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  1. psnet.ahrq.gov/web-mm/2-week-itch
    June 16, 2019 - The 2-Week Itch Citation Text: Cohen MR. The 2-Week Itch. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2003. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML EndNote 7 XML Endnote tagged PubMedId RIS …
  2. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/852699/psn-pdf
    August 30, 2023 - Beyond the Pandemic: Creating Total Systems Safety August 30, 2023 Van CM, Mossburg S, McGaffigan P. Beyond the Pandemic: Creating Total Systems Safety. PSNet [internet]. 2023. https://psnet.ahrq.gov/perspective/beyond-pandemic-creating-total-systems-safety The COVID-19 pandemic necessitated a shift in operations …
  3. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/73229/psn-pdf
    May 26, 2021 - Norepinephrine Dosing Error Associated with Multiple Health System Vulnerabilities May 26, 2021 Duby JJ, Schomer K, Oyewole V, et al. Norepinephrine Dosing Error Associated with Multiple Health System Vulnerabilities. PSNet [internet]. 2021. https://psnet.ahrq.gov/web-mm/norepinephrine-dosing-error-associated-mult…
  4. psnet.ahrq.gov/web-mm/i-just-want-go-home-understanding-deliriums-impact-treatment-preferences
    December 18, 2019 - I Just Want to Go Home: Understanding Delirium’s Impact on Treatment Preferences Citation Text: Steinberg K. I Just Want to Go Home: Understanding Delirium’s Impact on Treatment Preferences. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Servi…
  5. psnet.ahrq.gov/web-mm/raise-bar
    May 29, 2024 - Raise the Bar Citation Text: Stotts J, Lyndon A. Raise the Bar. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2014. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML EndNote 7 XML Endnote tagged PubMedId RIS …
  6. psnet.ahrq.gov/web-mm/diagnostic-failure-growing-deficit
    June 01, 2005 - Diagnostic Failure: The Growing Deficit Citation Text: Chang R, Flanders S. Diagnostic Failure: The Growing Deficit. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2019. Copy Citation Format: Google Scholar BibTeX EndNo…
  7. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/60722/psn-pdf
    February 06, 2023 - Coronavirus Disease 2019 (COVID-19) and Diagnostic Error January 11, 2022 Desai AN, Romano PS. Coronavirus Disease 2019 (COVID-19) and Diagnostic Error. PSNet [internet]. 2022. https://psnet.ahrq.gov/primer/coronavirus-disease-2019-covid-19-and-diagnostic-error Originally published July 30, 2020. Updated January …
  8. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/840140/psn-pdf
    January 01, 2023 - Implementation of the I-PASS handoff program in diverse clinical environments: a multicenter prospective effectiveness implementation study. November 16, 2022 Starmer AJ, Spector ND, O'Toole JK, et al. Implementation of the I?PASS handoff program in diverse clinical environments: a multicenter prospective effectiv…
  9. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/866731/psn-pdf
    September 18, 2024 - Root cause analysis of cases involving diagnosis. September 18, 2024 Graber ML, Castro GM, Danforth M, et al. Root cause analysis of cases involving diagnosis. Diagnosis (Berl). 2024;11(4):353-368. doi:10.1515/dx-2024-0102. https://psnet.ahrq.gov/issue/root-cause-analysis-cases-involving-diagnosis Root cause analy…
  10. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/50942/psn-pdf
    February 26, 2020 - Understanding the roles of three academic communities in a prospective learning health ecosystem for diagnostic excellence. February 26, 2020 Satterfield K, Rubin JC, Yang D, et al. Understanding the roles of three academic communities in a prospective learning health ecosystem for diagnostic excellence. Learn Hea…
  11. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/837972/psn-pdf
    September 01, 2022 - Patient safety: where to aim when zero harm is not the target-a case for learning and resilience. September 1, 2022 Stockwell DC, Kayes DC, Thomas EJ. Patient safety: where to aim when zero harm is not the target-a case for learning and resilience. J Patient Saf. 2022;18(5):e877-e882. doi:10.1097/pts.00000000000009…
  12. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/73211/psn-pdf
    May 05, 2021 - The effectiveness of interruptive prescribing alerts in ambulatory CPOE to change prescriber behaviour and improve safety. May 5, 2021 Cerqueira O, Gill M, Swar B, et al. The effectiveness of interruptive prescribing alerts in ambulatory CPOE to change prescriber behaviour and improve safety. BMJ Qual Saf. 2021;30…
  13. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/861774/psn-pdf
    January 31, 2024 - Grand rounds in methodology: key considerations for implementing machine learning solutions in quality improvement initiatives. January 31, 2024 Verma AA, Trbovich PL, Mamdani MM, et al. Grand rounds in methodology: key considerations for implementing machine learning solutions in quality improvement initiatives. …
  14. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/837143/psn-pdf
    January 01, 2023 - Understanding the factors influencing implementation of a new national patient safety policy in England: lessons from 'Learning from Deaths'. May 18, 2022 Lalani M, Morgan S, Basu A, et al. Understanding the factors influencing implementation of a new national patient safety policy in England: lessons from ‘Learni…
  15. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/837502/psn-pdf
    June 22, 2022 - Toward safer opioid prescribing in HIV care (TOWER): a mixed-methods, cluster-randomized trial. June 22, 2022 Cedillo G, George MC, Deshpande R, et al. Toward safer opioid prescribing in HIV care (TOWER): a mixed-methods, cluster-randomized trial. Addict Sci Clin Pract. 2022;17(1):28. doi:10.1186/s13722-022- 00311…
  16. psnet.ahrq.gov/issue/center-consumer-health-care-information-patient-safety-center
    February 04, 2025 - Multi-use Website Center for Consumer Health Care Information Patient Safety Center. Save Save to your library Print Download PDF Share Facebook Twitter Linkedin Copy URL March 6, 2005 The Center's efforts for pati…
  17. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/867690/psn-pdf
    March 05, 2025 - Trends of diagnostic adverse events in hospital deaths: longitudinal analyses of four retrospective record review studies. March 5, 2025 Hooftman J, Zwaan L, Sikkens JJ, et al. Trends of diagnostic adverse events in hospital deaths: longitudinal analyses of four retrospective record review studies. Diagnosis (Berl…
  18. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/867684/psn-pdf
    March 05, 2025 - Development of a preliminary patient safety classification system for generative AI. March 5, 2025 Hose B-Z, Handley JL, Biro J, et al. Development of a preliminary patient safety classification system for generative AI. BMJ Qual Saf. 2025;34(2):130-132. doi:10.1136/bmjqs-2024-017918. https://psnet.ahrq.gov/issue/…
  19. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/867691/psn-pdf
    March 05, 2025 - Surgeon perception and attitude towards the moral imperative of institutionally addressing second-victim syndrome in surgery. March 5, 2025 Hsiao L-H, Kopar PK. Surgeon perception and attitude towards the moral imperative of institutionally addressing second-victim syndrome in surgery. J Am Coll Surg. 2025;240(2):…
  20. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/60644/psn-pdf
    July 01, 2020 - Adverse events and burnout: the moderating effects of workgroup identification and safety climate. July 1, 2020 Vogus TJ, Ramanujam R, Novikov Z, et al. Adverse events and burnout: the moderating effects of workgroup identification and safety climate. Med Care. 2020;58(7):594-600. doi:10.1097/mlr.0000000000001341.…

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