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Revisiting duty-hour limits — IOM recommendations for patient safety and resident education. | PSNet

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February 17, 2011 - Commentary Revisiting duty-hour limits — IOM recommendations for patient safety and resident education. Citation Text: Iglehart JK. Revisiting duty-hour limits--IOM recommendations for patient safety and resident education. N Engl J Med. 2008;359(25):2633-5. doi:10.1056/NEJMp0808736. …

Submit Case | PSNet

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March 25, 2025 - Breadcrumb Home Training and Education WebM&M: Case Studies WebM&M Case Submission PSNet is looking for interesting, provocative cases that illustrate key issues in patient safety such as medication errors, diagnostic errors, and adverse events that either had the potential …

Rural hospital information technology implementation for safety and quality improvement: lessons learned. | PSNet

psnet.ahrq.gov/issue/rural-hospital-information-technology-implementation-safety-and-quality-improvement-lessons

April 24, 2018 - Study Rural hospital information technology implementation for safety and quality improvement: lessons learned. Citation Text: Tietze MF, Williams J, Galimbertti M. Rural hospital information technology implementation for safety and quality improvement: lessons learned. Comput Inform N…

Half-life of a printed handoff document. | PSNet

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April 24, 2018 - Study Half-life of a printed handoff document. Citation Text: Rosenbluth G, Jacolbia R, Milev D, et al. Half-life of a printed handoff document. BMJ Qual Saf. 2016;25(5):324-8. doi:10.1136/bmjqs-2015-004585. Copy Citation Format: DOI Google Scholar PubMed BibTeX EndNote X3 …

Epidemiology of diagnostic errors in pediatric emergency departments using electronic triggers. | PSNet

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December 16, 2020 - Study Epidemiology of diagnostic errors in pediatric emergency departments using electronic triggers. Citation Text: Mahajan P, White E, Shaw KN, et al. Epidemiology of diagnostic errors in pediatric emergency departments using electronic triggers. Acad Emerg Med. 2025;Epub Jan 15. doi:1…

Peer support for nurses as second victims: resilience, burnout, and job satisfaction. | PSNet

psnet.ahrq.gov/issue/peer-support-nurses-second-victims-resilience-burnout-and-job-satisfaction

March 03, 2019 - Study Emerging Classic Peer support for nurses as second victims: resilience, burnout, and job satisfaction. Citation Text: Connors C, Dukhanin V, March AL, et al. Peer support for nurses as second victims: Resilience, burnout, and job satisfaction. J Patient Sa…

Thematic analysis of women's perspectives on the meaning of safety during hospital-based birth. | PSNet

psnet.ahrq.gov/issue/thematic-analysis-womens-perspectives-meaning-safety-during-hospital-based-birth

May 08, 2019 - Study Thematic analysis of women's perspectives on the meaning of safety during hospital-based birth. Citation Text: Lyndon A, Malana J, Hedli LC, et al. Thematic Analysis of Women's Perspectives on the Meaning of Safety During Hospital-Based Birth. J Obstet Gynecol Neonatal Nurs. 2018;4…

The patient is in: patient involvement strategies for diagnostic error mitigation. | PSNet

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April 24, 2018 - Review The patient is in: patient involvement strategies for diagnostic error mitigation. Citation Text: McDonald KM, Bryce CL, Graber ML. The patient is in: patient involvement strategies for diagnostic error mitigation. BMJ Qual Saf. 2013;22 Suppl 2:ii33-ii39. doi:10.1136/bmjqs-2012-…

Patient and clinician experiences of uncertainty in the diagnostic process: current understanding and future directions. | PSNet

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March 11, 2020 - Commentary Patient and clinician experiences of uncertainty in the diagnostic process: current understanding and future directions. Citation Text: Meyer AND, Giardina TD, Khawaja L, et al. Patient and clinician experiences of uncertainty in the diagnostic process: current understanding a…

Evaluation of clinical practice guidelines on fall prevention and management for older adults: a systematic review. | PSNet

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March 09, 2022 - Review Evaluation of clinical practice guidelines on fall prevention and management for older adults: a systematic review. Citation Text: Montero-Odasso MM, Kamkar N, Pieruccini-Faria F, et al. Evaluation of clinical practice guidelines on fall prevention and management for older adults:…

