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  1. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/50414/psn-pdf
    September 04, 2019 - Rating the raters: an evaluation of publicly reported hospital quality rating systems. September 4, 2019 Bilimoria KY, Birkmeyer JD, Burstin H, et al. NEJM Catalyst. August 14, 2019. https://psnet.ahrq.gov/issue/rating-raters-evaluation-publicly-reported-hospital-quality-rating-systems Numerous publicly available …
  2. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/39895/psn-pdf
    September 21, 2011 - Improving America's Hospitals: The Joint Commission's Annual Report on Quality and Safety 2010. September 21, 2011 Oakbrook Terrace, IL: The Joint Commission; September 2010. https://psnet.ahrq.gov/issue/improving-americas-hospitals-joint-commissions-annual-report-quality-and- safety-2010 In the fifth report on t…
  3. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/47756/psn-pdf
    February 06, 2019 - Meltdown: Why Our Systems Fail and What We Can Do About It. February 6, 2019 Clearfield C, Tilcsik A. New York, NY: Penguin Press; 2018. ISBN: 978-0735222632. https://psnet.ahrq.gov/issue/meltdown-why-our-systems-fail-and-what-we-can-do-about-it Complex systems are prone to failure. This book provides a multi-indu…
  4. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/861279/psn-pdf
    January 24, 2024 - Mistreatment in health care among women in Appalachia. January 24, 2024 Alspaugh A, Swan LET, Auerbach SL, et al. Mistreatment in health care among women in Appalachia. Cult Health Sex. 2023;25(12):1690-1706. doi:10.1080/13691058.2023.2176547. https://psnet.ahrq.gov/issue/mistreatment-health-care-among-women-appala…
  5. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/38071/psn-pdf
    February 15, 2011 - A multifaceted approach to safety: the synergistic detection of adverse drug events in adult inpatients. February 15, 2011 Ferranti JM, Horvath MM, Cozart H, et al. A Multifaceted Approach to Safety. J Patient Saf. 2008;4(3):184- 190. doi:10.1097/pts.0b013e318184a9d5. https://psnet.ahrq.gov/issue/multifaceted-appr…
  6. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/46601/psn-pdf
    January 25, 2018 - Night-time communication at Stanford University Hospital: perceptions, reality and solutions. January 25, 2018 Sun AJ, Wang L, Go M, et al. Night-time communication at Stanford University Hospital: perceptions, reality and solutions. BMJ Qual Saf. 2018;27(2):156-162. doi:10.1136/bmjqs-2017-006727. https://psnet.ah…
  7. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/45798/psn-pdf
    February 01, 2017 - American College of Surgeons and Surgical Infection Society: Surgical Site Infection Guidelines, 2016 Update. February 1, 2017 Ban KA, Minei JP, Laronga C, et al. American College of Surgeons and Surgical Infection Society: Surgical Site Infection Guidelines, 2016 Update. J Am Coll Surg. 2017;224(1):59-74. doi:10.…
  8. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/60235/psn-pdf
    April 15, 2020 - Independent Mortality Review of Cardiac Surgery at St George’s University Hospitals NHS Foundation Trust. April 15, 2020 NHS Improvement. Independent Mortality Review of Cardiac Surgery at St George’s University Hospitals NHS Foundation Trust. NHS England. March 2020. https://psnet.ahrq.gov/issue/independent-morta…
  9. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/43671/psn-pdf
    December 10, 2014 - Reducing emergency department charting and ordering errors with a room number watermark on the electronic medical record display. December 10, 2014 Yamamoto LG. Reducing emergency department charting and ordering errors with a room number watermark on the electronic medical record display. Hawaii J Med Public Heal…
  10. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/859355/psn-pdf
    December 20, 2023 - Systems-Based Approaches to Improve Patient Safety by Improving Healthcare Worker Safety and Well-Being (R01 Clinical Trial Optional). December 20, 2023 PA-24-093. Rockville, MD: Agency for Healthcare Research and Quality. December 5, 2023. https://psnet.ahrq.gov/issue/systems-based-approaches-improve-patient-safe…
