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psnet.ahrq.gov/node/39730/psn-pdf
December 21, 2014 - Surgical case listing accuracy: failure analysis at a high-
volume academic medical center.
December 21, 2014
Cima RR, Hale C, Kollengode A, et al. Surgical case listing accuracy: failure analysis at a high-volume
academic medical center. Arch Surg. 2010;145(7):641-6. doi:10.1001/archsurg.2010.112.
https://psnet.a…
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psnet.ahrq.gov/node/46203/psn-pdf
June 14, 2017 - Prescription errors related to the use of computerized
provider order-entry system for pediatric patients.
June 14, 2017
Alhanout K, Bun S-S, Retornaz K, et al. Prescription errors related to the use of computerized provider
order-entry system for pediatric patients. Int J Med Inform. 2017;103:15-19.
doi:10.1016/j…
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psnet.ahrq.gov/node/46842/psn-pdf
June 22, 2018 - Do EPs change their clinical behaviour in the hallway or
when a companion is present? A cross-sectional survey.
June 22, 2018
Stoklosa H, Scannell M, Ma Z, et al. Do EPs change their clinical behaviour in the hallway or when a
companion is present? A cross-sectional survey. Emerg Med J. 2018;35(7):406-411.
doi:10.…
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psnet.ahrq.gov/node/44476/psn-pdf
September 26, 2016 - The impact of interruptions on the duration of nursing
interventions: a direct observation study in an academic
emergency department.
September 26, 2016
Cole G, Stefanus D, Gardner H, et al. The impact of interruptions on the duration of nursing interventions: a
direct observation study in an academic emergency de…
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psnet.ahrq.gov/node/38354/psn-pdf
September 24, 2010 - Barriers to emergency departments' adherence to four
medication safety–related Joint Commission National
Patient Safety Goals.
September 24, 2010
Juarez A, Gacki-Smith J, Bauer MR, et al. Barriers to emergency departments' adherence to four
medication safety-related Joint Commission National Patient Safety Goals. …
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psnet.ahrq.gov/node/45556/psn-pdf
June 29, 2017 - Readmission rates after passage of the Hospital
Readmissions Reduction Program: a pre–post analysis.
June 29, 2017
Wasfy JH, Zigler CM, Choirat C, et al. Readmission Rates After Passage of the Hospital Readmissions
Reduction Program: A Pre-Post Analysis. Ann Intern Med. 2017;166(5):324-331. doi:10.7326/M16-0185.
h…
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psnet.ahrq.gov/node/43016/psn-pdf
May 28, 2014 - Identification of serious and reportable events in home
care: a Delphi survey to develop consensus.
May 28, 2014
Doran DM, Baker R, Szabo C, et al. Identification of serious and reportable events in home care: a Delphi
survey to develop consensus. Int J Health Care Qual. 2014;26(2):136-143. doi:10.1093/intqhc/mzu00…
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psnet.ahrq.gov/node/38553/psn-pdf
April 14, 2010 - The effect of computerized physician order entry on
medication prescription errors and clinical outcome in
pediatric and intensive care: a systematic review.
April 14, 2010
van Rosse F, Maat B, Rademaker CMA, et al. The effect of computerized physician order entry on
medication prescription errors and clinical out…
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psnet.ahrq.gov/node/847717/psn-pdf
April 19, 2023 - Quality improvement initiative to decrease central line-
associated bloodstream infections during the COVID-19
pandemic: a "zero harm" approach.
April 19, 2023
Redstone CS, Zadeh M, Wilson M-A, et al. Quality improvement initiative to decrease central line-
associated bloodstream infections during the COVID-19 pan…
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psnet.ahrq.gov/node/44372/psn-pdf
June 21, 2016 - Hospital characteristics associated with penalties in the
Centers for Medicare & Medicaid Services Hospital-
Acquired Condition Reduction Program.
