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psnet.ahrq.gov/node/45246/psn-pdf
August 15, 2016 - Reliability of verbal handoff assessment and handoff
quality before and after implementation of a resident
handoff bundle.
August 15, 2016
Feraco AM, Starmer AJ, Sectish TC, et al. Reliability of Verbal Handoff Assessment and Handoff Quality
Before and After Implementation of a Resident Handoff Bundle. Acad Pediat…
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psnet.ahrq.gov/node/40962/psn-pdf
December 14, 2011 - American College of Surgeons' Committee on Trauma
performance improvement and patient safety program:
maximal impact in a mature trauma center.
December 14, 2011
Sarkar B, Brunsvold ME, Cherry-Bukoweic JR, et al. American College of Surgeons' Committee on Trauma
Performance Improvement and Patient Safety program: …
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psnet.ahrq.gov/node/853442/psn-pdf
September 13, 2023 - Pediatric Diagnostic Safety: State of the Science and
Future Directions.
September 13, 2023
Grubenhoff JA, Cifra CL, Marshall T, et al. Rockville, MD: Agency for Healthcare Research and Quality;
September 2023. AHRQ Publication No. 23-0040-5-EF.
https://psnet.ahrq.gov/issue/pediatric-diagnostic-safety-state-scienc…
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psnet.ahrq.gov/node/46114/psn-pdf
June 07, 2017 - Standardizing concentrations of adult drug infusions in
Indiana.
June 7, 2017
Walroth TA, Dossett HA, Doolin M, et al. Standardizing concentrations of adult drug infusions in Indiana.
Am J Health Syst Pharm. 2017;74(7):491-497. doi:10.2146/ajhp151018.
https://psnet.ahrq.gov/issue/standardizing-concentrations-adult…
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psnet.ahrq.gov/node/44597/psn-pdf
October 28, 2015 - Smarter clinical checklists: how to minimize checklist
fatigue and maximize clinician performance.
October 28, 2015
Grigg EB. Smarter Clinical Checklists: How to Minimize Checklist Fatigue and Maximize Clinician
Performance. Anesth Analg. 2015;121(2):570-3. doi:10.1213/ANE.0000000000000352.
https://psnet.ahrq.gov/…
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psnet.ahrq.gov/node/43080/psn-pdf
March 26, 2014 - Hospital-based transfusion error tracking from 2005 to
2010: identifying the key errors threatening patient
transfusion safety.
March 26, 2014
Maskens C, Downie H, Wendt A, et al. Hospital-based transfusion error tracking from 2005 to 2010:
identifying the key errors threatening patient transfusion safety. Transfu…
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psnet.ahrq.gov/node/60954/psn-pdf
September 30, 2020 - Catheter-associated urinary tract infection reduction in a
pediatric safety engagement network.
September 30, 2020
Foster CB, Ackerman K, Hupertz V, et al. Catheter-associated urinary tract infection reduction in a pediatric
safety engagement network. Pediatrics. 2020;146(4):e20192057. doi:10.1542/peds.2019-2057.
…
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psnet.ahrq.gov/node/35130/psn-pdf
March 11, 2011 - A trial of automated decision support alerts for
contraindicated medications using computerized
physician order entry.
March 11, 2011
Galanter W, Didomenico RJ, Polikaitis A. A trial of automated decision support alerts for contraindicated
medications using computerized physician order entry. J Am Med Inform Assoc…
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psnet.ahrq.gov/node/836986/psn-pdf
April 27, 2022 - Habit and automaticity in medical alert override: cohort
study.
April 27, 2022
Wang L, Goh KH, Yeow A, et al. Habit and automaticity in medical alert override: cohort study. J Med
Internet Res. 2022;24(2):e23355. doi:10.2196/23355.
https://psnet.ahrq.gov/issue/habit-and-automaticity-medical-alert-override-cohort-s…
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psnet.ahrq.gov/node/865978/psn-pdf
May 29, 2024 - Ensuring safe and equitable discharge: a quality
improvement initiative for individuals with hypertensive
disorders of pregnancy.
