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psnet.ahrq.gov/innovation/patient-and-family-centered-i-pass-family-centered-communication-program-reduce-medical
February 26, 2025 - Patient and Family Centered I-PASS (Family-Centered Communication Program to Reduce Medical Errors and Improve Family Experience and Communication Processes)
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psnet.ahrq.gov/innovation/nudge-unit-supports-physician-patient-behavioral-changes-towards-medical-decisions
July 23, 2024 - Nudge Unit Supports Physician, Patient Behavioral Changes Towards Medical Decisions that Improve Care Value and Quality of Care
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December 23, 2020
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psnet.ahrq.gov/issue/coping-strategies-health-care-providers-second-victims-systematic-review
June 30, 2021 - Review
Coping strategies in health care providers as second victims: a systematic review.
Citation Text:
Kappes M, Romero‐García M, Delgado‐Hito P. Coping strategies in health care providers as second victims: a systematic review. Int Nurs Rev. 2021;68(4):471-481. doi:10.1111/inr.12694. …
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psnet.ahrq.gov/issue/does-standardisation-improve-post-operative-anaesthesia-handoffs-meta-analyses-provider
June 29, 2022 - Review
Does standardisation improve post-operative anaesthesia handoffs? Meta-analyses on provider, patient, organisational, and handoff outcomes.
Citation Text:
Lazzara EH, Simonson RJ, Gisick LM, et al. Does standardisation improve post-operative anaesthesia handoffs? Meta-analyses on …
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psnet.ahrq.gov/issue/effects-electronic-prescribing-community-based-providers-ambulatory-medication-safety
March 04, 2015 - Study
The effects of electronic prescribing by community-based providers on ambulatory medication safety.
Citation Text:
Abramson EL, Pfoh ER, Barrón Y, et al. The effects of electronic prescribing by community-based providers on ambulatory medication safety. Jt Comm J Qual Patient Saf…
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psnet.ahrq.gov/issue/preoperative-communication-between-anesthesia-surgery-and-primary-care-providers-older
April 11, 2011 - Study
Preoperative communication between anesthesia, surgery, and primary care providers for older surgical patients.
Citation Text:
Ron D, Gunn CM, Havidich JE, et al. Preoperative communication between anesthesia, surgery, and primary care providers for older surgical patients. Jt Comm…
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psnet.ahrq.gov/issue/impact-hindsight-bias-diagnosis-perioperative-events-anesthesia-providers-multicenter
December 16, 2020 - Study
The impact of hindsight bias on the diagnosis of perioperative events by anesthesia providers: a multicenter randomized crossover study.
Citation Text:
Millan PD, Kleiman AM, Friedman JF, et al. The impact of hindsight bias on the diagnosis of perioperative events by anesthesia pro…
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psnet.ahrq.gov/issue/are-verbal-orders-threat-patient-safety
July 31, 2008 - Review
Are verbal orders a threat to patient safety?
Citation Text:
Wakefield DS, Wakefield BJ. Are verbal orders a threat to patient safety? Qual Saf Health Care. 2009;18(3):165-168. doi:10.1136/qshc.2009.034041.
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psnet.ahrq.gov/issue/how-does-routine-disclosure-medical-error-affect-patients-propensity-sue-and-their-assessment
December 04, 2016 - Study
How does routine disclosure of medical error affect patients' propensity to sue and their assessment of provider quality?: Evidence from survey data.
