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psnet.ahrq.gov/node/46299/psn-pdf
September 13, 2017 - Simulation-based assessment of the management of
critical events by board-certified anesthesiologists.
September 13, 2017
Weinger MB, Banerjee A, Burden AR, et al. Simulation-based assessment of the management of critical
events by board-certified anesthesiologists. Anesthesiology. 2017;127(3):475-489.
doi:10.1097…
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psnet.ahrq.gov/node/46662/psn-pdf
August 20, 2018 - Weekend specialist intensity and admission mortality in
acute hospital trusts in England: a cross-sectional study.
August 20, 2018
Aldridge C, Bion J, Boyal A, et al. Weekend specialist intensity and admission mortality in acute hospital
trusts in England: a cross-sectional study. Lancet. 2016;388(10040):178-86. do…
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psnet.ahrq.gov/node/41257/psn-pdf
April 22, 2012 - Development of an evidence-based framework of factors
contributing to patient safety incidents in hospital
settings: a systematic review.
April 22, 2012
Lawton R, McEachan RRC, Giles SJ, et al. Development of an evidence-based framework of factors
contributing to patient safety incidents in hospital settings: a sy…
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psnet.ahrq.gov/node/43452/psn-pdf
August 20, 2014 - Electronic health record–related safety concerns: a cross-
sectional survey.
August 20, 2014
Menon S, Singh H, Meyer AND, et al. Electronic health record-related safety concerns: a cross-sectional
survey. J Healthc Risk Manag. 2014;34(1):14-26. doi:10.1002/jhrm.21146.
https://psnet.ahrq.gov/issue/electronic-health…
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psnet.ahrq.gov/node/854623/psn-pdf
January 01, 2025 - Do junior doctors make more prescribing errors than
experienced doctors when prescribing electronically
using a computerised physician order entry system
combined with a clinical decision support system? A
cross-sectional study.
October 18, 2023
Kalfsvel L, Wilkes S, van der Kuy H, et al. Do junior doctors make m…
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psnet.ahrq.gov/node/46797/psn-pdf
March 14, 2018 - Empowering informal caregivers with health information:
OpenNotes as a safety strategy.
March 14, 2018
Chimowitz H, Gerard M, Fossa A, et al. Empowering Informal Caregivers with Health Information:
OpenNotes as a Safety Strategy. Jt Comm J Qual Saf. 2018;44(3):130-136. doi:10.1016/j.jcjq.2017.09.004.
https://psnet…
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psnet.ahrq.gov/node/38164/psn-pdf
July 02, 2009 - A Compendium of Strategies to Prevent Healthcare-
Associated Infections in Acute Care Hospitals.
July 2, 2009
Yokoe DS, Mermel LA, Anderson DJ, et al. Infect Control Hosp Epidemiol. 2008;29:901-994.
https://psnet.ahrq.gov/issue/compendium-strategies-prevent-healthcare-associated-infections-acute-care-
hospi…
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psnet.ahrq.gov/node/46515/psn-pdf
December 22, 2018 - A contemporary medicolegal analysis of outpatient
medication management in chronic pain.
December 22, 2018
Abrecht CR, Brovman EY, Greenberg P, et al. A Contemporary Medicolegal Analysis of Outpatient
Medication Management in Chronic Pain. Anesth Analg. 2017;125(5):1761-1768.
doi:10.1213/ANE.0000000000002499.
htt…
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psnet.ahrq.gov/node/42938/psn-pdf
February 12, 2014 - Successful implementation of a unit-based quality nurse
to reduce central line-associated bloodstream infections.
February 12, 2014
Thom KA, Li S, Custer M, et al. Successful implementation of a unit-based quality nurse to reduce central
line-associated bloodstream infections. Am J Infect Control. 2014;42(2):139-43…
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psnet.ahrq.gov/node/45796/psn-pdf
June 29, 2017 - Characteristics of initial prescription episodes and
likelihood of long-term opioid use—United States,
2006–2015.
