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psnet.ahrq.gov/issue/learning-health-systems
December 24, 2008 - Multi-use Website
Learning Health Systems
Citation Text:
Learning Health Systems Agency for Health Research and Quality.
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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.
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psnet.ahrq.gov/issue/accidents-claiming-and-regional-subcultures-are-medical-errors-and-malpractice-lawsuits
October 16, 2024 - Study
Accidents, claiming, and regional subcultures: are medical errors and malpractice lawsuits related to social capital?
Citation Text:
Williams J. Accidents, claiming, and regional subcultures: Are medical errors and malpractice lawsuits related to social capital? J Safety Res. 200…
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psnet.ahrq.gov/perspective/conversation-richard-platt-md-msc
October 01, 2016 - time trying to understand how to repurpose electronic health record and billing data for these new purposes … However, most electronic health data is not automatically useful for these other purposes. … A great deal of additional work is usually required to make it useful for new purposes like patient safety
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psnet.ahrq.gov/node/49462/psn-pdf
October 01, 2004 - cylinder, and was brought a CO2 cylinder with a CO2 regulator attached (these are
used for certain purposes … They appear to be used for two main purposes:
to administer nebulized medications (eg, bronchodilators
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psnet.ahrq.gov/issue/healthcare-failure-mode-and-effect-analysis
May 24, 2017 - Toolkit
Healthcare Failure Mode and Effect Analysis.
Citation Text:
Healthcare Failure Mode and Effect Analysis. National Center for Patient Safety.
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psnet.ahrq.gov/issue/tune-and-time-out-toward-surgeon-led-prevention-never-events
July 24, 2024 - Study
Tune-in and time-out: toward surgeon-led prevention of "never" events.
Citation Text:
Jones N. Tune-In and Time-Out: Toward Surgeon-Led Prevention of "Never" Events. J Patient Saf. 2019;15(4):e36-e39. doi:10.1097/PTS.0000000000000259.
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psnet.ahrq.gov/node/49396/psn-pdf
April 01, 2003 - The 2-Week Itch
April 1, 2003
Cohen MR. The 2-Week Itch. PSNet [internet]. 2003.
https://psnet.ahrq.gov/web-mm/2-week-itch
The Case
A 40-year-old woman with bipolar disorder (on trazodone) came to her primary care physician with new
urticaria. She received a handwritten prescription for Zyrtec and Atarax.
The ha…
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psnet.ahrq.gov/node/866847/psn-pdf
September 25, 2024 - In Conversation with Carole Stockmeier about Zero Harm:
Striving to Reduce Preventable Harms – Point,
Counterpoint, and Areas of Agreement
September 25, 2024
Stockmeier CA, Mossburg S, Lee M. In Conversation with Carole Stockmeier about Zero Harm: Striving to
Reduce Preventable Harms – Point, Counterpoint, and Are…
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psnet.ahrq.gov/perspective/conversation-withpatrick-s-romano-md-mph
July 10, 2024 - Our charge from AHRQ was to consider indicators that would be useful for quality improvement purposes … we come out with scores that represent the panel's assessment of the usability of the indicators for purposes
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psnet.ahrq.gov/issue/role-failure-mode-and-effects-analysis-health-care
December 22, 2021 - Newspaper/Magazine Article
The role of failure mode and effects analysis in health care.
Citation Text:
Fibuch E, Ahmed A. The role of failure mode and effects analysis in health care. Physician Exec. 2014;40(4):28-32.
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psnet.ahrq.gov/issue/healthcare-scandals-and-failings-doctors-do-official-inquiries-hold-profession-account
November 13, 2019 - Review
Healthcare scandals and the failings of doctors: do official inquiries hold the profession to account?
Citation Text:
Mannion R, Davies H, Powell M, et al. Healthcare scandals and the failings of doctors. J Health Organ Manag. 2019;33(2):221-240. doi:10.1108/JHOM-04-2018-0126.
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psnet.ahrq.gov/issue/parent-participation-morbidity-and-mortality-review-parent-and-physician-perspectives
May 18, 2022 - Study
Parent participation in morbidity and mortality review: parent and physician perspectives.
Citation Text:
de Loizaga SR, Clarke-Myers K, R Khoury P, et al. Parent participation in morbidity and mortality review: parent and physician perspectives. J Patient Exp. 2022;9:2374373522110…
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psnet.ahrq.gov/issue/pediatric-faculty-knowledge-and-comfort-discussing-diagnostic-errors-pilot-survey-understand
April 22, 2020 - Study
Pediatric faculty knowledge and comfort discussing diagnostic errors: a pilot survey to understand barriers to an educational program.
Citation Text:
Grubenhoff JA, Ziniel SI, Bajaj L, et al. Pediatric faculty knowledge and comfort discussing diagnostic errors: a pilot survey to un…
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psnet.ahrq.gov/issue/deficient-care-patient-who-died-suicide-and-facility-leaders-response-charlie-norwood-va
November 29, 2023 - Book/Report
Deficient Care of a Patient Who Died by Suicide and Facility Leaders' Response at the Charlie Norwood VA Medical Center in Augusta, Georgia.
Citation Text:
Deficient Care of a Patient Who Died by Suicide and Facility Leaders' Response at the Charlie Norwood VA Medical Center …
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psnet.ahrq.gov/node/33603/psn-pdf
September 15, 2024 - Both the NHSN and NSQIP definitions are widely used for both quality
improvement and research purposes
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psnet.ahrq.gov/issue/positive-deviance-different-approach-achieving-patient-safety
May 15, 2024 - Commentary
Positive deviance: a different approach to achieving patient safety.
Citation Text:
Lawton R, Taylor N, Clay-Williams R, et al. Positive deviance: a different approach to achieving patient safety. BMJ Qual Saf. 2014;23(11):880-3. doi:10.1136/bmjqs-2014-003115.
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psnet.ahrq.gov/issue/how-long-does-it-take-train-surgeon
October 16, 2024 - Commentary
How long does it take to train a surgeon?
Citation Text:
Jackson GP, Tarpley JL. How long does it take to train a surgeon? BMJ. 2009;339:b4260. doi:10.1136/bmj.b4260.
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psnet.ahrq.gov/issue/association-face-face-handoffs-and-outcomes-hospitalized-internal-medicine-patients
March 12, 2025 - Study
Association of face-to-face handoffs and outcomes of hospitalized internal medicine patients.
Citation Text:
Schouten WM, Burton C, Jones LKD, et al. Association of face-to-face handoffs and outcomes of hospitalized internal medicine patients. J Hosp Med. 2015;10(3):137-41. doi:10.…
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psnet.ahrq.gov/node/33747/psn-pdf
March 01, 2013 - common simulation
modalities: virtual patients (3) and technology-enhanced simulation.(4-6) For the purposes