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  1. The Armstrong Institute Resident/Fellow Scholars: a multispecialty curriculum to train future leaders in patient safety and quality improvement. | PSNet

    psnet.ahrq.gov/issue/armstrong-institute-residentfellow-scholars-multispecialty-curriculum-train-future-leaders
    October 19, 2022 - Commentary The Armstrong Institute Resident/Fellow Scholars: a multispecialty curriculum to train future leaders in patient safety and quality improvement. Citation Text: Rinke ML, Mock CK, Persing NM, et al. The Armstrong Institute Resident/Fellow Scholars: A Multispecialty Curriculum t…

  2. Use of medical emergency team (MET) responses to detect medical errors. | PSNet

    psnet.ahrq.gov/issue/use-medical-emergency-team-met-responses-detect-medical-errors
    April 06, 2011 - Study Use of medical emergency team (MET) responses to detect medical errors. Citation Text: Braithwaite RS, Devita MA, Mahidhara R, et al. Use of medical emergency team (MET) responses to detect medical errors. Qual Saf Health Care. 2004;13(4):255-259. Copy Citation Format: …

  3. Review of alternatives to root cause analysis: developing a robust system for incident report analysis. | PSNet

    psnet.ahrq.gov/issue/review-alternatives-root-cause-analysis-developing-robust-system-incident-report-analysis
    November 14, 2018 - Review Review of alternatives to root cause analysis: developing a robust system for incident report analysis. Citation Text: Hagley G, Mills PD, Watts B, et al. Review of alternatives to root cause analysis: developing a robust system for incident report analysis. BMJ Open Qual. 2019;8(…

  4. An adverse event screening tool based on routinely collected hospital-acquired diagnoses. | PSNet

    psnet.ahrq.gov/issue/adverse-event-screening-tool-based-routinely-collected-hospital-acquired-diagnoses
    July 23, 2008 - Study An adverse event screening tool based on routinely collected hospital-acquired diagnoses. Citation Text: Brand CA, Tropea J, Gorelik A, et al. An adverse event screening tool based on routinely collected hospital-acquired diagnoses. Int J Qual Health Care. 2012;24(3):266-78. doi:10…

  5. Impact of resident participation on morbidity and mortality in neurosurgical procedures: an analysis of 16,098 patients. | PSNet

    psnet.ahrq.gov/issue/impact-resident-participation-morbidity-and-mortality-neurosurgical-procedures-analysis-16098
    June 17, 2014 - Study Impact of resident participation on morbidity and mortality in neurosurgical procedures: an analysis of 16,098 patients. Citation Text: Bydon M, Abt NB, De la Garza-Ramos R, et al. Impact of resident participation on morbidity and mortality in neurosurgical procedures: an analysis …

  6. Workforce planning and safe workload in sterile compounding hospital pharmacy services. | PSNet

    psnet.ahrq.gov/issue/workforce-planning-and-safe-workload-sterile-compounding-hospital-pharmacy-services
    October 19, 2022 - Study Workforce planning and safe workload in sterile compounding hospital pharmacy services. Citation Text: Chaker A, Omair I, Mohamed WH, et al. Workforce planning and safe workload in sterile compounding hospital pharmacy services. Am J Health Syst Pharm. 2022;79(3):187–192. doi:10.10…

  7. Can we make airway management (even) safer?—lessons from national audit. | PSNet

    psnet.ahrq.gov/issue/can-we-make-airway-management-even-safer-lessons-national-audit
    March 01, 2023 - Review Can we make airway management (even) safer?—lessons from national audit. Citation Text: Woodall N, Frerk C, Cook TM. Can we make airway management (even) safer?--lessons from national audit. Anaesthesia. 2011;66 Suppl 2:27-33. doi:10.1111/j.1365-2044.2011.06931.x. Copy Citatio…

  8. Patient care, square-rigger sailing, and safety. | PSNet

    psnet.ahrq.gov/issue/patient-care-square-rigger-sailing-and-safety
    November 16, 2022 - Commentary Patient care, square-rigger sailing, and safety. Citation Text: Henkind SJ, Sinnett C. Patient care, square-rigger sailing, and safety. JAMA. 2008;300(14):1691-3. doi:10.1001/jama.300.14.1691. Copy Citation Format: DOI Google Scholar PubMed BibTeX EndNote X3 XM…

  9. A conceptual framework to reduce inpatient preventable deaths. | PSNet

    psnet.ahrq.gov/issue/conceptual-framework-reduce-inpatient-preventable-deaths
    April 24, 2018 - Study A conceptual framework to reduce inpatient preventable deaths. Citation Text: Davis DP, Aguilar SA, Lawrence B, et al. A Conceptual Framework to Reduce Inpatient Preventable Deaths. Jt Comm J Qual Patient Saf. 2018;44(7):413-420. doi:10.1016/j.jcjq.2018.01.003. Copy Citation …

  10. Elopement: evidence-based mitigation and management. | PSNet

    psnet.ahrq.gov/issue/elopement-evidence-based-mitigation-and-management
    October 19, 2022 - Study Elopement: evidence-based mitigation and management. Citation Text: Marlett JE, Vacovsky BA, Krug EA, et al. Elopement: evidence‐based mitigation and management. Worldviews Evid Based Nurs. 2024;20(6):634-641. doi:10.1111/wvn.12683. Copy Citation Format: DOI Google Sc…

