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psnet.ahrq.gov/node/865967/psn-pdf
May 29, 2024 - Impact of diagnostic management team on patient time to
diagnosis and percent of accurate and clinically
actionable diagnoses.
May 29, 2024
Brashear J, Mize R, Laposata M, et al. Impact of diagnostic management team on patient time to diagnosis
and percent of accurate and clinically actionable diagnoses. Diagnosis…
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www.ahrq.gov/prevention/guidelines/tobacco/clinicians/presentations/2008update-full/slide126.html
October 01, 2014 - 126. Treatment Recommendations: Medications (Continued)
Treating Tobacco Use and Dependence: 2008 Update
Text version of slide presentation.
Clinical guidelines for prescribing medication for treating tobacco use and dependence (continued)
What medications should a clinician use with a patient who…
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psnet.ahrq.gov/node/841486/psn-pdf
January 26, 2018 - Do words matter? Stigmatizing language and the
transmission of bias in the medical record.
January 26, 2018
P. Goddu A, O’Conor KJ, Lanzkron S, et al. Do words matter? Stigmatizing language and the transmission
of bias in the medical record. J Gen Intern Med. 2018;33(5):685-691. doi:10.1007/s11606-017-4289-2.
http…
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psnet.ahrq.gov/node/60909/psn-pdf
September 16, 2020 - Improving patient handoffs and transitions through
adaptation and implementation of I-PASS across multiple
handoff settings.
September 16, 2020
Blazin LJ, Sitthi-Amorn J, Hoffman JM, et al. Improving patient handoffs and transitions through adaptation
and implementation of I-PASS across multiple handoff settings. …
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psnet.ahrq.gov/node/34649/psn-pdf
June 11, 2014 - On error management: lessons from aviation.
June 11, 2014
Helmreich RL. On error management: lessons from aviation. BMJ . 2000;320(7237):781-785.
https://psnet.ahrq.gov/issue/error-management-lessons-aviation
In this perspective, the author draws on analogies from aviation to frame the issues of patient safety and
…
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psnet.ahrq.gov/node/47426/psn-pdf
October 13, 2018 - Patient-centered insights: using health care complaints to
reveal hot spots and blind spots in quality and safety.
October 13, 2018
Gillespie A, Reader TW. Patient-Centered Insights: Using Health Care Complaints to Reveal Hot Spots and
Blind Spots in Quality and Safety. Milbank Q. 2018;96(3):530-567. doi:10.1111/14…
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psnet.ahrq.gov/node/47580/psn-pdf
November 28, 2018 - Patient engagement in health care safety: an overview of
mixed-quality evidence.
November 28, 2018
Sharma AE, Rivadeneira NA, Barr-Walker J, et al. Patient Engagement In Health Care Safety: An Overview
Of Mixed-Quality Evidence. Health Aff (Millwood). 2018;37(11):1813-1820. doi:10.1377/hlthaff.2018.0716.
https://p…
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psnet.ahrq.gov/node/73581/psn-pdf
January 01, 2022 - Applying human factors engineering to address the
telemetry alarm problem in a large medical center.
August 11, 2021
Patterson ES, Rayo MF, Edworthy JR, et al. Applying human factors engineering to address the telemetry
alarm problem in a large medical center. Hum Factors. 2022;64(1):126-142.
doi:10.1177/001872082…
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psnet.ahrq.gov/node/855432/psn-pdf
November 15, 2023 - Alarm burden and the nursing care environment: a 213-
hospital cross-sectional study.
November 15, 2023
Ruppel H, Dougherty M, Bonafide CP, et al. Alarm burden and the nursing care environment: a 213-
hospital cross-sectional study. BMJ Open Qual. 2023;12(4):e002342. doi:10.1136/bmjoq-2023-002342.
https://psnet.ah…
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psnet.ahrq.gov/node/44022/psn-pdf
May 28, 2015 - Initiatives to identify and mitigate medication errors in
England.
May 28, 2015
Cousins D, Gerrett D, Richards N, et al. Initiatives to identify and mitigate medication errors in England.
Drug Saf. 2015;38(4):349-357. doi:10.1007/s40264-015-0270-3.
https://psnet.ahrq.gov/issue/initiatives-identify-and-mitigate-med…
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psnet.ahrq.gov/node/36333/psn-pdf
July 10, 2008 - The care transitions intervention: results of a randomized
controlled trial.
