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  1. Deficiencies in the Community Care Network Credentialing Process of a Former VA Surgeon and Veterans Health Administration Oversight Failures. | PSNet

    psnet.ahrq.gov/issue/deficiencies-community-care-network-credentialing-process-former-va-surgeon-and-veterans
    November 29, 2023 - Book/Report Deficiencies in the Community Care Network Credentialing Process of a Former VA Surgeon and Veterans Health Administration Oversight Failures. Citation Text: Deficiencies in the Community Care Network Credentialing Process of a Former VA Surgeon and Veterans Health Administra…

  2. Relationship between preventability of death after coronary artery bypass graft surgery and all-cause risk-adjusted mortality rates. | PSNet

    psnet.ahrq.gov/issue/relationship-between-preventability-death-after-coronary-artery-bypass-graft-surgery-and-all
    September 23, 2020 - Study Relationship between preventability of death after coronary artery bypass graft surgery and all-cause risk-adjusted mortality rates. Citation Text: Guru V, Tu J, Etchells E, et al. Relationship between preventability of death after coronary artery bypass graft surgery and all-cau…

  3. Partnership as a pathway to diagnostic excellence: the challenges and successes of implementing the Safer Dx Learning Lab. | PSNet

    psnet.ahrq.gov/issue/partnership-pathway-diagnostic-excellence-challenges-and-successes-implementing-safer-dx
    April 13, 2022 - Study Partnership as a pathway to diagnostic excellence: the challenges and successes of implementing the Safer Dx Learning Lab. Citation Text: Sloane J, Singh H, Upadhyay DK, et al. Partnership as a pathway to diagnostic excellence: the challenges and successes of implementing the Safer…

  4. Creating a framework to integrate residency program and medical center approaches to quality improvement and patient safety training | PSNet

    psnet.ahrq.gov/issue/creating-framework-integrate-residency-program-and-medical-center-approaches-quality
    November 11, 2020 - Commentary Creating a framework to integrate residency program and medical center approaches to quality improvement and patient safety training Citation Text: Chen A, Wolpaw BJ, Vande Vusse LK, et al. Creating a framework to integrate residency program and medical center approaches to qu…

  5. Patient reported receipt of medication instructions for warfarin is associated with reduced risk of serious bleeding events. | PSNet

    psnet.ahrq.gov/issue/patient-reported-receipt-medication-instructions-warfarin-associated-reduced-risk-serious
    February 03, 2011 - Study Patient reported receipt of medication instructions for warfarin is associated with reduced risk of serious bleeding events. Citation Text: Metlay JP, Hennessy S, Localio R, et al. Patient reported receipt of medication instructions for warfarin is associated with reduced risk of…

  6. Hospital-acquired SARS-CoV-2 infection: lessons for public health. | PSNet

    psnet.ahrq.gov/issue/hospital-acquired-sars-cov-2-infection-lessons-public-health
    November 25, 2020 - Commentary Hospital-acquired SARS-CoV-2 infection: lessons for public health. Citation Text: Richterman A, Meyerowitz EA, Cevik M. Hospital-acquired SARS-CoV-2 infection: lessons for public health. JAMA. 2020;324(21):2155. doi:10.1001/jama.2020.21399. Copy Citation Format: …

  7. The effect of contact precautions on frequency of hospital adverse events. | PSNet

    psnet.ahrq.gov/issue/effect-contact-precautions-frequency-hospital-adverse-events
    September 30, 2015 - Study The effect of contact precautions on frequency of hospital adverse events. Citation Text: Croft LD, Liquori M, Ladd J, et al. The Effect of Contact Precautions on Frequency of Hospital Adverse Events. Infect Control Hosp Epidemiol. 2015;36(11):1268-74. doi:10.1017/ice.2015.192. C…

  8. Preserving organizational resilience, patient safety, and staff retention during COVID-19 requires a holistic consideration of the psychological safety of healthcare workers | PSNet

    psnet.ahrq.gov/issue/preserving-organizational-resilience-patient-safety-and-staff-retention-during-covid-19
    May 08, 2019 - Commentary Classic Preserving organizational resilience, patient safety, and staff retention during COVID-19 requires a holistic consideration of the psychological safety of healthcare workers Citation Text: Rangachari P, L. Woods J. Preserving organizational re…

  9. The You CAN campaign: teamwork training for patients and families in ambulatory oncology. | PSNet

    psnet.ahrq.gov/issue/you-can-campaign-teamwork-training-patients-and-families-ambulatory-oncology
    September 01, 2016 - Study The You CAN campaign: teamwork training for patients and families in ambulatory oncology. Citation Text: Weingart SN, Simchowitz B, Eng TK, et al. The You CAN campaign: teamwork training for patients and families in ambulatory oncology. Jt Comm J Qual Patient Saf. 2009;35(2):63-71.…

  10. Impact of patient safety bundle and team-based training on obstetric hypertensive emergencies. | PSNet

    psnet.ahrq.gov/issue/impact-patient-safety-bundle-and-team-based-training-obstetric-hypertensive-emergencies
    July 21, 2021 - Study Impact of patient safety bundle and team-based training on obstetric hypertensive emergencies. Citation Text: Grogan L, Peterson E, Flatley M, et al. Impact of patient safety bundle and team-based training on obstetric hypertensive emergencies. Am J Perinatol. 2025;42(4):452-461. d…