  11. Improving surgical complications and patient safety at the nation's largest military hospital: an analysis of National Surgical Quality Improvement Program data. | PSNet

    psnet.ahrq.gov/issue/improving-surgical-complications-and-patient-safety-nations-largest-military-hospital
    November 09, 2022 - Study Improving surgical complications and patient safety at the nation's largest military hospital: an analysis of National Surgical Quality Improvement Program data. Citation Text: Maturo S, Hughes C, Kallingal G, et al. Improving Surgical Complications and Patient Safety at the Nation…

  12. The frequency of diagnostic errors in radiologic reports depends on the patient's age. | PSNet

    psnet.ahrq.gov/issue/frequency-diagnostic-errors-radiologic-reports-depends-patients-age
    March 09, 2022 - Study The frequency of diagnostic errors in radiologic reports depends on the patient's age. Citation Text: Diaz S, Ekberg O. The frequency of diagnostic errors in radiologic reports depends on the patient's age. Acta Radiol. 2010;51(8):934-8. doi:10.3109/02841851.2010.503192. Copy C…

  13. Achieving rapid door-to-balloon times: how top hospitals improve complex clinical systems. | PSNet

    psnet.ahrq.gov/issue/achieving-rapid-door-balloon-times-how-top-hospitals-improve-complex-clinical-systems
    November 07, 2012 - Study Achieving rapid door-to-balloon times: how top hospitals improve complex clinical systems. Citation Text: Bradley EH, Curry LA, Webster TR, et al. Achieving rapid door-to-balloon times: how top hospitals improve complex clinical systems. Circulation. 2006;113(8):1079-85. Copy C…

  14. Quality improvement implementation and hospital performance on patient safety indicators. | PSNet

    psnet.ahrq.gov/issue/quality-improvement-implementation-and-hospital-performance-patient-safety-indicators
    January 12, 2022 - Study Classic Quality improvement implementation and hospital performance on patient safety indicators. Citation Text: Weiner BJ, Alexander JA, Baker LC, et al. Quality improvement implementation and hospital performance on patient safety indicators. Med Care …

  15. A systematic review of the effect of distraction on surgeon performance: directions for operating room policy and surgical training. | PSNet

    psnet.ahrq.gov/issue/systematic-review-effect-distraction-surgeon-performance-directions-operating-room-policy-and
    November 14, 2011 - Review A systematic review of the effect of distraction on surgeon performance: directions for operating room policy and surgical training. Citation Text: Mentis HM, Chellali A, Manser K, et al. A systematic review of the effect of distraction on surgeon performance: directions for opera…

  16. Assessment of a simulated case-based measurement of physician diagnostic performance. | PSNet

    psnet.ahrq.gov/issue/assessment-simulated-case-based-measurement-physician-diagnostic-performance
    May 20, 2019 - Study Assessment of a simulated case-based measurement of physician diagnostic performance. Citation Text: Chatterjee S, Desai S, Manesh R, et al. Assessment of a Simulated Case-Based Measurement of Physician Diagnostic Performance. JAMA Netw Open. 2019;2(1):e187006. doi:10.1001/jamanetw…

  17. Measuring faculty reflection on adverse patient events: development and initial validation of a case-based learning system. | PSNet

    psnet.ahrq.gov/issue/measuring-faculty-reflection-adverse-patient-events-development-and-initial-validation-case
    September 20, 2011 - Study Measuring faculty reflection on adverse patient events: development and initial validation of a case-based learning system. Citation Text: Wittich CM, Lopez-Jimenez F, Decker LK, et al. Measuring faculty reflection on adverse patient events: development and initial validation of a …

  18. Consensus bundle on prevention of surgical site infections after major gynecologic surgery. | PSNet

    psnet.ahrq.gov/issue/consensus-bundle-prevention-surgical-site-infections-after-major-gynecologic-surgery
    January 15, 2014 - Commentary Consensus bundle on prevention of surgical site infections after major gynecologic surgery. Citation Text: Pellegrini JE, Toledo P, Soper DE, et al. Consensus Bundle on Prevention of Surgical Site Infections After Major Gynecologic Surgery. Obstet Gynecol. 2017;129(1):50-61. d…

  19. How do simulated error experiences impact attitudes related to error prevention? | PSNet

    psnet.ahrq.gov/issue/how-do-simulated-error-experiences-impact-attitudes-related-error-prevention
    October 19, 2022 - Study How do simulated error experiences impact attitudes related to error prevention? Citation Text: Breitkreuz KR, Dougal RL, Wright MC. How Do Simulated Error Experiences Impact Attitudes Related to Error Prevention? Simul Healthc. 2016;11(5):323-333. Copy Citation Format: …

  20. Emergency department boarding and adverse hospitalization outcomes among patients admitted to a general medical service. | PSNet

    psnet.ahrq.gov/issue/emergency-department-boarding-and-adverse-hospitalization-outcomes-among-patients-admitted
    July 13, 2016 - Study Emergency department boarding and adverse hospitalization outcomes among patients admitted to a general medical service. Citation Text: Lord K, Parwani V, Ulrich A, et al. Emergency department boarding and adverse hospitalization outcomes among patients admitted to a general medica…
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