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Showing results for "references".

2001. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/838180/psn-pdf
      January 01, 2023 - To err is human, but what happens when surgeons err? September 28, 2022 Lin JS, Olutoye OO, Samora JB. To err is human, but what happens when surgeons err? J Pediatr Surg. 2023;58(3):496-502. doi:10.1016/j.jpedsurg.2022.06.019. https://psnet.ahrq.gov/issue/err-human-what-happens-when-surgeons-err Clinicians involv…

2002. Diagnostic Errors Case Studies | PSNet
      psnet.ahrq.gov/curated-library/diagnostic-errors-case-studies
      August 10, 2025 - Breadcrumb Home The PSNet Collection Curated Libraries Subscribed Diagnostic Errors Case Studies  Download  Share Facebook Twitter Linkedin Copy URL Subscribe Created By: Maria Mirica, PRIDE Group …

2003. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/34691/psn-pdf
      May 18, 2016 - Error in medicine. May 18, 2016 Leape L. Error in medicine. JAMA. 1994;272(23):1851-1857. https://psnet.ahrq.gov/issue/error-medicine Leape discusses how traditional methods of error reduction in medicine have focused on individual performance rather than on the systems in which individuals operate. With reference…

2004. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/38317/psn-pdf
      September 01, 2016 - Impact of non-interruptive medication laboratory monitoring alerts in ambulatory care. September 1, 2016 Lo HG, Matheny ME, Seger DL, et al. Impact of non-interruptive medication laboratory monitoring alerts in ambulatory care. J Am Med Inform Assoc. 2009;16(1):66-71. doi:10.1197/jamia.M2687. https://psnet.ahrq.go…

2005. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/764406/psn-pdf
      March 02, 2022 - Patient safety assurance in the age of defensive medicine: a review. March 2, 2022 Shenoy A, Shenoy GN, Shenoy GG. Patient safety assurance in the age of defensive medicine: a review. Patient Saf Surg. 2022;16(1):10. doi:10.1186/s13037-022-00319-8. https://psnet.ahrq.gov/issue/patient-safety-assurance-age-defensiv…

2006. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/73541/psn-pdf
      July 28, 2021 - Misdiagnosis of heart failure: a systematic review of the literature. July 28, 2021 Wong CW, Tafuro J, Azam Z, et al. Misdiagnosis of heart failure: a systematic review of the literature. J Cardiac Failure. 2021;27(9):925-933. doi:10.1016/j.cardfail.2021.05.014. https://psnet.ahrq.gov/issue/misdiagnosis-heart-fail…

2007. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/47159/psn-pdf
      August 01, 2018 - Safety II behavior in a pediatric intensive care unit. August 1, 2018 Merandi J, Vannatta K, Davis T, et al. Safety II Behavior in a Pediatric Intensive Care Unit. Pediatrics. 2018;141(6):e20180018. doi:10.1542/peds.2018-0018. https://psnet.ahrq.gov/issue/safety-ii-behavior-pediatric-intensive-care-unit The tradit…

2008. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/36463/psn-pdf
      July 10, 2008 - Missed opportunities in the primary care management of early acute ischemic heart disease. July 10, 2008 Sequist TD, Marshall R, Lampert S, et al. Missed opportunities in the primary care management of early acute ischemic heart disease. Arch Intern Med. 2006;166(20):2237-43. https://psnet.ahrq.gov/issue/missed-op…

2009. Situational Awareness | PSNet
      psnet.ahrq.gov/taxonomy/term/3440
      April 10, 2025 - Situational Awareness Situational awareness refers to the degree to which one's perception of a situation matches reality. In the context of crisis management, where the phrase is most often used, situational awareness includes awareness of fatigue and stress among team members (including oneself), environmental thre…

2010. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/47843/psn-pdf
      March 06, 2019 - Structural iatrogenesis—a 43-year-old man with "opioid misuse." March 6, 2019 Stonington S, Coffa D. Structural Iatrogenesis - A 43-Year-Old Man with "Opioid Misuse". N Engl J Med. 2019;380(8):701-704. doi:10.1056/NEJMp1811473. https://psnet.ahrq.gov/issue/structural-iatrogenesis-43-year-old-man-opioid-misuse The…

