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6661. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/45782/psn-pdf
      January 18, 2017 - Standardization of inpatient handoff communication. January 18, 2017 Jewell JA. Standardization of Inpatient Handoff Communication. Pediatrics. 2016;138(5):e20162681. doi:10.1542/peds.2016-2681. https://psnet.ahrq.gov/issue/standardization-inpatient-handoff-communication Handoffs at shift changes are vulnerable to…

6662. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/41546/psn-pdf
      December 29, 2014 - Using a logic model to design and evaluate quality and patient safety improvement programs. December 29, 2014 Goeschel CA, Weiss WM, Pronovost P. Using a logic model to design and evaluate quality and patient safety improvement programs. Int J Qual Health Care. 2012;24(4):330-7. doi:10.1093/intqhc/mzs029. https://…

6663. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/849336/psn-pdf
      May 24, 2023 - AI may be on its way to your doctor’s office, but it’s not ready to see patients. May 24, 2023 Tahir D. KFF Health News. May 12, 2023. https://psnet.ahrq.gov/issue/ai-may-be-its-way-your-doctors-office-its-not-ready-see-patients Real-time use of artificial intelligence (AI) in health care settings continues to cau…

6664. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/47881/psn-pdf
      July 10, 2019 - Cognitive Errors and Diagnostic Mistakes: A Case-Based Guide to Critical Thinking in Medicine. July 10, 2019 Howard J. Cham, Switzerland: Springer Nature Switzerland; 2019. ISBN: 9783319932231. https://psnet.ahrq.gov/issue/cognitive-errors-and-diagnostic-mistakes-case-based-guide-critical-thinking- medicine Cogni…

6665. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/853058/psn-pdf
      August 30, 2023 - Diagnostic reliability in teledermatology: a systematic review and a meta-analysis. August 30, 2023 Bourkas AN, Barone N, Bourkas MEC, et al. Diagnostic reliability in teledermatology: a systematic review and a meta-analysis. BMJ Open. 2023;13(8):e068207. doi:10.1136/bmjopen-2022-068207. https://psnet.ahrq.gov/iss…

6666. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/837630/psn-pdf
      July 06, 2022 - Mandating limits on workload, duty, and speed in radiology. July 6, 2022 Alexander R, Waite S, Bruno MA, et al. Mandating limits on workload, duty, and speed in radiology. Radiology. 2022:212631. doi:10.1148/radiol.212631. https://psnet.ahrq.gov/issue/mandating-limits-workload-duty-and-speed-radiology To reduce m…

6667. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/41717/psn-pdf
      September 01, 2016 - A clinical data warehouse-based process for refining medication orders alerts. September 1, 2016 Boussadi A, Caruba T, Zapletal E, et al. A clinical data warehouse-based process for refining medication orders alerts. J Am Med Inform Assoc. 2012;19(5):782-5. doi:10.1136/amiajnl-2012-000850. https://psnet.ahrq.gov/i…

6668. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/45188/psn-pdf
      June 01, 2016 - Reporting and second-order problem solving can turn short-term fixes into long-term remedies. June 1, 2016 ISMP Medication Safety Alert! Acute Care Edition. May 19, 2016;21:1-4. https://psnet.ahrq.gov/issue/reporting-and-second-order-problem-solving-can-turn-short-term-fixes-long- term-remedies Workarounds are pr…

6669. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/45530/psn-pdf
      October 19, 2016 - As a critical behavior to improve quality and patient safety in health care: speaking up! October 19, 2016 Nacioglu A. As a critical behavior to improve quality and patient safety in health care: speaking up!. Safety in Health. 2016;2(1). doi:10.1186/s40886-016-0021-x. https://psnet.ahrq.gov/issue/critical-behavio…

6670. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/73476/psn-pdf
      July 07, 2021 - The role of apology laws in medical malpractice. July 7, 2021 Ross NE, Newman WJ. J Am Acad Psychiatry Law. 2021;49(3):406-414. https://psnet.ahrq.gov/issue/role-apology-laws-medical-malpractice Open disclosure of errors and adverse events is increasingly encouraged in healthcare, but clinicians frequently ci…