June 29, 2017
Shah A, Hayes CJ, Martin BC. Characteristics of Initial Prescription Episodes and Likelihood of Long-Term
Opioid Use - United States, 2006-2015. MMWR Morb Mortal Wkly Rep. 2017;66(10):265…
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psnet.ahrq.gov/node/47333/psn-pdf
October 10, 2018 - Changing dynamics of the drug overdose epidemic in the
United States from 1979 through 2016.
October 10, 2018
Jalal H, Buchanich JM, Roberts MS, et al. Changing dynamics of the drug overdose epidemic in the United
States from 1979 through 2016. Science (1979). 2018;361(6408). doi:10.1126/science.aau1184.
https://p…
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psnet.ahrq.gov/node/50368/psn-pdf
September 25, 2019 - A patient and family reporting system for perceived
ambulatory note mistakes: experience at 3 U.S. healthcare
centers.
September 25, 2019
Bourgeois FC, Fossa A, Gerard M, et al. A patient and family reporting system for perceived ambulatory
note mistakes: experience at 3 U.S. healthcare centers. J Am Med Inform As…
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psnet.ahrq.gov/node/47908/psn-pdf
April 24, 2019 - "Sorry" is never enough: how state apology laws fail to
reduce medical malpractice liability risk.
April 24, 2019
McMichael BJ, Van Horn L, Viscusi K. "Sorry” Is Never Enough: How State Apology Laws Fail to Reduce
Medical Malpractice Liability Risk. Stanford Law Rev. 2019;71(2):341-409.
https://psnet.ahrq.gov/issu…
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psnet.ahrq.gov/node/43115/psn-pdf
December 18, 2014 - Multistate point-prevalence survey of health care-
associated infections.
December 18, 2014
Magill SS, Edwards JR, Bamberg W, et al. Multistate point-prevalence survey of health care-associated
infections. N Engl J Med. 2014;370(13):1198-208. doi:10.1056/NEJMoa1306801.
https://psnet.ahrq.gov/issue/multistate-point…
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psnet.ahrq.gov/node/43049/psn-pdf
October 31, 2014 - Vital signs: improving antibiotic use among hospitalized
patients.
October 31, 2014
Fridkin SK, Baggs J, Fagan R, et al. Vital signs: improving antibiotic use among hospitalized patients.
MMWR Morb Mortal Wkly Rep. 2014;63(9):194-200.
https://psnet.ahrq.gov/issue/vital-signs-improving-antibiotic-use-among-hospital…
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psnet.ahrq.gov/node/47203/psn-pdf
October 25, 2018 - Speaking up about care concerns in the ICU: patient and
family experiences, attitudes and perceived barriers.
October 25, 2018
Bell SK, Roche S, Mueller A, et al. Speaking up about care concerns in the ICU: patient and family
experiences, attitudes and perceived barriers. BMJ Qual Saf. 2018;27(11):928-936. doi:10.1…
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psnet.ahrq.gov/glossary/handoffs-and-handovers
September 13, 2021 - Handoffs and Handovers
September 13, 2021
Anonymous (not verified)
See Primer . The process when one health care professional updates another on the status of one or more patients for the purpose of taking over their care. Typical examples involve a physician who has been on call overnight telling an incoming …
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psnet.ahrq.gov/perspective/conversation-sharon-k-inouye-md-mph
December 01, 2012 - In Conversation With… Sharon K. Inouye, MD, MPH
December 1, 2012
Also Read an Essay
Citation Text:
In Conversation With… Sharon K. Inouye, MD, MPH. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Ser…
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psnet.ahrq.gov/node/851389/psn-pdf
July 31, 2023 - Ambulatory Safety Nets to Reduce Missed and Delayed
Diagnoses of Cancer
July 31, 2023
https://psnet.ahrq.gov/innovation/ambulatory-safety-nets-reduce-missed-and-delayed-diagnoses-cancer
Summary
Concern over patient safety issues associated with inadequate tracking of test results has grown over the
last decade, a…
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psnet.ahrq.gov/web-mm/difficult-encounters-cmo-and-cno-respond
March 01, 2018 - SPOTLIGHT CASE
Difficult Encounters: A CMO and CNO Respond
Citation Text:
Ring EJ, Hirsch JE. Difficult Encounters: A CMO and CNO Respond. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2009.
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