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  1. In pursuit of quality and safety: an 8-year study of clinical peer review best practices in US hospitals. | PSNet

    psnet.ahrq.gov/issue/pursuit-quality-and-safety-8-year-study-clinical-peer-review-best-practices-us-hospitals
    April 13, 2017 - Study In pursuit of quality and safety: an 8-year study of clinical peer review best practices in US hospitals. Citation Text: Edwards MT. In pursuit of quality and safety: an 8-year study of clinical peer review best practices in US hospitals. Int J Qual Health Care. 2018;30(8):602-607.…

  2. Utilizing pharmacy students in transitions-of-care services. | PSNet

    psnet.ahrq.gov/issue/utilizing-pharmacy-students-transitions-care-services
    October 19, 2022 - Commentary Utilizing pharmacy students in transitions-of-care services. Citation Text: L'Hommedieu T, DeCoske M, Lababidi RE, et al. Utilizing pharmacy students in transitions-of-care services. Am J Health Syst Pharm. 2015;72(15):1266-8. doi:10.2146/ajhp140561. Copy Citation Format…

  3. Communication discrepancies between physicians and hospitalized patients. | PSNet

    psnet.ahrq.gov/issue/communication-discrepancies-between-physicians-and-hospitalized-patients
    October 12, 2022 - Study Classic Communication discrepancies between physicians and hospitalized patients. Citation Text: Olson DP, Windish DM. Communication discrepancies between physicians and hospitalized patients. Arch Intern Med. 2010;170(15):1302-1307. doi:10.1001/archintern…

  4. The influence of organizational context on quality improvement and patient safety efforts in infection prevention: a multi-center qualitative study. | PSNet

    psnet.ahrq.gov/issue/influence-organizational-context-quality-improvement-and-patient-safety-efforts-infection
    May 08, 2017 - Study The influence of organizational context on quality improvement and patient safety efforts in infection prevention: a multi-center qualitative study. Citation Text: Krein SL, Damschroder LJ, Kowalski CP, et al. The influence of organizational context on quality improvement and pat…

  5. The role of emotion in patient safety: are we brave enough to scratch beneath the surface? | PSNet

    psnet.ahrq.gov/issue/role-emotion-patient-safety-are-we-brave-enough-scratch-beneath-surface
    January 09, 2014 - Review The role of emotion in patient safety: are we brave enough to scratch beneath the surface? Citation Text: Heyhoe J, Birks Y, Harrison R, et al. The role of emotion in patient safety: Are we brave enough to scratch beneath the surface? J R Soc Med. 2016;109(2):52-8. doi:10.1177/014…

  6. Rapid response systems: a systematic review and meta-analysis. | PSNet

    psnet.ahrq.gov/issue/rapid-response-systems-systematic-review-and-meta-analysis
    January 29, 2018 - Review Rapid response systems: a systematic review and meta-analysis. Citation Text: Maharaj R, Raffaele I, Wendon J. Rapid response systems: a systematic review and meta-analysis. Crit Care. 2015;19(1). doi:10.1186/s13054-015-0973-y. Copy Citation Format: DOI Google Schola…

  7. Development of "SWARM" as a model for high reliability, rapid problem solving, and institutional learning. | PSNet

    psnet.ahrq.gov/issue/development-swarm-model-high-reliability-rapid-problem-solving-and-institutional-learning
    November 16, 2022 - Commentary Development of "SWARM" as a model for high reliability, rapid problem solving, and institutional learning. Citation Text: Williams EA, Nikolai DA, Ladwig L, et al. Development of "SWARM" as a Model for High Reliability, Rapid Problem Solving, and Institutional Learning. Jt Com…

  8. Development of patient safety measures to identify inappropriate diagnosis of common infections. | PSNet

    psnet.ahrq.gov/issue/development-patient-safety-measures-identify-inappropriate-diagnosis-common-infections
    April 10, 2024 - Study Development of patient safety measures to identify inappropriate diagnosis of common infections. Citation Text: White AT, Vaughn VM, Petty LA, et al. Development of patient safety measures to identify inappropriate diagnosis of common infections. Clin Infect Dis. 2024;78(6):1403-14…

  9. Improving adverse drug event reporting by healthcare professionals. | PSNet

    psnet.ahrq.gov/issue/improving-adverse-drug-event-reporting-healthcare-professionals
    April 12, 2019 - Review Improving adverse drug event reporting by healthcare professionals. Citation Text: Shalviri G, Mohebbi N, Mirbaha F, et al. Improving adverse drug event reporting by healthcare professionals. Cochrane Database Syst Rev. 2024;2024(10):CD012594. doi:10.1002/14651858.cd012594.pub2. …

  10. Feedback loop failure modes in medical diagnosis: how biases can emerge and be reinforced. | PSNet

    psnet.ahrq.gov/issue/feedback-loop-failure-modes-medical-diagnosis-how-biases-can-emerge-and-be-reinforced
    November 01, 2023 - Study Feedback loop failure modes in medical diagnosis: how biases can emerge and be reinforced. Citation Text: Aikens RC, Chen JH, Baiocchi M, et al. Feedback loop failure modes in medical diagnosis: how biases can emerge and be reinforced. Med Decis Making. 2024;44(5):481-496. doi:10.1…

