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psnet.ahrq.gov/node/38712/psn-pdf
June 17, 2009 - Silence, power and communication in the operating room.
June 17, 2009
Gardezi F, Lingard LA, Espin S, et al. Silence, power and communication in the operating room. J Adv
Nurs. 2009;65(7):1390-1399. doi:10.1111/j.1365-2648.2009.04994.x.
https://psnet.ahrq.gov/issue/silence-power-and-communication-operating-room
Co…
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psnet.ahrq.gov/node/47974/psn-pdf
May 08, 2019 - Reducing surgical mortality in Scotland by use of the
WHO Surgical Safety Checklist.
May 8, 2019
Ramsay G, Haynes AB, Lipsitz SR, et al. Reducing surgical mortality in Scotland by use of the WHO
Surgical Safety Checklist. Br J Surg. 2019;106(8):1005-1011. doi:10.1002/bjs.11151.
https://psnet.ahrq.gov/issue/reducin…
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psnet.ahrq.gov/node/40400/psn-pdf
June 20, 2011 - Determinants of patient-reported medication errors: a
comparison among seven countries.
June 20, 2011
Lu CY, Roughead E. Determinants of patient-reported medication errors: a comparison among seven
countries. Int J Clin Pract. 2011;65(7):733-40. doi:10.1111/j.1742-1241.2011.02671.x.
https://psnet.ahrq.gov/issue/de…
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psnet.ahrq.gov/node/40200/psn-pdf
July 02, 2014 - Checklists to reduce diagnostic errors.
July 2, 2014
Ely JW, Graber ML, Croskerry P. Checklists to reduce diagnostic errors. Acad Med. 2011;86(3):307-313.
doi:10.1097/ACM.0b013e31820824cd.
https://psnet.ahrq.gov/issue/checklists-reduce-diagnostic-errors
Diagnostic errors are rapidly gaining attention as the next f…
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psnet.ahrq.gov/node/47939/psn-pdf
May 08, 2019 - Patient safety in medical imaging: a joint paper of the
European Society of Radiology (ESR) and the European
Federation of Radiographer Societies (EFRS).
May 8, 2019
Radiology ES of, Societies EF of R. Patient Safety in Medical Imaging: a joint paper of the European
Society of Radiology (ESR) and the European Fede…
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psnet.ahrq.gov/node/43367/psn-pdf
May 01, 2015 - Promoting Patient Safety Through Effective Health
Information Technology Risk Management.
May 1, 2015
Schneider EC, Ridgely MS, Meeker D, Hunter LE, Khodyakov D, Rudin R. RAND Health. Washington, DC:
Office of the National Coordinator for Health Information Technology; May 2014. RR-654-DHHSNCH.
https://psnet.ahrq.…
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psnet.ahrq.gov/node/40453/psn-pdf
May 18, 2011 - A 60-year-old man with delayed care for a renal mass.
May 18, 2011
Schiff G. Medical error: a 60-year-old man with delayed care for a renal mass. JAMA. 2011;305(18):1890-
8. doi:10.1001/jama.2011.496.
https://psnet.ahrq.gov/issue/60-year-old-man-delayed-care-renal-mass
Clinical Crossroads is a popular series in th…
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psnet.ahrq.gov/node/43313/psn-pdf
April 22, 2015 - Stress on the ward: evidence of safety tipping points in
hospitals.
April 22, 2015
Kuntz L, Mennicken R, Scholtes S. Stress on the Ward: Evidence of Safety Tipping Points in Hospitals.
Manage Sci. 2014;61(4). doi:10.1287/mnsc.2014.1917.
https://psnet.ahrq.gov/issue/stress-ward-evidence-safety-tipping-points-hospit…
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psnet.ahrq.gov/node/42068/psn-pdf
April 09, 2013 - Wisdom through adversity: learning and growing in the
wake of an error.
April 9, 2013
Plews-Ogan M, Owens JE, May NB. Wisdom through adversity: learning and growing in the wake of an
error. Patient Educ Couns. 2013;91(2):236-42. doi:10.1016/j.pec.2012.12.006.
https://psnet.ahrq.gov/issue/wisdom-through-adversity-l…
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psnet.ahrq.gov/node/60181/psn-pdf
April 01, 2020 - Adapting rapid assessment procedures for
implementation research using a team-based approach to
analysis: a case example of patient quality and safety
interventions in the ICU.
