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psnet.ahrq.gov/node/37181/psn-pdf
October 06, 2011 - Inter-rater reliability of a classification system for hospital
adverse drug event reports.
October 6, 2011
Haynes K, Hennessy S, Morales KH, et al. Inter-rater reliability of a classification system for hospital
adverse drug event reports. Clin Pharmacol Ther. 2008;83(3):485-8.
https://psnet.ahrq.gov/issue/inter-…
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psnet.ahrq.gov/node/40193/psn-pdf
December 21, 2014 - Special report: suicidal ideation among American
surgeons.
December 21, 2014
Shanafelt TD, Balch CM, Dyrbye LN, et al. Special report: suicidal ideation among American surgeons.
Arch Surg. 2011;146(1):54-62. doi:10.1001/archsurg.2010.292.
https://psnet.ahrq.gov/issue/special-report-suicidal-ideation-among-american…
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psnet.ahrq.gov/node/40089/psn-pdf
July 27, 2011 - Serious Reportable Events
July 27, 2011
National Quality Forum. 2009-2011.
https://psnet.ahrq.gov/issue/patient-safety-serious-reportable-events-healthcare
This project--now complete--examined the presence and tracking of never events as part of a larger
National Quality Forum strategy to improve patient safety. T…
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psnet.ahrq.gov/web-mm/delayed-breast-cancer-diagnosis-false-sense-security
May 01, 2005 - BI-RADS Atlas – Mammography Reporting Systems. 2013.
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psnet.ahrq.gov/node/40331/psn-pdf
July 31, 2012 - Keeping the Commitment: A Progress Report on Four
Early Leaders in Patient Safety Improvement.
July 31, 2012
McCarthy D, Klein S. New York, NY: The Commonwealth Fund; March 15, 2011.
https://psnet.ahrq.gov/issue/keeping-commitment-progress-report-four-early-leaders-patient-safety-
improvement
Updating a previous …
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psnet.ahrq.gov/node/38007/psn-pdf
September 05, 2008 - Building a Culture of Patient Safety: Report of the
Commission on Patient Safety and Quality Assurance.
September 5, 2008
Dublin, Ireland: Department of Health & Children, Commission on Patient Safety and Quality
Assurance; 2008. ISBN: 9781406421835.
https://psnet.ahrq.gov/issue/building-culture-patient-safety-rep…
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psnet.ahrq.gov/node/42132/psn-pdf
July 03, 2014 - Surgeon-reported conflict with intensivists about
postoperative goals of care.
July 3, 2014
Olson TJP, Brasel KJ, Redmann AJ, et al. Surgeon-reported conflict with intensivists about postoperative
goals of care. JAMA Surg. 2013;148(1):29-35. doi:10.1001/jamasurgery.2013.403.
https://psnet.ahrq.gov/issue/surgeon-re…
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psnet.ahrq.gov/node/36446/psn-pdf
March 28, 2011 - Healthcare provider complaints to the emergency
department: a preliminary report on a new quality
improvement instrument.
March 28, 2011
Griffey RT, Bohan JS. Healthcare provider complaints to the emergency department: a preliminary report
on a new quality improvement instrument. Qual Saf Health Care. 2006;15(5):3…
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psnet.ahrq.gov/node/38161/psn-pdf
October 22, 2008 - Discrepancies between home medications listed at
hospital admission and reported medical conditions.
October 22, 2008
Slain D, Kincaid SE, Dunsworth TS. Discrepancies between home medications listed at hospital admission
and reported medical conditions. Am J Geriatr Pharmacother. 2008;6(3):161-6.
doi:10.1016/j.amj…
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psnet.ahrq.gov/node/40775/psn-pdf
September 14, 2011 - Ambulatory surgery facilities: a comprehensive review of
medication error reports in Pennsylvania.
September 14, 2011
Grissinger M, Dabliz R. Pa Patient Saf Advis 2011 Sep;8(3):85-93.
https://psnet.ahrq.gov/issue/ambulatory-surgery-facilities-comprehensive-review-medication-error-reports-
pennsylvania
Anal…
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psnet.ahrq.gov/node/39700/psn-pdf
November 02, 2010 - Patient report on information given, consultation time and
safety in primary care.
