. To what extent do pediatricians accept computer-based dosing suggestions? Pediatrics. 2007;119(1):e69-75.
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psnet.ahrq.gov/issue/organizational-culture-critical-success-factors-and-reduction-hospital-errors
December 12, 2014 - Study
Organizational culture, critical success factors, and the reduction of hospital errors.
Citation Text:
Stock GN, McFadden KL, Gowen CR. Organizational culture, critical success factors, and the reduction of hospital errors. Int J Prod Econ. 2006;106(2). doi:10.1016/j.ijpe.2006.0…
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psnet.ahrq.gov/issue/patient-experience-must-move-beyond-bad-apples
September 02, 2009 - Commentary
Patient experience must move beyond bad apples.
Citation Text:
Hamedani A, Safdar B, Aaronson E, et al. Patient Experience Must Move Beyond Bad Apples. Ann Intern Med. 2016;165(12):869-870. doi:10.7326/M16-1725.
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psnet.ahrq.gov/issue/checking-anaesthetic-equipment-2012-association-anaesthetists-great-britain-and-ireland
August 04, 2021 - Organizational Policy/Guidelines
Checking anaesthetic equipment 2012: Association of Anaesthetists of Great Britain and Ireland.
Citation Text:
Anderson E, Bythell V, Gemmell L, et al. Checking Anaesthetic Equipment 2012. Anaesthesia. 2012;67(6). doi:10.1111/j.1365-2044.2012.07163.x.
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psnet.ahrq.gov/issue/radiation-protection-and-dose-monitoring-medical-imaging-journey-awareness-through
May 18, 2022 - Review
Radiation protection and dose monitoring in medical imaging: a journey from awareness, through accountability, ability and action … but where will we arrive?
Citation Text:
Frush DP, Denham CR, Goske MJ, et al. Radiation Protection and Dose Monitoring in Medical Imaging. J Patien…
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psnet.ahrq.gov/issue/patient-involvement-patient-safety-what-factors-influence-patient-participation-and
February 15, 2013 - Review
Patient involvement in patient safety: what factors influence patient participation and engagement?
Citation Text:
Davis R, Jacklin R, Sevdalis N, et al. Patient involvement in patient safety: what factors influence patient participation and engagement? Health Expect. 2007;10(3)…
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psnet.ahrq.gov/issue/preventable-errors-operating-room-part-2-retained-foreign-objects-sharps-injuries-and-wrong
April 25, 2018 - Review
Preventable errors in the operating room--part 2: retained foreign objects, sharps injuries, and wrong site surgery.
Citation Text:
Dagi F, Berguer R, Moore S, et al. Preventable errors in the operating room--part 2: retained foreign objects, sharps injuries, and wrong site surg…
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psnet.ahrq.gov/issue/computerized-provider-order-entry-strategies-successful-implementation
February 15, 2017 - Commentary
Computerized provider order entry: strategies for successful implementation.
Citation Text:
Jones S, Moss J. Computerized Provider Order Entry. J Nurs Admin. 2006;36(3):136-139. doi:10.1097/00005110-200603000-00007.
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psnet.ahrq.gov/issue/use-briefings-and-debriefings-tool-improving-team-work-efficiency-and-communication-operating
September 07, 2011 - Study
Use of briefings and debriefings as a tool in improving team work, efficiency, and communication in the operating theatre.
Citation Text:
Bethune R, Sasirekha G, Sahu A, et al. Use of briefings and debriefings as a tool in improving team work, efficiency, and communication in the…
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psnet.ahrq.gov/issue/leadership-initiative-improve-communication-and-enhance-safety
March 11, 2009 - Commentary
A leadership initiative to improve communication and enhance safety.
Citation Text:
Donahue M, Miller M, Smith L, et al. A Leadership Initiative to Improve Communication and Enhance Safety. American Journal of Medical Quality. 2011;26(3). doi:10.1177/1062860610387410.
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psnet.ahrq.gov/web-mm/turn-other-cheek
October 26, 2010 - Outcome of 6 years of protocol use for preventing wrong site office surgery. … February 10, 2012
Outcome of 6 years of protocol use for preventing wrong site office … August 2, 2015
Outcome of 6 years of protocol use for preventing wrong site office surgery
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psnet.ahrq.gov/node/49466/psn-pdf
October 14, 2004 - studies cite practitioner communication
skills as a factor in malpractice.(1,2) Furthermore, the tragic outcome … /psnet.ahrq.gov/web-mm/hard-swallow
https://psnet.ahrq.gov//#references
were made NPO pending the outcome … clinicians at the time, could have led to follow-up actions to mitigate or avert an
adverse patient outcome
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psnet.ahrq.gov/node/49833/psn-pdf
June 01, 2018 - challenges us to
review potential system and cognitive factors that could have contributed to this outcome … This case represents the treatment of a stroke mimic or misdiagnosis that contributed to an adverse
outcome … Association of outcome with early stroke treatment: pooled
analysis of ATLANTIS, ECASS, and NINDS rt-PA
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psnet.ahrq.gov/web-mm/refused-medication-error
November 01, 2005 - is problematic on many levels, this commentary focuses on the three likely causes of the unfortunate outcome … transfer can be discussed and improved upon.( 11 ) Several best practices might have led to a different outcome … overcome those barriers to effectively communicate.( 7 ) Such practices might have led to a better outcome
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psnet.ahrq.gov/issue/usability-study-two-common-defibrillators-reveals-hazards
June 16, 2009 - September 30, 2010
EMS helicopter crashes: what influences fatal outcome?
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psnet.ahrq.gov/issue/sages-fuse-program-bridging-patient-safety-gap
April 05, 2017 - June 7, 2018
Fatal outcome after inadvertent injection of topical epinephrine.