6671. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/39731/psn-pdf
      August 04, 2010 - Comparing errors in ED computer-assisted vs conventional pediatric drug dosing and administration. August 4, 2010 Yamamoto LG, Kanemori J. Comparing errors in ED computer-assisted vs conventional pediatric drug dosing and administration. Am J Emerg Med. 2010;28(5):588-92. doi:10.1016/j.ajem.2009.02.009. https://ps…

6672. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/61047/psn-pdf
      October 21, 2020 - COVID-19: an emerging threat to antibiotic stewardship in the emergency department. October 21, 2020 Pulia M, Wolf I, Schulz L, et al. COVID-19: an emerging threat to antibiotic stewardship in the emergency department. West J Emerg Med. 2020;21(5):1283-1286. doi:10.5811/westjem.2020.7.48848. https://psnet.ahrq.gov…

6673. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/45826/psn-pdf
      January 18, 2017 - Ensuring staff safety when treating potentially violent patients. January 18, 2017 Roca RP, Charen B, Boronow J. Ensuring Staff Safety When Treating Potentially Violent Patients. JAMA. 2016;316(24):2669-2670. doi:10.1001/jama.2016.18260. https://psnet.ahrq.gov/issue/ensuring-staff-safety-when-treating-potentially-…

6674. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/46564/psn-pdf
      December 06, 2017 - Can the aviation industry be useful in teaching oncology about safety? December 6, 2017 Davies JM, Delaney G. Can the Aviation Industry be Useful in Teaching Oncology about Safety? Clin Oncol (R Coll Radiol). 2017;29(10):669-675. doi:10.1016/j.clon.2017.06.007. https://psnet.ahrq.gov/issue/can-aviation-industry-be…

6675. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/72852/psn-pdf
      March 17, 2021 - Declaring uncertainty: using quality improvement methods to change the conversation of diagnosis. March 17, 2021 Ipsaro AJ, Patel SJ, Warner DC, et al. Declaring Uncertainty: Using Quality Improvement Methods to Change the Conversation of Diagnosis. Hosp Pediatr. 2021;11(4):334-341. doi:10.1542/hpeds.2020- 000174.…

6676. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/44425/psn-pdf
      February 24, 2016 - Dangerous doses. February 24, 2016 Roe S, King K. Chicago Tribune. February 10–13, 2016. https://psnet.ahrq.gov/issue/dangerous-doses Drug interactions can be hazardous to patients, particularly when combined with risk factors such as age and use of medications for chronic conditions. This series of news reports d…

6677. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/47055/psn-pdf
      May 23, 2018 - Surgical checklists save lives—but once in a while, they don't. Why? May 23, 2018 Mukherjee S. New York Times Magazine. May 9, 2018. https://psnet.ahrq.gov/issue/surgical-checklists-save-lives-once-while-they-dont-why Checklists can coordinate action and communication to augment safety, but human and system factor…

6678. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/45383/psn-pdf
      August 31, 2016 - Case report of a medication error: in the eye of the beholder. August 31, 2016 Naunton M, Nor K, Bartholomaeus A, et al. Case report of a medication error. Medicine (Baltimore). 2016;95(28):e4186. doi:10.1097/md.0000000000004186. https://psnet.ahrq.gov/issue/case-report-medication-error-eye-beholder Look-alike dr…

6679. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/43333/psn-pdf
      January 15, 2017 - A multidisciplinary, multifaceted improvement initiative to eliminate mislabelled laboratory specimens at a large tertiary care hospital. January 15, 2017 Seferian EG, Jamal S, Clark K, et al. A multidisciplinary, multifaceted improvement initiative to eliminate mislabelled laboratory specimens at a large tertiary…

6680. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/73966/psn-pdf
      October 13, 2021 - Prescribing errors with low-molecular-weight heparins. October 13, 2021 Slikkerveer M, van de Plas A, Driessen JHM, et al. Prescribing errors with low-molecular-weight heparins. J Patient Saf. 2021;17(7):e587-e592. doi:10.1097/pts.0000000000000417. https://psnet.ahrq.gov/issue/prescribing-errors-low-molecular-weigh…