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psnet.ahrq.gov/node/36664/psn-pdf
May 27, 2011 - A prospective hazard and improvement analytic approach
to predicting the effectiveness of medication error
interventions.
May 27, 2011
Karnon J, McIntosh A, Dean JE, et al. A prospective hazard and improvement analytic approach to
predicting the effectiveness of medication error interventions. Saf Sci. 2006;45(4).…
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psnet.ahrq.gov/node/46630/psn-pdf
November 15, 2017 - Patient Safety in the Office-Based Practice Setting.
November 15, 2017
Philadelphia, PA: American College of Physicians; 2017.
https://psnet.ahrq.gov/issue/patient-safety-office-based-practice-setting
Patient safety in the ambulatory setting is gaining traction as a focus for research, intervention, and policy.
Th…
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psnet.ahrq.gov/node/42102/psn-pdf
April 03, 2013 - Enhancing electronic health record usability in pediatric
patient care: a scenario-based approach.
April 3, 2013
Patterson ES, Zhang J, Abbott P, et al. Enhancing electronic health record usability in pediatric patient
care: a scenario-based approach. Jt Comm J Qual Patient Saf. 2013;39(3):129-135.
https://psnet.a…
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psnet.ahrq.gov/node/38925/psn-pdf
September 16, 2009 - A literature review of the individual and systems factors
that contribute to medication errors in nursing practice.
September 16, 2009
Brady A-M, Malone A-M, Fleming S. A literature review of the individual and systems factors that contribute
to medication errors in nursing practice. J Nurs Manag. 2009;17(6):679-97…
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psnet.ahrq.gov/node/73256/psn-pdf
May 12, 2021 - Addiction treatment providers in Pa. face little state
scrutiny despite harm to clients.
May 12, 2021
Pattani A, Mahon E. Kaiser Health News. April 30, 2021.
https://psnet.ahrq.gov/issue/addiction-treatment-providers-pa-face-little-state-scrutiny-despite-harm-clients
Systemic oversight weaknesses and lack of…
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psnet.ahrq.gov/node/42415/psn-pdf
July 24, 2013 - Strategies for improving communication in the
emergency department: mediums and messages in a
noisy environment.
July 24, 2013
Welch SJ, Cheung DS, Apker J, et al. Strategies for improving communication in the emergency
department: mediums and messages in a noisy environment. Jt Comm J Qual Patient Saf. 2013;39(6)…
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psnet.ahrq.gov/node/43120/psn-pdf
September 27, 2016 - How studying human factors improves patient safety.
September 27, 2016
Eggertson L. How studying human factors improves patient safety. The Canadian nurse. 2014;110(2):25-9.
https://psnet.ahrq.gov/issue/how-studying-human-factors-improves-patient-safety
Human factors engineering is being increasingly promoted as an…
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psnet.ahrq.gov/node/50809/psn-pdf
January 15, 2020 - Electronic Health Record (EHR) Safety and Usability: See
What We Mean.
January 15, 2020
MedStar Health National Center for Human Factors in Healthcare.
https://psnet.ahrq.gov/issue/electronic-health-record-ehr-safety-and-usability-see-what-we-mean
Electronic health records (EHR) optimize information functions in c…
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psnet.ahrq.gov/node/838638/psn-pdf
September 01, 2012 - Directed peer review in surgical pathology.
September 1, 2012
Smith ML, Raab SS. Directed peer review in surgical pathology. Adv Anat Pathol. 2012;19(5):331-337.
doi:10.1097/pap.0b013e31826661b7.
https://psnet.ahrq.gov/issue/directed-peer-review-surgical-pathology
Diagnostic error in pathology can result in delaye…
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psnet.ahrq.gov/node/42355/psn-pdf
February 11, 2015 - Advancing Successful Care Transitions to Improve
Outcomes.
February 11, 2015
Society of Hospital Medicine
https://psnet.ahrq.gov/issue/project-boost-mentored-implementation-program
This Web site provides resources associated with the Better Outcomes for Older adults through Safe
Transitions project, called Projec…
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psnet.ahrq.gov/node/47320/psn-pdf
September 05, 2018 - Patient safety climate: a study of Southern California
healthcare organizations.