April 1, 2020
Holdsworth LM, Safaeinili N, Winget M, et al. Adapting rapid assessment procedures for implementation
research using a team…
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psnet.ahrq.gov/node/45957/psn-pdf
August 15, 2018 - Comparison of appendectomy outcomes between senior
general surgeons and general surgery residents.
August 15, 2018
Siam B, Al-Kurd A, Simanovsky N, et al. Comparison of Appendectomy Outcomes Between Senior General
Surgeons and General Surgery Residents. JAMA Surg. 2017;152(7):679-685.
doi:10.1001/jamasurg.2017.057…
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psnet.ahrq.gov/node/42947/psn-pdf
February 19, 2014 - Is the skillset obtained in surgical simulation transferable
to the operating theatre?
February 19, 2014
Buckley CE, Kavanagh DO, Traynor O, et al. Is the skillset obtained in surgical simulation transferable to
the operating theatre? Am J Surg. 2014;207(1):146-57. doi:10.1016/j.amjsurg.2013.06.017.
https://psnet.…
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psnet.ahrq.gov/node/846158/psn-pdf
March 15, 2023 - Safety risks and workflow implications associated with
nursing-related free-text communication orders.
March 15, 2023
Staes CJ, Yusuf S, Hambly M, et al. Safety risks and workflow implications associated with nursing-related
free-text communication orders. J Am Med Inform Assoc. 2023;30(5):828-837. doi:10.1093/jami…
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psnet.ahrq.gov/node/45461/psn-pdf
January 03, 2017 - Operating room–to-ICU patient handovers: a
multidisciplinary human-centered design approach.
January 3, 2017
Segall N, Bonifacio AS, Barbeito A, et al. Operating Room-to-ICU Patient Handovers: A Multidisciplinary
Human-Centered Design Approach. Jt Comm J Qual Patient Saf. 2016;42(9):400-14.
https://psnet.ahrq.gov/…
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psnet.ahrq.gov/node/39896/psn-pdf
July 03, 2014 - Effect of availability bias and reflective reasoning on
diagnostic accuracy among internal medicine residents.
July 3, 2014
Mamede S, Van Gog T, Van den Berge K, et al. Effect of availability bias and reflective reasoning on
diagnostic accuracy among internal medicine residents. JAMA. 2010;304(11):1198-1203.
doi:1…
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psnet.ahrq.gov/node/47733/psn-pdf
April 27, 2019 - Impact of the Agency for Healthcare Research and
Quality's Safety Program for Perinatal Care.
April 27, 2019
Kahwati LC, Sorensen A, Teixeira-Poit S, et al. Impact of the Agency for Healthcare Research and
Quality's Safety Program for Perinatal Care. Jt Comm J Qual Patient Saf. 2019;45(4):231-240.
doi:10.1016/j.jc…
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psnet.ahrq.gov/node/39821/psn-pdf
July 16, 2014 - Performance of a fail-safe system to follow up abnormal
mammograms in primary care.
July 16, 2014
Grossman E, Phillips RS, Weingart SN. Performance of a fail-safe system to follow up abnormal
mammograms in primary care. J Patient Saf. 2010;6(3):172-179.
https://psnet.ahrq.gov/issue/performance-fail-safe-system-fol…
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psnet.ahrq.gov/node/73130/psn-pdf
January 01, 2022 - Improving peripherally inserted central catheter
appropriateness and reducing device-related
complications: a quasiexperimental study in 52 Michigan
hospitals.
April 14, 2021
Chopra V, O'Malley M, Horowitz J, et al. Improving peripherally inserted central catheter appropriateness
and reducing device-related compl…
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psnet.ahrq.gov/node/46439/psn-pdf
August 20, 2018 - Hospital-readmission risk--isolating hospital effects from
patient effects.
August 20, 2018
Krumholz HM, Wang K, Lin Z, et al. Hospital-Readmission Risk - Isolating Hospital Effects from Patient
Effects. N Engl J Med. 2017;377(11):1055-1064. doi:10.1056/NEJMsa1702321.
https://psnet.ahrq.gov/issue/hospital-readmiss…
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psnet.ahrq.gov/node/40978/psn-pdf
March 21, 2012 - Relationship between patient safety and hospital surgical
volume.
March 21, 2012
Hernandez-Boussard T, Downey JR, McDonald KM, et al. Relationship between Patient Safety and
Hospital Surgical Volume. Health Serv Res. 2011;47(2). doi:10.1111/j.1475-6773.2011.01310.x.
https://psnet.ahrq.gov/issue/relationship-betwee…