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  1. psnet.ahrq.gov/issue/defining-diagnostic-error-scoping-review-assess-impact-national-academies-report-improving
    March 03, 2021 - Review Defining diagnostic error: a scoping review to assess the impact of the National Academies' report Improving Diagnosis in Health Care. Citation Text: Giardina TD, Hunte H, Hill MA, et al. Defining diagnostic error: a scoping review to assess the impact of the National Academies' r…
  2. psnet.ahrq.gov/issue/patterns-medication-incidents-10-yr-experience-cross-national-anaesthesia-incident-reporting
    January 15, 2025 - Study Patterns in medication incidents: a 10-yr experience of a cross-national anaesthesia incident reporting system. Citation Text: Sanduende-Otero Y, Villalón-Coca J, Romero-García E, et al. Patterns in medication incidents: A 10-yr experience of a cross-national anaesthesia incident r…
  3. psnet.ahrq.gov/issue/interdisciplinary-quality-improvement-conference-using-revised-morbidity-and-mortality-format
    July 22, 2020 - Study Interdisciplinary Quality Improvement Conference: using a revised morbidity and mortality format to focus on systems-based patient safety issues in a VA hospital: design and outcomes. Citation Text: Gerstein WH, Ledford J, Cooper J, et al. Interdisciplinary Quality Improvement Conf…
  4. psnet.ahrq.gov/issue/diagnostic-error-medicine-analysis-583-physician-reported-errors
    June 24, 2009 - Study Classic Diagnostic error in medicine: analysis of 583 physician-reported errors. Citation Text: Schiff G, Hasan O, Kim S, et al. Diagnostic error in medicine: analysis of 583 physician-reported errors. Arch Intern Med. 2009;169(20):1881-1887. doi:10.1001/a…
  5. psnet.ahrq.gov/issue/unscheduled-return-visits-emergency-department-icu-admission-trigger-tool-diagnostic-error
    December 02, 2020 - Study Unscheduled return visits to the emergency department with ICU admission: a trigger tool for diagnostic error. Citation Text: Aaronson E, Jansson P, Wittbold K, et al. Unscheduled return visits to the emergency department with ICU admission: A trigger tool for diagnostic error. Am …
  6. psnet.ahrq.gov/issue/intravenous-infusion-administration-comparative-study-practices-and-errors-between-united
    October 18, 2018 - Study Intravenous infusion administration: a comparative study of practices and errors between the United States and England and their implications for patient safety. Citation Text: Blandford A, Dykes PC, Franklin BD, et al. Intravenous Infusion Administration: A Comparative Study of Pr…
  7. psnet.ahrq.gov/issue/artificial-intelligence-identifying-prevention-medication-incidents-causing-serious-or
    March 11, 2020 - Study Artificial intelligence for identifying the prevention of medication incidents causing serious or moderate harm: an analysis using incident reporters' views. Citation Text: Härkänen M, Haatainen K, Vehviläinen-Julkunen K, et al. Artificial intelligence for identifying the preventio…
  8. psnet.ahrq.gov/issue/case-controlled-study-relatives-complaints-concerning-patients-who-died-hospital-role
    November 16, 2022 - Study A case-controlled study of relatives' complaints concerning patients who died in hospital: the role of treatment escalation/limitation planning. Citation Text: Taylor DR, Bouttell J, Campbell JN, et al. A case-controlled study of relatives’ complaints concerning patients who died i…
  9. psnet.ahrq.gov/issue/patient-initiated-voluntary-online-survey-adverse-medical-events-perspective-696-injured
    May 20, 2020 - Study Classic A patient-initiated voluntary online survey of adverse medical events: the perspective of 696 injured patients and families. Citation Text: Southwick FS, Cranley NM, Hallisy JA. A patient-initiated voluntary online survey of adverse medical events:…
  10. psnet.ahrq.gov/issue/frequency-intravenous-medication-administration-errors-related-smart-infusion-pumps
