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psnet.ahrq.gov/issue/impact-health-care-strikes-patient-mortality-systematic-review-and-meta-analysis
April 27, 2022 - Review
The impact of health care strikes on patient mortality: a systematic review and meta-analysis of observational studies.
Citation Text:
Essex R, Weldon SM, Thompson T, et al. The impact of health care strikes on patient mortality: a systematic review and meta‐analysis of observatio…
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psnet.ahrq.gov/issue/diagnostic-errors-medical-students-results-prospective-qualitative-study
May 18, 2022 - Study
Diagnostic errors by medical students: results of a prospective qualitative study.
Citation Text:
Braun LT, Zwaan L, Kiesewetter J, et al. Diagnostic errors by medical students: results of a prospective qualitative study. BMC Med Educ. 2017;17(1):191. doi:10.1186/s12909-017-1044-7.…
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psnet.ahrq.gov/issue/retrospective-review-serious-surgical-incidents-5-large-uk-teaching-hospitals-system-based
May 26, 2021 - Study
A retrospective review of serious surgical incidents in 5 large UK teaching hospitals: a system-based approach.
Citation Text:
Serou N, Slight RD, Husband AK, et al. A retrospective review of serious surgical incidents in 5 large UK teaching hospitals: a system-based approach. J Pa…
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psnet.ahrq.gov/issue/are-operating-room-distractions-interruptions-and-disruptions-associated-performance-and
December 02, 2020 - Review
Are operating room distractions, interruptions, and disruptions associated with performance and patient safety? A systematic review and meta-analysis.
Citation Text:
Mcmullan RD, Urwin R, Gates PJ, et al. Are operating room distractions, interruptions and disruptions associated wi…
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psnet.ahrq.gov/issue/learning-incident-reporting-analysis-incidents-resulting-patient-injuries-web-based-system
August 04, 2021 - Study
Learning from incident reporting? Analysis of incidents resulting in patient injuries in a web-based system in Swedish health care.
Citation Text:
Ahlberg E-L, Elfström J, Borgstedt MR, et al. Learning from incident reporting? Analysis of incidents resulting in patient injuries in …
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psnet.ahrq.gov/issue/how-incident-reporting-systems-can-stimulate-social-and-participative-learning-mixed-methods
November 04, 2020 - Study
How incident reporting systems can stimulate social and participative learning: a mixed-methods study.
Citation Text:
de Kam D, Kok J, Grit K, et al. How incident reporting systems can stimulate social and participative learning: a mixed-methods study. Health Policy (New York). 202…
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psnet.ahrq.gov/issue/nature-and-timing-incidents-intercepted-surpass-checklist-surgical-patients
September 20, 2011 - Study
Nature and timing of incidents intercepted by the SURPASS checklist in surgical patients.
Citation Text:
de Vries EN, Prins HA, Bennink C, et al. Nature and timing of incidents intercepted by the SURPASS checklist in surgical patients. BMJ Qual Saf. 2012;21(6):503-8. doi:10.1136/…
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psnet.ahrq.gov/issue/impact-full-personal-protective-equipment-alertness-healthcare-workers-prospective-study
August 24, 2022 - Study
Impact of full personal protective equipment on alertness of healthcare workers: a prospective study.
Citation Text:
Wells HJ, Raithatha M, Elhag S, et al. Impact of full personal protective equipment on alertness of healthcare workers: a prospective study. BMJ Open Qual. 2022;11(1…
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psnet.ahrq.gov/issue/intravenous-infusion-administration-comparative-study-practices-and-errors-between-united
October 18, 2018 - Study
Intravenous infusion administration: a comparative study of practices and errors between the United States and England and their implications for patient safety.
Citation Text:
Blandford A, Dykes PC, Franklin BD, et al. Intravenous Infusion Administration: A Comparative Study of Pr…
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psnet.ahrq.gov/web-mm/anesthesia-weighty-issue
September 01, 2006 - Anesthesia: A Weighty Issue
Citation Text:
Sinha AC. Anesthesia: A Weighty Issue. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2013.
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psnet.ahrq.gov/node/49709/psn-pdf
May 01, 2014 - Raise the Bar
May 1, 2014
Stotts J, Lyndon A. Raise the Bar. PSNet [internet]. 2014.
https://psnet.ahrq.gov/web-mm/raise-bar
The Case
A 57-year-old man presented to an ambulatory surgery center for excision of a right groin lipoma. The
patient was seen and evaluated by an anesthesiologist who was new to the cente…
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psnet.ahrq.gov/innovation/rescue-improvement-conference-innovation-summary
September 23, 2024 - Rescue Improvement Conference Innovation Summary
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July 23, 2024
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Innovation
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psnet.ahrq.gov/primer/detection-safety-hazards
March 30, 2022 - Detection of Safety Hazards
Citation Text:
Detection of Safety Hazards. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2019.
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psnet.ahrq.gov/perspective/conversation-withrichard-p-shannon-md
August 01, 2010 - )
Awareness and Outreach
A small number of AMCs have succeeded in moving toward becoming highly reliable
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psnet.ahrq.gov/curated-library/patient-team-member-clinical-care
March 15, 2025 - Breadcrumb
Home
The PSNet Collection
Curated Libraries
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Patient as a Team Member in Clinical Care
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Created By: Lorri Zipperer, Cybraria…
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psnet.ahrq.gov/web-mm/do-not-disturb
February 03, 2011 - SPOTLIGHT CASE
Do Not Disturb!
Citation Text:
Duffy DF, Cassel C. Do Not Disturb!. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2007.
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psnet.ahrq.gov/perspective/conversation-susan-haas-md-msc
March 01, 2019 - In Conversation With… Susan Haas, MD, MSc
March 1, 2019
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Citation Text:
In Conversation With… Susan Haas, MD, MSc. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2019.
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psnet.ahrq.gov/perspective/conversation-withmark-chassin-md-mpp-mph
April 01, 2009 - In Conversation with...Mark Chassin, MD, MPP, MPH
April 1, 2009
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Citation Text:
In Conversation with..Mark Chassin, MD, MPP, MPH . PSNet [internet]. 2009.In Conversation with...Mark Chassin, MD, MPP, MPH . PSNet [internet]. Rockville (MD): A…
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psnet.ahrq.gov/perspective/conversation-jessica-behrhorst-about-evolution-root-cause-analysis
February 26, 2025 - In Conversation with Jessica Behrhorst about The Evolution of Root Cause Analysis
Jessica Behrhorst, MPH, CPPS, CPHRM, CPHQ; Bryan Gale, MA; Cindy Manaoat Van, MHSA, CPPS | February 26, 2025
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psnet.ahrq.gov/perspective/evolution-root-cause-analysis
February 26, 2025 - The Evolution of Root Cause Analysis
Jessica Behrhorst, MPH, CPPS, CPHRM, CPHQ; Bryan Gale, MA; Cindy Manaoat Van, MHSA, CPPS | February 26, 2025
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Citation Text:
Behrhorst J, Gale B, Van CM. Th…