September 5, 2018
Avramchuk AS, McGuire SJJ. Patient Safety Climate: A Study of Southern California Healthcare
Organizations. J Healthc Manag. 2018;63(3):175-192. doi:10.1097/JHM-D-16-00004.
https://psnet.ahrq.gov/issue/patient-safety…
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psnet.ahrq.gov/node/46943/psn-pdf
November 16, 2018 - A piece of my mind. The art of constructive worrying.
November 16, 2018
John CC. The Art of Constructive Worrying. JAMA. 2018;319(22):2273-2274. doi:10.1001/jama.2018.6670.
https://psnet.ahrq.gov/issue/piece-my-mind-art-constructive-worrying
Both organizational culture and individual accountability are key to admit…
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psnet.ahrq.gov/node/34585/psn-pdf
March 07, 2005 - John M. Eisenberg Patient Safety Awards. Research:
David W. Bates, MD, MSc, Brigham and Women's
Hospital.
March 7, 2005
Bates DW. John M. Eisenberg Patient Safety Awards. Research: David W. Bates, MD, MSc, Brigham and
Women's Hospital. Interview by Steven Berman. Jt Comm J Qual Improv. 2002;28(12):651-659, 633.
h…
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psnet.ahrq.gov/node/43763/psn-pdf
April 22, 2015 - The nurse's role in medication safety.
April 22, 2015
Durham B. The nurse's role in medication safety. Nursing (Brux). 2015;45(4).
doi:10.1097/01.NURSE.0000461850.24153.8b.
https://psnet.ahrq.gov/issue/nurses-role-medication-safety-0
Nurses perform a critical role in preventing medication errors. This commentary e…
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psnet.ahrq.gov/node/38559/psn-pdf
June 16, 2009 - Regional surveillance of emergency-department visits for
outpatient adverse drug events.
June 16, 2009
Capuano A, Irpino A, Gallo M, et al. Regional surveillance of emergency-department visits for outpatient
adverse drug events. Eur J Clin Pharmacol. 2009;65(7):721-8. doi:10.1007/s00228-009-0641-8.
https://psnet.a…
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psnet.ahrq.gov/node/47112/psn-pdf
May 09, 2018 - 34 ways to survive your next trip to the hospital.
May 9, 2018
Crouch M. Reader's Digest. April 2018.
https://psnet.ahrq.gov/issue/34-ways-survive-your-next-trip-hospital
Involving patients in their care can help improve safety. This magazine article provides 34 tips from leading
patient safety experts to assist p…
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psnet.ahrq.gov/node/47412/psn-pdf
October 31, 2018 - The systems approach at the sharp end.
October 31, 2018
Cross SRH. The systems approach at the sharp end. Future Healthc J. 2019;5(3):176-180.
doi:10.7861/futurehosp.5-3-176.
https://psnet.ahrq.gov/issue/systems-approach-sharp-end
Systems solutions are often focused on creating improvements at the organizational o…
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psnet.ahrq.gov/node/41378/psn-pdf
March 04, 2015 - Clinically missed cancer: how effectively can radiologists
use computer-aided detection?
March 4, 2015
Nishikawa RM, Schmidt RA, Linver MN, et al. Clinically Missed Cancer: How Effectively Can Radiologists
Use Computer-Aided Detection? American Journal of Roentgenology. 2012;198(3).
doi:10.2214/ajr.11.6423.
https…
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digital.ahrq.gov/ahrq-funded-projects/enabling-shared-decision-making-reduce-harm-drug-interactions-end-end/citation/shared-decision
January 01, 2023 - Shared decision-making for drug-drug interactions: Formative evaluation of an anticoagulant drug interaction.
Citation
Gomez Lumbreras A, Reese TJ, Del Fiol G, Tan MS, Butler JM, Hurwitz JT, Brown M, Kawamoto K, Thiess H, Wright M, Malone DC. Shared decision-making for drug-drug interactions: Formativ…
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digital.ahrq.gov/ahrq-funded-projects/integrating-contextual-factors-clinical-decision-support-reduce-contextual/citation/effect
January 01, 2023 - Effect of electronic health record clinical decision support on contextualization of care: A randomized clinical trial.
Citation
Weiner SJ, Schwartz A, Weaver F, Galanter W, Olender S, Kochendorfer K, Binns-Calvey A, Saini R, Iqbal S, Diaz M, Michelfelder A, Varkey A. Effect of electronic health recor…