The elephant of patient safety: what you see depends on how you look. | PSNet

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June 22, 2022 - Commentary Classic The elephant of patient safety: what you see depends on how you look. Citation Text: Shojania KG. The elephant of patient safety: what you see depends on how you look. Jt Comm J Qual Patient Saf. 2010;36(9):399-401. Copy Citation Format:…

Lack of patient knowledge regarding hospital medications. | PSNet

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September 20, 2006 - Study Lack of patient knowledge regarding hospital medications. Citation Text: Lack of patient knowledge regarding hospital medications. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML EndNote 7 XML Endnote tagged PubMedId RIS Download Citation …

The role of housestaff in implementing medication reconciliation on admission at an academic medical center. | PSNet

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March 30, 2011 - Commentary The role of housestaff in implementing medication reconciliation on admission at an academic medical center. Citation Text: Evans AS, Lazar EJ, Tiase VL, et al. The role of housestaff in implementing medication reconciliation on admission at an academic medical center. Am J Me…

Improving communication and resolution following adverse events using a patient-created simulation exercise. | PSNet

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September 01, 2018 - Study Improving communication and resolution following adverse events using a patient-created simulation exercise. Citation Text: Gallagher TH, Etchegaray J, Bergstedt B, et al. Improving Communication and Resolution Following Adverse Events Using a Patient-Created Simulation Exercise. H…

An ethnography of parents' perceptions of patient safety in the neonatal intensive care unit. | PSNet

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September 01, 2018 - Study An ethnography of parents' perceptions of patient safety in the neonatal intensive care unit. Citation Text: Ottosen MJ, Engebretson J, Etchegaray J, et al. An Ethnography of Parents' Perceptions of Patient Safety in the Neonatal Intensive Care Unit. Adv Neonatal Care. 2019;19(6):5…

A systematic review of the effectiveness, compliance, and critical factors for implementation of safety checklists in surgery. | PSNet

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December 04, 2024 - Review A systematic review of the effectiveness, compliance, and critical factors for implementation of safety checklists in surgery. Citation Text: Borchard A, Schwappach DLB, Barbir A, et al. A systematic review of the effectiveness, compliance, and critical factors for implementatio…

Learning from mistakes and near mistakes: using root cause analysis as a risk management tool. | PSNet

psnet.ahrq.gov/issue/learning-mistakes-and-near-mistakes-using-root-cause-analysis-risk-management-tool

June 19, 2024 - Commentary Learning from mistakes and near mistakes: using root cause analysis as a risk management tool. Citation Text: Cerniglia-Lowensen J. Learning From Mistakes and Near Mistakes: Using Root Cause Analysis as a Risk Management Tool. J Radiol Nurs. 2015;34(1). doi:10.1016/j.jradnu.20…

An overview of the use and implementation of checklists in surgical specialities - a systematic review. | PSNet

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July 31, 2013 - Review An overview of the use and implementation of checklists in surgical specialities - a systematic review. Citation Text: Patel J, Ahmed K, Guru KA, et al. An overview of the use and implementation of checklists in surgical specialities - a systematic review. Int J Surg. 2014;12(12):…

Improving incident reporting among physician trainees. | PSNet

psnet.ahrq.gov/issue/improving-incident-reporting-among-physician-trainees

October 08, 2016 - Study Improving incident reporting among physician trainees. Citation Text: Krouss M, Alshaikh J, Croft LD, et al. Improving Incident Reporting Among Physician Trainees. J Patient Saf. 2019;15(4):308-310. doi:10.1097/PTS.0000000000000325. Copy Citation Format: DOI Google Sc…

Listening and question-asking behaviors in resident and nurse handoff conversations: a prospective observational study. | PSNet

psnet.ahrq.gov/issue/listening-and-question-asking-behaviors-resident-and-nurse-handoff-conversations-prospective

June 27, 2018 - Study Listening and question-asking behaviors in resident and nurse handoff conversations: a prospective observational study. Citation Text: Kannampallil TG, Abraham J. Listening and question-asking behaviors in resident and nurse handoff conversations: a prospective observational study.…

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