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psnet.ahrq.gov/node/47462/psn-pdf
October 31, 2018 - Emergency department checklist: an innovation to
improve safety in emergency care.
October 31, 2018
Redfern E, Hoskins R, Gray J, et al. Emergency department checklist: an innovation to improve safety in
emergency care. BMJ Open Qual. 2018;7(3):e000325. doi:10.1136/bmjoq-2018-000325.
https://psnet.ahrq.gov/issue/e…
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psnet.ahrq.gov/node/867016/psn-pdf
October 23, 2024 - An automated, dynamic radiation oncology prescription
checking system.
October 23, 2024
Pashtan IM, Kosak T, Shin K-Y, et al. An automated, dynamic radiation oncology prescription checking
system. Pract Radiat Oncol. 2024;14(4):343-352. doi:10.1016/j.prro.2023.12.002.
https://psnet.ahrq.gov/issue/automated-dynamic…
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psnet.ahrq.gov/node/41425/psn-pdf
June 19, 2012 - Mortality and morbidity meetings: an untapped resource
for improving the governance of patient safety?
June 19, 2012
Higginson J, Walters R, Fulop NJ. Mortality and morbidity meetings: an untapped resource for improving
the governance of patient safety? BMJ Qual Saf. 2012;21(7):576-585. doi:10.1136/bmjqs-2011-00060…
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psnet.ahrq.gov/node/74848/psn-pdf
February 16, 2022 - Patients for Patient Safety US.
February 16, 2022
404.510.8787; info@pfps.us
https://psnet.ahrq.gov/issue/patients-patient-safety-us
Patient safety improvement has made progress but more can be done. This organization supports
community efforts in the United States to engage policymakers in work toward aligning ef…
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psnet.ahrq.gov/node/73396/psn-pdf
June 16, 2021 - The impact of the built environment on patient falls in
hospital rooms: an integrative review.
June 16, 2021
Pati D, Valipoor S, Lorusso L, et al. The impact of the built environment on patient falls in hospital rooms:
an integrative review. J Patient Saf. 2021;17(4):273-281. doi:10.1097/pts.0000000000000613.
http…
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psnet.ahrq.gov/node/39332/psn-pdf
July 24, 2010 - Risk-sensitive events during laparoscopic
cholecystectomy: the influence of the integrated
operating room and a preoperative checklist tool.
July 24, 2010
Buzink SN, van Lier L, de Hingh IHJT, et al. Risk-sensitive events during laparoscopic cholecystectomy:
the influence of the integrated operating room and a pre…
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psnet.ahrq.gov/node/854252/psn-pdf
October 04, 2023 - Standardization and visualization of the surgical time-out.
October 4, 2023
Levy BE, Wilt WS, Lantz S, et al. Standardization and visualization of the surgical time-out. J Patient Saf.
2023;19(7):453-459. doi:10.1097/pts.0000000000001156.
https://psnet.ahrq.gov/issue/standardization-and-visualization-surgical-time-…
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psnet.ahrq.gov/node/46322/psn-pdf
August 02, 2017 - Sophisticated digital aids could help determine what ails
you.
August 2, 2017
Maron DF. Scientific American. July 21, 2017.
https://psnet.ahrq.gov/issue/sophisticated-digital-aids-could-help-determine-what-ails-you
Clinical decision support systems are a key strategy to improve diagnostic accuracy. This magazine a…
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psnet.ahrq.gov/node/34870/psn-pdf
April 18, 2016 - Unintended medication discrepancies at the time of
hospital admission.
April 18, 2016
Cornish PL, Knowles SR, Marchesano R, et al. Unintended medication discrepancies at the time of hospital
admission. Arch Intern Med. 2005;165(4):424-9.
https://psnet.ahrq.gov/issue/unintended-medication-discrepancies-time-hospita…
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psnet.ahrq.gov/node/36106/psn-pdf
May 27, 2011 - Evidence-based red cell transfusion in the critically ill:
quality improvement using computerized physician order
entry.
May 27, 2011
Rana R, Afessa B, Keegan MT, et al. Evidence-based red cell transfusion in the critically ill: quality
improvement using computerized physician order entry. Crit Care Med. 2006;34(7…
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psnet.ahrq.gov/node/44838/psn-pdf
February 10, 2016 - ADVERSE drug events: incidence and risk reduction
across the care continuum.