    June 27, 2018 - Study The frequency of intravenous medication administration errors related to smart infusion pumps: a multihospital observational study. Citation Text: Schnock KO, Dykes PC, Albert J, et al. The frequency of intravenous medication administration errors related to smart infusion pumps: a…
  11. psnet.ahrq.gov/issue/can-patients-contribute-enhancing-safety-and-effectiveness-test-result-follow-qualitative
    August 19, 2020 - Study Can patients contribute to enhancing the safety and effectiveness of test-result follow-up? Qualitative outcomes from a health consumer workshop. Citation Text: Thomas J, Dahm MR, Li J, et al. Can patients contribute to enhancing the safety and effectiveness of test‐result follow‐u…
  12. psnet.ahrq.gov/issue/association-adverse-events-opioid-addiction-treatment-quality-measure-continuity
    March 09, 2022 - Study Association of adverse events in opioid addiction treatment with quality measure for continuity of pharmacotherapy. Citation Text: Liu Y, Becker A, Mattke S. Association of adverse events in opioid addiction treatment with quality measure for continuity of pharmacotherapy. J Health…
  13. psnet.ahrq.gov/issue/financial-incentives-reduce-hospital-acquired-infections-under-alternative-payment
    September 29, 2017 - Study Financial incentives to reduce hospital-acquired infections under alternative payment arrangements. Citation Text: Cohen CC, Liu J, Cohen B, et al. Financial Incentives to Reduce Hospital-Acquired Infections Under Alternative Payment Arrangements. Infect Control Hosp Epidemiol. 201…
  14. psnet.ahrq.gov/issue/wrong-patient-blood-transfusion-error-leveraging-technology-overcome-human-error
    December 09, 2020 - Study Wrong-patient blood transfusion error: leveraging technology to overcome human error in intraoperative blood component administration. Citation Text: Hensley NB, Koch CG, Pronovost P, et al. Wrong-Patient Blood Transfusion Error: Leveraging Technology to Overcome Human Error in Int…
  15. psnet.ahrq.gov/web-mm/hazards-loading-doses
    December 01, 2003 - Hazards of Loading Doses Citation Text: Mucksavage JJ, Tesoro EP. Hazards of Loading Doses. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2017. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML EndNote 7 XML E…
  16. psnet.ahrq.gov/web-mm/toxic-tachycardia
    March 01, 2005 - Toxic Tachycardia Citation Text: Wartofsky L. Toxic Tachycardia. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2007. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML EndNote 7 XML Endnote tagged PubMedId RIS …
  17. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/853772/psn-pdf
    September 27, 2023 - Insulin Administration: Pen vs Vial – Similar, but Not Interchangeable September 27, 2023 Camarillo H. Insulin Administration: Pen vs Vial – Similar, but Not Interchangeable. PSNet [internet]. 2023. https://psnet.ahrq.gov/web-mm/insulin-administration-pen-vs-vial-similar-not-interchangeable The Case A fourteen-ye…
  18. psnet.ahrq.gov/web-mm/anesthesia-weighty-issue
    September 01, 2006 - Anesthesia: A Weighty Issue Citation Text: Sinha AC. Anesthesia: A Weighty Issue. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2013. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML EndNote 7 XML Endnote tag…
  19. psnet.ahrq.gov/curated-library/medicationdrug-errors
    March 12, 2021 - Breadcrumb Home The PSNet Collection Curated Libraries Subscribed Medication/Drug Errors  Download  Share Facebook Twitter Linkedin Copy URL Subscribe Created By: Dr. Yan Xiao, AHRQ TEP Member Date…
  20. psnet.ahrq.gov/periodic-issue/periodic-issue-473
    March 25, 2025 - March 5, 2025 Weekly Issue PSNet highlights the latest patient safety literature, news, and expert commentary, including Weekly Updates, WebM&M, and Perspectives on Safety. The current issue highlights what's new this week in patient safety literature, news, conferences, reports, …

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