  11. Using behavioral insights to strengthen strategies for change. Practical applications for quality improvement in healthcare. | PSNet

    psnet.ahrq.gov/issue/using-behavioral-insights-strengthen-strategies-change-practical-applications-quality
    April 06, 2022 - Commentary Using behavioral insights to strengthen strategies for change. Practical applications for quality improvement in healthcare. Citation Text: Johansen RLR, Tulloch S. Using behavioral insights to strengthen strategies for change. Practical applications for quality improvement in…

  12. Experiences with diagnostic delay among underserved racial and ethnic patients: a systematic review of the qualitative literature. | PSNet

    psnet.ahrq.gov/issue/experiences-diagnostic-delay-among-underserved-racial-and-ethnic-patients-systematic-review
    November 03, 2015 - Review Experiences with diagnostic delay among underserved racial and ethnic patients: a systematic review of the qualitative literature. Citation Text: Faugno E, Galbraith AA, Walsh KE, et al. Experiences with diagnostic delay among underserved racial and ethnic patients: a systematic r…

  13. Building a resilient patient safety culture: a large healthcare organization's approach to systematically reviewing serious harm events. | PSNet

    psnet.ahrq.gov/issue/building-resilient-patient-safety-culture-large-healthcare-organizations-approach
    November 03, 2015 - Study Building a resilient patient safety culture: a large healthcare organization's approach to systematically reviewing serious harm events. Citation Text: Harvey B, Dhalla IA, O'Neill C, et al. Building a resilient patient safety culture: a large healthcare organization's approach to …

  14. Client, caregiver, and provider perspectives of safety in palliative home care: a mixed method design. | PSNet

    psnet.ahrq.gov/issue/client-caregiver-and-provider-perspectives-safety-palliative-home-care-mixed-method-design
    March 02, 2016 - Study Client, caregiver, and provider perspectives of safety in palliative home care: a mixed method design. Citation Text: Lang A, Toon L, Cohen SR, et al. Client, caregiver, and provider perspectives of safety in palliative home care: a mixed method design. Safety Health. 2015;1(1):3. …

  15. Improving patient safety in public hospitals: developing standard measures to track medical errors and process breakdowns. | PSNet

    psnet.ahrq.gov/issue/improving-patient-safety-public-hospitals-developing-standard-measures-track-medical-errors
    December 19, 2018 - Study Improving patient safety in public hospitals: developing standard measures to track medical errors and process breakdowns. Citation Text: Ackerman SL, Gourley G, Le G, et al. Improving Patient Safety in Public Hospitals: Developing Standard Measures to Track Medical Errors and Proc…

  16. Perceptions of hospital safety climate and incidence of readmission. | PSNet

    psnet.ahrq.gov/issue/perceptions-hospital-safety-climate-and-incidence-readmission
    March 25, 2015 - Study Perceptions of hospital safety climate and incidence of readmission. Citation Text: Hansen LO, Williams M, Singer SJ. Perceptions of hospital safety climate and incidence of readmission. Health Serv Res. 2011;46(2):596-616. doi:10.1111/j.1475-6773.2010.01204.x. Copy Citation …

  17. Variation in 17 obstetric care pathways: potential danger for health professionals and patient safety? | PSNet

    psnet.ahrq.gov/issue/variation-17-obstetric-care-pathways-potential-danger-health-professionals-and-patient-safety
    September 21, 2016 - Study Variation in 17 obstetric care pathways: potential danger for health professionals and patient safety? Citation Text: Sarrechia M, Van Gerven E, Hermans L, et al. Variation in 17 obstetric care pathways: potential danger for health professionals and patient safety? J Adv Nurs. 20…

  18. Interventions and measurements of highly reliable/resilient organization implementations: a literature review. | PSNet

    psnet.ahrq.gov/issue/interventions-and-measurements-highly-reliableresilient-organization-implementations
    July 21, 2021 - Review Interventions and measurements of highly reliable/resilient organization implementations: a literature review. Citation Text: Cantu J, Tolk J, Fritts S, et al. Interventions and measurements of highly reliable/resilient organization implementations: a literature review. Appl Ergon…

  19. Does crew resource management training work? An update, an extension, and some critical needs. | PSNet

    psnet.ahrq.gov/issue/does-crew-resource-management-training-work-update-extension-and-some-critical-needs
    January 02, 2017 - Review Does crew resource management training work? An update, an extension, and some critical needs. Citation Text: Salas E, Wilson KA, Burke CS, et al. Does Crew Resource Management Training Work? An Update, an Extension, and Some Critical Needs. Hum Factors. 2006;48(2):392-412. doi:…

  20. The impact of burnout on paediatric nurses' attitudes about patient safety in the acute hospital setting: a systematic review. | PSNet

    psnet.ahrq.gov/issue/impact-burnout-paediatric-nurses-attitudes-about-patient-safety-acute-hospital-setting
    June 05, 2019 - Review The impact of burnout on paediatric nurses' attitudes about patient safety in the acute hospital setting: a systematic review. Citation Text: Flynn C, Watson C, Patton D, et al. The impact of burnout on paediatric nurses' attitudes about patient safety in the acute hospital setti…
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