July 10, 2008
Coleman EA, Parry C, Chalmers S, et al. The care transitions intervention: results of a randomized
controlled trial. Arch Intern Med. 2006;166(17):1822-8.
https://psnet.ahrq.gov/issue/care-transitions-intervention-results-ra…
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psnet.ahrq.gov/node/866115/psn-pdf
June 12, 2024 - Defining, identifying and addressing problematic
polypharmacy within multimorbidity in primary care: a
scoping review.
June 12, 2024
Tsang JY, Sperrin M, Blakeman T, et al. Defining, identifying and addressing problematic polypharmacy
within multimorbidity in primary care: a scoping review. BMJ Open. 2024;14(5):e0…
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psnet.ahrq.gov/node/61096/psn-pdf
November 04, 2020 - Wrong drug and wrong dose dispensing errors identified
in pharmacist professional liability claims.
November 4, 2020
Reiner G, Pierce SL, Flynn J. J Am Pharm Assoc (2003). 2020;60(5):e50-e56.
https://psnet.ahrq.gov/issue/wrong-drug-and-wrong-dose-dispensing-errors-identified-pharmacist-
professional-liability
Des…
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psnet.ahrq.gov/node/38290/psn-pdf
February 17, 2011 - Revisiting duty-hour limits — IOM recommendations for
patient safety and resident education.
February 17, 2011
Iglehart JK. Revisiting duty-hour limits--IOM recommendations for patient safety and resident education. N
Engl J Med. 2008;359(25):2633-5. doi:10.1056/NEJMp0808736.
https://psnet.ahrq.gov/issue/revisitin…
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psnet.ahrq.gov/node/46453/psn-pdf
October 04, 2017 - Evaluation of patient and family outpatient complaints as
a strategy to prioritize efforts to improve cancer care
delivery.
October 4, 2017
Mack JW, Jacobson J, Frank D, et al. Evaluation of Patient and Family Outpatient Complaints as a
Strategy to Prioritize Efforts to Improve Cancer Care Delivery. Jt Comm J Qual…
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psnet.ahrq.gov/node/73135/psn-pdf
April 14, 2021 - Debrief it all: a tool for inclusion of Safety-II.
April 14, 2021
Bentley SK, McNamara S, Meguerdichian MJ, et al. Debrief it all: a tool for inclusion of Safety-II. Adv Simul
(Lond). 2021;6(1):9. doi:10.1186/s41077-021-00163-3.
https://psnet.ahrq.gov/issue/debrief-it-all-tool-inclusion-safety-ii
Debriefing is a c…
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psnet.ahrq.gov/node/838237/psn-pdf
October 05, 2022 - Deprescribing medicines in older people living with
multimorbidity and polypharmacy: the TAILOR evidence
synthesis.
October 5, 2022
Reeve J, Maden M, Hill R, et al. Deprescribing medicines in older people living with multimorbidity and
polypharmacy: the TAILOR evidence synthesis. Health Technol Assess. 2022;26(32)…
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psnet.ahrq.gov/node/45895/psn-pdf
February 22, 2017 - Opioids for pain management in older adults: strategies
for safe prescribing.
February 22, 2017
Davies PS. Opioids for pain management in older adults. Nurse Pract. 2017;42(2).
doi:10.1097/01.npr.0000511772.62176.10.
https://psnet.ahrq.gov/issue/opioids-pain-management-older-adults-strategies-safe-prescribing
Use…
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psnet.ahrq.gov/node/36178/psn-pdf
September 30, 2010 - Analysis of surgical errors in closed malpractice claims at
4 liability insurers.
September 30, 2010
Rogers SO, Gawande AA, Kwaan M, et al. Analysis of surgical errors in closed malpractice claims at 4
liability insurers. Surgery. 2006;140(1):25-33.
https://psnet.ahrq.gov/issue/analysis-surgical-errors-closed-malp…
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psnet.ahrq.gov/node/47109/psn-pdf
June 06, 2018 - Principles of automation for patient safety in intensive
care: learning from aviation.
June 6, 2018
Dominiczak J, Khansa L. Principles of Automation for Patient Safety in Intensive Care: Learning From
Aviation. Jt Comm J Qual Patient Saf. 2018;44(6):366-371. doi:10.1016/j.jcjq.2017.11.008.
https://psnet.ahrq.gov/i…