February 10, 2016
Wanderer JP, Rathmell JP. ADVERSE Drug Events: Incidence & risk reduction across the care continuum.
Anesthesiology. 2016;124(1):A23. doi:10.1097/01.anes.0000473722.20007.03.
https://psnet.ahrq.gov/issue/adverse-drug-eve…
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psnet.ahrq.gov/node/45986/psn-pdf
March 29, 2017 - Pediatric prehospital medication dosing errors: a national
survey of paramedics.
March 29, 2017
Hoyle JD, Crowe RP, Bentley MA, et al. Pediatric prehospital medication dosing errors: a national survey of
paramedics. Prehosp Emerg Care. 2017;21(2):185-191. doi:10.1080/10903127.2016.1227001.
https://psnet.ahrq.gov/i…
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psnet.ahrq.gov/node/44473/psn-pdf
September 27, 2016 - Medication errors in hospitals: a literature review of
disruptions to nursing practice during medication
administration.
September 27, 2016
Hayes C, Jackson D, Davidson PM, et al. Medication errors in hospitals: a literature review of disruptions to
nursing practice during medication administration. J Clin Nurs. 2…
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psnet.ahrq.gov/node/841492/psn-pdf
December 14, 2022 - Cybersecurity is Patient Safety: Policy Options in the
Health Care Sector.
December 14, 2022
Washington DC; Office of Senator Mark Warner: November 25, 2022.
https://psnet.ahrq.gov/issue/cybersecurity-patient-safety-policy-options-health-care-sector
There is lack of consensus concerning the need for increased syst…
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psnet.ahrq.gov/node/837605/psn-pdf
June 29, 2022 - Under the Skin. The Hidden Toll of Racism on American
Lives and on the Health of our Nation.
June 29, 2022
Villarosa L. New York, NT: Doubleday: 2022. ISBN 9780385544887.
https://psnet.ahrq.gov/issue/under-skin-hidden-toll-racism-american-lives-and-health-our-nation
Health inequities are receiving increased …
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psnet.ahrq.gov/node/44048/psn-pdf
November 20, 2015 - Clinical handover of the critically ill postoperative patient:
an integrative review.
November 20, 2015
Gardiner TM, Marshall AP, Gillespie BM. Clinical handover of the critically ill postoperative patient: an
integrative review. Aust Crit Care. 2015;28(4):226-34. doi:10.1016/j.aucc.2015.02.001.
https://psnet.ahrq…
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psnet.ahrq.gov/node/45792/psn-pdf
December 20, 2017 - Reevaluation of diagnosis in adults with physician-
diagnosed asthma.
December 20, 2017
Aaron SD, Vandemheen KL, FitzGerald M, et al. Reevaluation of Diagnosis in Adults With Physician-
Diagnosed Asthma. JAMA. 2017;317(3):269-279. doi:10.1001/jama.2016.19627.
https://psnet.ahrq.gov/issue/reevaluation-diagnosis-adu…
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psnet.ahrq.gov/node/39263/psn-pdf
February 03, 2010 - Is there a benefit to multidisciplinary rounds in an open
trauma intensive care unit regarding ventilator-associated
pneumonia?
February 3, 2010
Johnson V, Mangram A, Mitchell C, et al. Is there a benefit to multidisciplinary rounds in an open trauma
intensive care unit regarding ventilator-associated pneumonia? A…
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psnet.ahrq.gov/node/40219/psn-pdf
December 29, 2014 - Cardiac surgery errors: results from the UK National
Reporting and Learning System.
December 29, 2014
Martinez EA, Shore AD, Colantuoni E, et al. Cardiac surgery errors: results from the UK National Reporting
and Learning System. Int J Qual Health Care. 2011;23(2):151-8. doi:10.1093/intqhc/mzq084.
https://psnet.ah…
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psnet.ahrq.gov/node/73249/psn-pdf
May 12, 2021 - I-PASS handover system: a decade of evidence demands
action.
May 12, 2021
Shahian DM. I-PASS handover system: a decade of evidence demands action. BMJ Qual Saf.
2021;30(10):769-774. doi:10.1136/bmjqs-2021-013314.
https://psnet.ahrq.gov/issue/i-pass-handover-system-decade-evidence-demands-action
The I-PASS structu…