2011. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/43153/psn-pdf
      May 07, 2014 - Is oral chemotherapy prescription safe for patients? A cross-sectional survey. May 7, 2014 Bourmaud A, Pacaut C, Melis A, et al. Is oral chemotherapy prescription safe for patients? A cross- sectional survey. Ann Oncol. 2014;25(2):500-504. doi:10.1093/annonc/mdt553. https://psnet.ahrq.gov/issue/oral-chemotherapy-p…

2012. Workaround | PSNet
      psnet.ahrq.gov/taxonomy/term/3504
      June 24, 2025 - Workaround From the perspective of frontline personnel trying to accomplish their work, the design of equipment or the policies governing work tasks can seem counterproductive. When frontline personnel adopt consistent patterns of work or ways of bypassing safety features of medical equipment, these patterns and acti…

2013. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/867633/psn-pdf
      February 26, 2025 - Failure to rescue female patients undergoing high-risk surgery. February 26, 2025 Wagner CM, Joynt Maddox KE, Ailawadi G, et al. Failure to rescue female patients undergoing high-risk surgery. JAMA Surg. 2024;160(1):29-36. doi:10.1001/jamasurg.2024.4574. https://psnet.ahrq.gov/issue/failure-rescue-female-patients-…

2014. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/46470/psn-pdf
      October 11, 2017 - The weekend effect in hospitalized patients: a meta- analysis. October 11, 2017 Pauls LA, Johnson-Paben R, McGready J, et al. The Weekend Effect in Hospitalized Patients: A Meta- Analysis. J Hosp Med. 2017;12(9):760-766. doi:10.12788/jhm.2815. https://psnet.ahrq.gov/issue/weekend-effect-hospitalized-patients-meta-…

2015. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/74089/psn-pdf
      July 15, 2002 - The effect of race and sex on physicians' recommendations for cardiac catheterization. July 15, 2002 Schulman KA, Berlin JA, Harless W, et al. The effect of race and sex on physicians' recommendations for cardiac catheterization. N Engl J Med. 2002;340(8):618-626. doi:10.1056/nejm199902253400806. https://psnet.ahr…

2016. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/44403/psn-pdf
      June 21, 2016 - Preventability of hospital-acquired venous thromboembolism. June 21, 2016 Haut ER, Lau BD, Kraus PS, et al. Preventability of Hospital-Acquired Venous Thromboembolism. JAMA Surg. 2015;150(9):912-5. doi:10.1001/jamasurg.2015.1340. https://psnet.ahrq.gov/issue/preventability-hospital-acquired-venous-thromboembolism …

2017. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/46906/psn-pdf
      May 30, 2018 - Making an infusion error: the second victims of infusion therapy-related medication errors. May 30, 2018 Treiber LA, Jones JH. Making an Infusion Error: The Second Victims of Infusion Therapy-Related Medication Errors. J Infus Nurs. 2018;41(3):156-163. doi:10.1097/NAN.0000000000000273. https://psnet.ahrq.gov/issue…

2018. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/865527/psn-pdf
      April 10, 2024 - Teamwork matters: team situation awareness to build high-performing healthcare teams, a narrative review. April 10, 2024 Weller JM, Mahajan R, Fahey-Williams K, et al. Teamwork matters: team situation awareness to build high- performing healthcare teams, a narrative review. Br J Anaesth. 2024;132(4):771-778. doi:1…

2019. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/852449/psn-pdf
      August 16, 2023 - Missed nursing care in emergency departments: a scoping review. August 16, 2023 Duhalde H, Bjuresäter K, Karlsson I, et al. Missed nursing care in emergency departments: a scoping review. Int Emerg Nurs. 2023;69:101296. doi:10.1016/j.ienj.2023.101296. https://psnet.ahrq.gov/issue/missed-nursing-care-emergency-depa…

2020. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/43736/psn-pdf
      April 24, 2017 - Seeing risk and allocating responsibility: talk of culture and its consequences on the work of patient safety. April 24, 2017 Szymczak JE. Seeing risk and allocating responsibility: talk of culture and its consequences on the work of patient safety. Soc Sci Med. 2014;120:252-9. doi:10.1016/j.socscimed.2014.09.023. …