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Psn-Pdf (pdf file)
psnet.ahrq.gov/node/47508/psn-pdfOctober 24, 2018 - Root cause analysis of reported patient falls in ORs in the Veterans Health Administration. October 24, 2018 Soncrant CM, Warner LJ, Neily J, et al. Root Cause Analysis of Reported Patient Falls in ORs in the Veterans Health Administration. AORN J. 2018;108(4):386-397. doi:10.1002/aorn.12372. https://psnet.ahrq.go… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/44713/psn-pdfJanuary 20, 2016 - Are surgeons and anesthesiologists lying to each other or gaming the system? A national random sample survey about "truth-telling practices" in the perioperative setting in the United States. January 20, 2016 Nurok M, Lee Y-Y, Ma Y, et al. Are surgeons and anesthesiologists lying to each other or gaming the syste… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/45484/psn-pdfDecember 04, 2016 - High prevalence of medication discrepancies between home health referrals and Centers for Medicare and Medicaid Services home health certification and plan of care and their potential to affect safety of vulnerable elderly adults. December 4, 2016 Brody AA, Gibson B, Tresner-Kirsch D, et al. High Prevalence of Me… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/47317/psn-pdfAugust 15, 2018 - Actions Needed to Address Employee Misconduct Process and Ensure Accountability. August 15, 2018 Washington, DC: United States Government Accountability Office; July 2018. Publication GAO-18-137. https://psnet.ahrq.gov/issue/actions-needed-address-employee-misconduct-process-and-ensure- accountability Both organi… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/852447/psn-pdfAugust 16, 2023 - Patient safety in palliative care at the end of life from the perspective of complex thinking. August 16, 2023 Bittencourt NCC de M, Duarte S da CM, Marcon SS, et al. Patient safety in palliative care at the end of life from the perspective of complex thinking. Healthcare (Basel). 2023;11(14):2030. doi:10.3390/hea… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/851197/psn-pdfJuly 05, 2023 - Finnish emergency medical services managers' and medical directors' perceptions of collaborating with patients concerning patient safety issues: a qualitative study. July 5, 2023 Venesoja A, Tella S, Castrén M, et al. Finnish emergency medical services managers’ and medical directors’ perceptions of collaborating… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/46182/psn-pdfJune 28, 2017 - What we know about designing an effective improvement intervention (but too often fail to put into practice). June 28, 2017 Marshall M, de Silva D, Cruickshank L, et al. What we know about designing an effective improvement intervention (but too often fail to put into practice). BMJ Qual Saf. 2016;26(7). doi:10.113… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/47054/psn-pdfJuly 19, 2018 - A target to achieve zero preventable trauma deaths through quality improvement. July 19, 2018 Hashmi ZG, Haut ER, Efron DT, et al. A Target to Achieve Zero Preventable Trauma Deaths Through Quality Improvement. JAMA Surg. 2018;153(7):686-689. doi:10.1001/jamasurg.2018.0159. https://psnet.ahrq.gov/issue/target-achi… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/837890/psn-pdfAugust 24, 2022 - Accuracy of pressure ulcer events in US nursing home ratings. August 24, 2022 Chen Z, Gleason LJ, Sanghavi P. Accuracy of pressure ulcer events in US nursing home ratings. Med Care. 2022;60(10):775-783. doi:10.1097/mlr.0000000000001763. https://psnet.ahrq.gov/issue/accuracy-pressure-ulcer-events-us-nursing-home-ra… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/854251/psn-pdfOctober 04, 2023 - A scoping review exploring the confidence of healthcare professionals in assessing all skin tones. October 4, 2023 Harrison J. A scoping review exploring the confidence of healthcare professionals in assessing all skin tones. Br Paramed J. 2023;8(2):18-28. doi:10.29045/14784726.2023.9.8.2.18. https://psnet.ahrq.go… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/37903/psn-pdfMay 09, 2013 - Safe Surgery. May 9, 2013 World Health Organization. https://psnet.ahrq.gov/issue/safe-surgery-saves-lives-second-global-patient-safety-challenge This initiative provides a surgical safety checklist and related educational and training materials building on the Second Global Patient Safety Challenge vision to enco… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/853622/psn-pdfJanuary 01, 2024 - Enhancing patient safety: a national standard for cyber resiliency in healthcare. September 20, 2023 Samuelson-Kiraly C, Mitchell JI, Kingston D, et al. Enhancing patient safety: A national standard for cyber resiliency in healthcare. Healthc Manage Forum. 2024;37(1):9-12. doi:10.1177/08404704231196138. https://ps… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/40355/psn-pdfJuly 09, 2012 - The Silent Treatment: Why Safety Tools and Checklists Aren't Enough to Save Lives. July 9, 2012 Maxfield D, Grenny J, Lavandero R, et al. Provo, UT: VitalSmarts; 2011. https://psnet.ahrq.gov/issue/silent-treatment-why-safety-tools-and-checklists-arent-enough-save-lives Silence Kills was a 2005 report that highligh… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/866163/psn-pdfJune 19, 2024 - Performance evaluation of ChatGPT in detecting diagnostic errors and their contributing factors: an analysis of 545 case reports of diagnostic errors. June 19, 2024 Harada Y, Suzuki T, Harada T, et al. Performance evaluation of ChatGPT in detecting diagnostic errors and their contributing factors: an analysis of 5… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/44334/psn-pdfNovember 20, 2015 - Improvement in detection of wrong-patient errors when radiologists include patient photographs in their interpretation of portable chest radiographs. November 20, 2015 Tridandapani S, Olsen K, Bhatti P. Improvement in Detection of Wrong-Patient Errors When Radiologists Include Patient Photographs in Their Interpre… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/73311/psn-pdfJanuary 01, 2022 - Key considerations in ensuring a safe regional telehealth care model: a systematic review. May 26, 2021 Haveland S, Islam S. Key considerations in ensuring a safe regional telehealth care model: a systematic review. Telemed J E Health. 2022;28(5):602-612. doi:10.1089/tmj.2020.0580. https://psnet.ahrq.gov/issue/key… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/846447/psn-pdfMarch 22, 2023 - Prosocial voice in the hierarchy of healthcare professionals: the role of emotions after harmful patient safety incidents. March 22, 2023 Richmond JG, Burgess N. Prosocial voice in the hierarchy of healthcare professionals: the role of emotions after harmful patient safety incidents. J Health Organ Manag. 2023;37(… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/47725/psn-pdfMarch 06, 2019 - Overcoming human barriers to safety event reporting in radiology. March 6, 2019 Siewert B, Brook OR, Swedeen S, et al. Overcoming Human Barriers to Safety Event Reporting in Radiology. Radiographics. 2019;39(1):251-263. doi:10.1148/rg.2019180135. https://psnet.ahrq.gov/issue/overcoming-human-barriers-safety-event-… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/837697/psn-pdfJuly 20, 2022 - Outsourcing health-care services to the private sector and treatable mortality rates in England, 2013-20: an observational study of NHS privatisation. July 20, 2022 Goodair B, Reeves A. Outsourcing health-care services to the private sector and treatable mortality rates in England, 2013–20: an observational study … -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/44005/psn-pdfApril 08, 2015 - Case report of a medication error by look-alike packaging: a classic surrogate marker of an unsafe system. April 8, 2015 Schnoor J, Rogalski C, Frontini R, et al. Case report of a medication error by look-alike packaging: a classic surrogate marker of an unsafe system. Patient Saf Surg. 2015;9:12. doi:10.1186/s1303…
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