  11. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/34055/psn-pdf
    March 07, 2005 - What is driving hospitals' patient-safety efforts? March 7, 2005 Devers KJ, Pham HH, Liu G. What is driving hospitals' patient-safety efforts? Health Aff (Millwood). 2004;23(2):103-15. https://psnet.ahrq.gov/issue/what-driving-hospitals-patient-safety-efforts This study evaluated the role professionalism, regulati…
  12. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/850352/psn-pdf
    June 14, 2023 - Stigmatizing language expressed towards individuals with current or previous OUD who have pain and cancer: a qualitative study. June 14, 2023 Sedney CL, Dekeseredy P, Singh SA, et al. Stigmatizing language expressed towards individuals with current or previous OUD who have pain and cancer: a qualitative study. J P…
  13. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/46045/psn-pdf
    December 22, 2018 - Validating domains of patient contextual factors essential to preventing contextual errors: a qualitative study conducted at Chicago area Veterans Health Administration sites. December 22, 2018 Binns-Calvey AE, Malhiot A, Kostovich CT, et al. Validating Domains of Patient Contextual Factors Essential to Preventin…
  14. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/854835/psn-pdf
    October 25, 2023 - Improving patient safety by shifting power from health professionals to patients. October 25, 2023 BMJ. 2023(383):2219, 2278, 2319, 2331. https://psnet.ahrq.gov/issue/improving-patient-safety-shifting-power-health-professionals-patients This compendium of editorials and opinion pieces discuss “Martha’s Rule,” a ne…
  15. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/866408/psn-pdf
    July 31, 2024 - Influences of leadership, organizational culture, and hierarchy on raising concerns about patient deterioration: a qualitative study. July 31, 2024 Vehvilainen E, Charles A, Sainsbury J, et al. Influences of leadership, organizational culture, and hierarchy on raising concerns about patient deterioration: a qualit…
  16. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/47839/psn-pdf
    May 01, 2019 - Comparison of a prototype for indications-based prescribing with 2 commercial prescribing systems. May 1, 2019 Garabedian PM, Wright A, Newbury I, et al. Comparison of a Prototype for Indications-Based Prescribing With 2 Commercial Prescribing Systems. JAMA Netw Open. 2019;2(3):e191514. doi:10.1001/jamanetworkopen…
  17. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/46953/psn-pdf
    September 12, 2018 - An integrative review exploring the perceptions of patients and healthcare professionals towards patient involvement in promoting hand hygiene compliance in the hospital setting. September 12, 2018 Alzyood M, Jackson D, Brooke J, et al. An integrative review exploring the perceptions of patients and healthcare pr…
  18. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/72814/psn-pdf
    March 10, 2021 - Implementing a human factors approach to RCA(2) : tools, processes and strategies. March 10, 2021 Wiegmann DA, Wood LJ, Solomon DB, et al. Implementing a human factors approach to RCA(2) : tools, processes and strategies. J Healthc Risk Manag. 2021;41(1):31-46. doi:10.1002/jhrm.21454. https://psnet.ahrq.gov/issue/…
  19. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/42449/psn-pdf
    July 31, 2013 - The epidemiology of malpractice claims in primary care: a systematic review. July 31, 2013 Wallace E, Lowry J, Smith SM, et al. The epidemiology of malpractice claims in primary care: a systematic review. BMJ Open. 2013;3(7). doi:10.1136/bmjopen-2013-002929. https://psnet.ahrq.gov/issue/epidemiology-malpractice-cl…
  20. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/848816/psn-pdf
    May 10, 2023 - Racial bias in cesarean decision-making. May 10, 2023 Edwards SE, Class QA, Ford CE, et al. Racial bias in cesarean decision-making. Am J Obstet Gynecol MFM. 2023;5(5):100927. doi:10.1016/j.ajogmf.2023.100927. https://psnet.ahrq.gov/issue/racial-bias-cesarean-decision-making Racial bias negatively impacts maternal…

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