June 21, 2016
Rajaram R, Chung JW, Kinnier C, et al. Hospital Characteristics Associated With Penalties in the Centers
for Medicare & Medicaid Services Hospital-Acquire…
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psnet.ahrq.gov/node/842418/psn-pdf
January 11, 2023 - Tele-Rapid Response Team (Tele-RRT): the effect of
implementing patient safety network system on outcomes
of medical patients- a before and after cohort study.
January 11, 2023
Balshi AN, Al-Odat MA, Alharthy AM, et al. Tele-Rapid Response Team (Tele-RRT): The effect of
implementing patient safety network system o…
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psnet.ahrq.gov/node/40048/psn-pdf
December 01, 2010 - Temporal trends in rates of patient harm resulting from
medical care.
December 1, 2010
Landrigan CP, Parry G, Bones CB, et al. Temporal trends in rates of patient harm resulting from medical
care. N Engl J Med. 2010;363(22):2124-34. doi:10.1056/NEJMsa1004404.
https://psnet.ahrq.gov/issue/temporal-trends-rates-pati…
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psnet.ahrq.gov/node/41519/psn-pdf
September 01, 2016 - Failure to utilize functions of an electronic prescribing
system and the subsequent generation of 'technically
preventable' computerized alerts.
September 1, 2016
Baysari M, Reckmann MH, Li L, et al. Failure to utilize functions of an electronic prescribing system and the
subsequent generation of 'technically prev…
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psnet.ahrq.gov/node/41694/psn-pdf
September 19, 2012 - Effect of nonpayment for hospital-acquired,
catheter–associated urinary tract infection: a statewide
analysis.
September 19, 2012
Meddings JA, Reichert H, Rogers MAM, et al. Effect of nonpayment for hospital-acquired, catheter-
associated urinary tract infection: a statewide analysis. Ann Intern Med. 2012;157(5):3…
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psnet.ahrq.gov/node/42819/psn-pdf
October 31, 2014 - Implementing a national program to reduce catheter-
associated urinary tract infection: a quality improvement
collaboration of state hospital associations, academic
medical centers, professional societies, and
governmental agencies.
October 31, 2014
Fakih MG, George C, Edson B, et al. Implementing a national prog…
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psnet.ahrq.gov/node/37940/psn-pdf
June 16, 2010 - Comparing patient-reported hospital adverse events with
medical record review: do patients know something that
hospitals do not?
June 16, 2010
Weissman JS, Schneider EC, Weingart SN, et al. Comparing patient-reported hospital adverse events with
medical record review: do patients know something that hospitals do n…
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psnet.ahrq.gov/node/46135/psn-pdf
July 11, 2017 - Two-state collaborative study of a multifaceted
intervention to decrease ventilator-associated events.
July 11, 2017
Rawat N, Yang T, Ali KJ, et al. Two-State Collaborative Study of a Multifaceted Intervention to Decrease
Ventilator-Associated Events. Crit Care Med. 2017;45(7):1208-1215.
doi:10.1097/CCM.0000000000…
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effectivehealthcare.ahrq.gov/sites/default/files/pdf/migraine-emergency_research-protocol.pdf
July 18, 2011 - Patterns of diagnosis and acute and preventive treatment
for migraine in the United States: results
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/ambulatory-surgery/sections/implementation/training-tools/pf-engagement/pf-engagement-facnotes.docx
May 01, 2017 - AHRQ Safety Program for Ambulatory Surgery
Patient and Family Engagement in the Surgical Environment Module
Facilitator Notes
SAY:
The purpose of the Patient and Family Engagement in the Ambulatory Surgical Environment module is to augment the existing hospital setting Patient and Family Engagement module of th…
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety-2/vol2/Advances-Fitzgerald_108.pdf
January 01, 2007 - Challenges to Real-Time Decision Support in Health Care
Challenges to Real-Time Decision Support
in Health Care
Mark Fitzgerald, MB, BS, FACEM; Nathan Farrow, RN, BN (Hons) Adv Nur (Critical Care);
Pamela Scicluna, BSc; Angela Murray, RN; Yan Xiao, PhD;
Colin F. Mackenzie, MBChB, FRCA, FCCM
Abstract
This …