May 29, 2024
Zacherl KM, Sterrett EC, Hughes BL, et al. Ensuring safe and equitable discharge: a quality improvement
initiative for individuals with hypertensive disorders of pregnancy.…
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psnet.ahrq.gov/node/43836/psn-pdf
March 11, 2015 - Hospital organisation, management, and structure for
prevention of health-care-associated infection: a
systematic review and expert consensus.
March 11, 2015
Zingg W, Holmes A, Dettenkofer M, et al. Hospital organisation, management, and structure for prevention
of health-care-associated infection: a systematic re…
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psnet.ahrq.gov/node/36244/psn-pdf
June 13, 2012 - With Safety in Mind: Mental Health Services and Patient
Safety.
June 13, 2012
Scobie S, Minghella E, Dale C, et al. London, UK: National Patient Safety Agency; 2006.
https://psnet.ahrq.gov/issue/safety-mind-mental-health-services-and-patient-safety
This report, the second in a series from the United Kingdom's Nati…
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psnet.ahrq.gov/node/74710/psn-pdf
January 26, 2022 - The evolution of the Anesthesia Patient Safety Movement
in America: lessons learned and considerations to
promote further improvement in patient safety.
January 26, 2022
Warner MA, Warner ME. The evolution of the Anesthesia Patient Safety Movement in America: lessons
learned and considerations to promote further i…
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psnet.ahrq.gov/node/44072/psn-pdf
August 02, 2015 - The rise of the medical scribe industry: implications for
the advancement of electronic health records.
August 2, 2015
Gellert GA, Ramirez R, Webster L. The rise of the medical scribe industry: implications for the
advancement of electronic health records. JAMA. 2015;313(13):1315-1316. doi:10.1001/jama.2014.17128.
…
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psnet.ahrq.gov/node/43830/psn-pdf
February 04, 2015 - A combined teamwork training and work standardisation
intervention in operating theatres: controlled interrupted
time series study.
February 4, 2015
Morgan L, Pickering S, Hadi M, et al. A combined teamwork training and work standardisation intervention
in operating theatres: controlled interrupted time series stu…
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psnet.ahrq.gov/node/46597/psn-pdf
November 01, 2017 - A novel process audit for standardized perioperative
handoff protocols.
November 1, 2017
Pallekonda V, Scholl AT, McKelvey GM, et al. A Novel Process Audit for Standardized Perioperative
Handoff Protocols. Jt Comm J Qual Patient Saf. 2017;43(11):611-618. doi:10.1016/j.jcjq.2017.04.011.
https://psnet.ahrq.gov/issue…
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psnet.ahrq.gov/node/45228/psn-pdf
June 29, 2016 - An innovative approach to the surgical time out: a patient-
focused model.
June 29, 2016
Kozusko SD, Elkwood L, Gaynor D, et al. An Innovative Approach to the Surgical Time Out: A Patient-
Focused Model. AORN J. 2016;103(6):617-22. doi:10.1016/j.aorn.2016.04.001.
https://psnet.ahrq.gov/issue/innovative-approach-su…
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psnet.ahrq.gov/node/844748/psn-pdf
February 15, 2023 - 'They were his best shot. And they failed to help’: why did
EMS workers neglect Tyre Nichols?
February 15, 2023
Renault M. STAT. February 6, 2023.
https://psnet.ahrq.gov/issue/they-were-his-best-shot-and-they-failed-help-why-did-ems-workers-neglect-
tyre-nichols
Emergent care situations are vulnerable to a range …
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psnet.ahrq.gov/node/46633/psn-pdf
November 22, 2017 - The high costs of unnecessary care.
November 22, 2017
Carroll AE. The High Costs of Unnecessary Care. JAMA. 2017;318(18):1748-1749.
doi:10.1001/jama.2017.16193.
https://psnet.ahrq.gov/issue/high-costs-unnecessary-care
The provision of unneeded care can result in physical, financial, and psychological harm to patie…
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psnet.ahrq.gov/node/46130/psn-pdf
June 21, 2017 - High 5s initiative: implementation of medication
reconciliation in France a 5 years experimentation.
June 21, 2017
Dufay É, Doerper S, Michel B, et al. High 5s initiative: implementation of medication reconciliation in France
a 5 years experimentation. Safety in Health. 2017;3(1):6. doi:10.1186/s40886-017-0057-6.
…