Citation Text:
Helmchen LA, Richards MR, McDonald TB. How does routine disclosure of medical error affect patients' propensity to …
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psnet.ahrq.gov/node/72618/psn-pdf
December 23, 2020 - Nudge Unit Supports Physician, Patient Behavioral
Changes Towards Medical Decisions that Improve Care
Value and Quality of Care
December 23, 2020
https://psnet.ahrq.gov/innovation/nudge-unit-supports-physician-patient-behavioral-changes-towards-
medical-decisions
Summary
Nudges are a change in the way choices ar…
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psnet.ahrq.gov/node/49762/psn-pdf
June 01, 2016 - The Case of Mistaken Intubation
June 1, 2016
Silveira MJ. The Case of Mistaken Intubation. PSNet [internet]. 2016.
https://psnet.ahrq.gov/web-mm/case-mistaken-intubation
Case Objectives
Appreciate that most older adults and many younger chronically ill patients have discussed or
documented their preferences for l…
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psnet.ahrq.gov/node/46349/psn-pdf
August 16, 2017 - Health Literacy Tools for Providers of Medication Therapy
Management.
August 16, 2017
Rockville, MD: Agency for Healthcare Research and Quality; July 2017.
https://psnet.ahrq.gov/issue/health-literacy-tools-providers-medication-therapy-management
Health literacy is important for effective care communications and s…
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psnet.ahrq.gov/node/72761/psn-pdf
February 17, 2021 - Using ventilator splitters during the COVID-19 pandemic--
letter to health care providers.
February 17, 2021
Silver Spring, MD: Division of Industry and Consumer Education, US Food and Drug Administration;
February 9. 2021.
https://psnet.ahrq.gov/issue/using-ventilator-splitters-during-covid-19-pandemic-letter-hea…
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psnet.ahrq.gov/node/47809/psn-pdf
April 03, 2019 - What's in a name? Provider perception of injured John
Doe patients.
April 3, 2019
Janowak CF, Agarwal SK, Zarzaur BL. What's in a Name? Provider Perception of Injured John Doe
Patients. J Surg Res. 2019;238:218-223. doi:10.1016/j.jss.2019.01.027.
https://psnet.ahrq.gov/issue/whats-name-provider-perception-injured-…
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psnet.ahrq.gov/node/845305/psn-pdf
March 01, 2023 - An infrastructure to provide safer, higher quality, and
more equitable telehealth.
March 1, 2023
Kobeissi MM, Hickey JV. An infrastructure to provide safer, higher quality, and more equitable telehealth. Jt
Comm J Qual Patient Saf. 2023;49(4):213-222. doi:10.1016/j.jcjq.2023.01.006.
https://psnet.ahrq.gov/issue/in…
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psnet.ahrq.gov/webmm/submit-case
Submit a Case
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Case Form
The content of case submissions is anonymous. Do not provide any personally identifiable (patient or provider) information, and do not use institution…
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psnet.ahrq.gov/web-mm/comanagement-whos-charge
July 01, 2011 - Comanagement: Who's in Charge?
Citation Text:
Cheng HQ. Comanagement: Who's in Charge?. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2012.
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Google Scholar BibTeX EndNote X3 XML EndNote 7 XML Endno…
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psnet.ahrq.gov/issue/suffering-silence-medical-error-and-its-impact-health-care-providers
December 12, 2014 - Review
Suffering in silence: medical error and its impact on health care providers.
Citation Text:
Robertson JJ, Long B. Suffering in Silence: Medical Error and its Impact on Health Care Providers. J Emerg Med. 2018;54(4). doi:10.1016/j.jemermed.2017.12.001.
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psnet.ahrq.gov/issue/effect-provider-characteristics-responses-medication-related-decision-support-alerts
July 16, 2019 - Study
The effect of provider characteristics on the responses to medication-related decision support alerts.
Citation Text:
Cho IS, Slight SP, Nanji KC, et al. The effect of provider characteristics on the responses to medication-related decision support alerts. Int J Med Inform. 2015;84…
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psnet.ahrq.gov/issue/provider-interruptions-and-patient-perceptions-care-observational-study-emergency-department
June 26, 2024 - Study
Provider interruptions and patient perceptions of care: an observational study in the emergency department.
Citation Text:
Schneider A, Wehler M, Weigl M. Provider interruptions and patient perceptions of care: an observational study in the emergency department. BMJ Qual Saf. 2019;…