November 2, 2010
Mira JJ, Nebot C, Lorenzo S, et al. Patient report on information given, consultation time and safety in
primary care. Qual Saf Health Care. 2010;19(5):e33. doi:10.1136/qshc.2009.037978.
https://psnet.ahrq.gov/issue…
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psnet.ahrq.gov/node/42978/psn-pdf
February 26, 2014 - The Francis Report: One Year On.
February 26, 2014
Thorlby R, Smith J, Williams S, Dayan M. London, UK: Nuffield Trust; February 2014.
https://psnet.ahrq.gov/issue/francis-report-one-year
This publication offers insights from acute care hospital staff in England regarding recommendations from
the Francis rep…
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psnet.ahrq.gov/node/41445/psn-pdf
May 30, 2012 - Poll: Many Sick Americans Experience Significant
Financial Problems and Report Their Care is not Well-
Managed.
May 30, 2012
Princeton, NJ: Robert Wood Johnson Foundation, National Public Radio, and the Harvard School of Public
Health. May 21, 2012.
https://psnet.ahrq.gov/issue/poll-many-sick-americans-exp…
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psnet.ahrq.gov/node/73370/psn-pdf
June 09, 2021 - Burnout and its relationship to self-reported quality of
patient care and adverse events during COVID-19: a
cross-sectional online survey among nurses.
June 9, 2021
Kakemam E, Chegini Z, Rouhi A, et al. Burnout and its relationship to self?reported quality of patient care
and adverse events during COVID?19: a cros…
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psnet.ahrq.gov/node/60633/psn-pdf
July 01, 2020 - Frequency and types of patient-reported errors in
electronic health record ambulatory care notes.
July 1, 2020
Bell SK, Delbanco T, Elmore JG, et al. Frequency and types of patient-reported errors in electronic health
record ambulatory care notes. JAMA Netw Open. 2020;3(6):e205867.
doi:10.1001/jamanetworkopen.2020…
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psnet.ahrq.gov/node/36629/psn-pdf
January 05, 2017 - Patient-reported safety and quality of care in outpatient
oncology.
January 5, 2017
Weingart SN, Price J, Duncombe D, et al. Patient-reported safety and quality of care in outpatient
oncology. Jt Comm J Qual Patient Saf. 2007;33(2):83-94.
https://psnet.ahrq.gov/issue/patient-reported-safety-and-quality-care-outpat…
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psnet.ahrq.gov/node/863216/psn-pdf
February 28, 2024 - Association between sleep health and rates of self-
reported medical errors in intern physicians: an ancillary
analysis of the Intern Health Study.
February 28, 2024
Hassinger AB, Velez C, Wang J, et al. Association between sleep health and rates of self-reported medical
errors in intern physicians: an ancillary a…
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psnet.ahrq.gov/node/865522/psn-pdf
April 10, 2024 - An analysis of incident reports related to electronic
medication management: how they change over time.
April 10, 2024
Kinlay M, Zheng WY, Burke R, et al. An analysis of incident reports related to electronic medication
management: how they change over time. J Patient Saf. 2024;20(3):202-208.
doi:10.1097/pts.00000…
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psnet.ahrq.gov/node/40636/psn-pdf
November 21, 2011 - Incorrect surgical procedures within and outside of the
operating room: a follow-up report.
November 21, 2011
Neily J, Mills PD, Eldridge N, et al. Incorrect surgical procedures within and outside of the operating room:
a follow-up report. Arch Surg. 2011;146(11):1235-9. doi:10.1001/archsurg.2011.171.
https://psne…
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psnet.ahrq.gov/node/46450/psn-pdf
August 20, 2018 - Improving Diagnostic Quality and Safety Final Report.
August 20, 2018
Washington, DC: National Quality Forum. September 19, 2017.
https://psnet.ahrq.gov/issue/improving-diagnostic-quality-and-safety-final-report
Although diagnostic error is a well-recognized source of preventable patient harm, measuring and
mitiga…