  11. Large language models for preventing medication direction errors in online pharmacies. | PSNet

    psnet.ahrq.gov/issue/large-language-models-preventing-medication-direction-errors-online-pharmacies
    February 27, 2019 - Study Large language models for preventing medication direction errors in online pharmacies. Citation Text: Pais C, Liu J, Voigt R, et al. Large language models for preventing medication direction errors in online pharmacies. Nat Med. 2024;30(6):1574-1582. doi:10.1038/s41591-024-02933-8.…

  12. Strengthening the use of artificial intelligence within healthcare delivery organizations: balancing regulatory compliance and patient safety. | PSNet

    psnet.ahrq.gov/issue/strengthening-use-artificial-intelligence-within-healthcare-delivery-organizations-balancing
    September 18, 2024 - Commentary Strengthening the use of artificial intelligence within healthcare delivery organizations: balancing regulatory compliance and patient safety. Citation Text: Sendak MP, Liu VX, Beecy A, et al. Strengthening the use of artificial intelligence within healthcare delivery organiza…

  13. Framing family conversation after early diagnosis of iatrogenic injury and incidental findings. | PSNet

    psnet.ahrq.gov/issue/framing-family-conversation-after-early-diagnosis-iatrogenic-injury-and-incidental-findings
    November 14, 2011 - Study Framing family conversation after early diagnosis of iatrogenic injury and incidental findings. Citation Text: Barrios L, Tsuda S, Derevianko A, et al. Framing family conversation after early diagnosis of iatrogenic injury and incidental findings. Surg Endosc. 2009;23(11):2535-42…

  14. Understanding procedural violations using Safety-I and Safety-II: the case of community pharmacies. | PSNet

    psnet.ahrq.gov/issue/understanding-procedural-violations-using-safety-i-and-safety-ii-case-community-pharmacies
    February 06, 2019 - Study Understanding procedural violations using Safety-I and Safety-II: the case of community pharmacies. Citation Text: Jones CEL, Phipps D, Ashcroft DM. Understanding procedural violations using Safety-I and Safety-II: The case of community pharmacies. Saf Sci. 2018;105:114-120. doi:10…

  15. Impact of anesthetic handover on mortality and morbidity in cardiac surgery: a cohort study. | PSNet

    psnet.ahrq.gov/issue/impact-anesthetic-handover-mortality-and-morbidity-cardiac-surgery-cohort-study
    August 04, 2021 - Study Impact of anesthetic handover on mortality and morbidity in cardiac surgery: a cohort study. Citation Text: Hudson CCC, McDonald B, Hudson JKC, et al. Impact of anesthetic handover on mortality and morbidity in cardiac surgery: a cohort study. J Cardiothorac Vasc Anesth. 2015;29(1)…

  16. Combining ratings from multiple physician reviewers helped to overcome the uncertainty associated with adverse event classification. | PSNet

    psnet.ahrq.gov/issue/combining-ratings-multiple-physician-reviewers-helped-overcome-uncertainty-associated-adverse
    December 22, 2010 - Study Combining ratings from multiple physician reviewers helped to overcome the uncertainty associated with adverse event classification. Citation Text: Forster AJ, O'Rourke K, Shojania KG, et al. Combining ratings from multiple physician reviewers helped to overcome the uncertainty a…

  17. Medication reconciliation: comparing a customized medication history form to a standard medication form in a specialty clinic (CAMPII 2). | PSNet

    psnet.ahrq.gov/issue/medication-reconciliation-comparing-customized-medication-history-form-standard-medication
    September 23, 2020 - Study Medication reconciliation: comparing a customized medication history form to a standard medication form in a specialty clinic (CAMPII 2). Citation Text: Ryan GJ, Caudle JM, Rhee MK, et al. Medication reconciliation: comparing a customized medication history form to a standard medi…

  18. Hospital workload and adverse events. | PSNet

    psnet.ahrq.gov/issue/hospital-workload-and-adverse-events
    August 31, 2011 - Study Classic Hospital workload and adverse events. Citation Text: Weissman JS, Rothschild JM, Bendavid E, et al. Hospital workload and adverse events. Med Care. 2007;45(5):448-55. Copy Citation Format: Google Scholar PubMed BibTeX EndNote X3 XML…

  19. Medication reconciliation: barriers and facilitators from the perspectives of resident physicians and pharmacists. | PSNet

    psnet.ahrq.gov/issue/medication-reconciliation-barriers-and-facilitators-perspectives-resident-physicians-and
    October 23, 2024 - Study Medication reconciliation: barriers and facilitators from the perspectives of resident physicians and pharmacists. Citation Text: Boockvar KS, Santos SL, Kushniruk AW, et al. Medication reconciliation: Barriers and facilitators from the perspectives of resident physicians and pha…

  20. Mislabeled units of umbilical cord blood detected by a quality assurance program at the transplantation center. | PSNet

    psnet.ahrq.gov/issue/mislabeled-units-umbilical-cord-blood-detected-quality-assurance-program-transplantation
    October 19, 2022 - Study Mislabeled units of umbilical cord blood detected by a quality assurance program at the transplantation center. Citation Text: McCullough JS, McKenna D, Kadidlo D, et al. Mislabeled units of umbilical cord blood detected by a quality assurance program at the transplantation cente…
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