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  1. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/35736/psn-pdf
    May 27, 2011 - Video capture of clinical care to enhance patient safety. May 27, 2011 Weinger MB, Gonzales DC, Slagle J, et al. Video capture of clinical care to enhance patient safety. Qual Saf Health Care. 2004;13(2):136-44. https://psnet.ahrq.gov/issue/video-capture-clinical-care-enhance-patient-safety This study describes th…
  2. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/45934/psn-pdf
    March 01, 2017 - The evolving role of medical scribe: variation and implications for organizational effectiveness and safety. March 1, 2017 Woodcock D, Pranaat R, McGrath K, et al. The Evolving Role of Medical Scribe: Variation and Implications for Organizational Effectiveness and Safety. Stud Health Technol Inform. 2017;234:382-38…
  3. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/45716/psn-pdf
    September 29, 2017 - Microanalysis of video from the operating room: an underused approach to patient safety research. September 29, 2017 Bezemer J, Cope A, Korkiakangas T, et al. Microanalysis of video from the operating room: an underused approach to patient safety research. BMJ Qual Saf. 2017;26(7):583-587. doi:10.1136/bmjqs-2016-00…
  4. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/865532/psn-pdf
    April 10, 2024 - Let us to the TWISST; Plan, Simulate, Study and Act. April 10, 2024 Colman N, Hebbar KB. Let us to the TWISST; Plan, Simulate, Study and Act. Pediatr Qual Saf. 2023;8(4):e664. doi:10.1097/pq9.0000000000000664. https://psnet.ahrq.gov/innovation/let-us-twisst-plan-simulate-study-and-act In situ simulation can identi…
  5. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/45276/psn-pdf
    September 29, 2017 - Clinicians' expectations of the benefits and harms of treatments, screening, and tests: a systematic review. September 29, 2017 Hoffmann TC, Del Mar C. Clinicians' Expectations of the Benefits and Harms of Treatments, Screening, and Tests: A Systematic Review. JAMA Intern Med. 2017;177(3):407-419. doi:10.1001/jama…
  6. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/43907/psn-pdf
    April 27, 2015 - Association of hospital participation in a surgical outcomes monitoring program with inpatient complications and mortality. April 27, 2015 Etzioni DA, Wasif N, Dueck AC, et al. Association of hospital participation in a surgical outcomes monitoring program with inpatient complications and mortality. JAMA. 2015;313…
  7. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/38716/psn-pdf
    February 17, 2011 - Ending extra payment for "never events"—stronger incentives for patients' safety. February 17, 2011 Milstein A. Ending extra payment for "never events"--stronger incentives for patients' safety. N Engl J Med. 2009;360(23):2388-90. doi:10.1056/NEJMp0809125. https://psnet.ahrq.gov/issue/ending-extra-payment-never-ev…
  8. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/45857/psn-pdf
    July 11, 2017 - Assessing the impact of the anesthesia medication template on medication errors during anesthesia: a prospective study. July 11, 2017 Grigg EB, Martin LD, Ross FJ, et al. Assessing the Impact of the Anesthesia Medication Template on Medication Errors During Anesthesia: A Prospective Study. Anesth Analg. 2017;124(5…
  9. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/45878/psn-pdf
    September 20, 2017 - Development of a trigger tool to identify adverse events and harm in emergency medical services. September 20, 2017 Howard IL, Bowen JM, Shaikh LAHA, et al. Development of a trigger tool to identify adverse events and harm in Emergency Medical Services. Emerg Med J. 2017;34(6):391-397. doi:10.1136/emermed-2016- 20…
  10. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/35060/psn-pdf
    November 04, 2015 - Risk factors for adverse drug events: a 10-year analysis. November 4, 2015 Evans S, Lloyd JF, Stoddard GJ, et al. Risk factors for adverse drug events: a 10-year analysis. Ann Pharmacother. 2005;39(7-8):1161-8. https://psnet.ahrq.gov/issue/risk-factors-adverse-drug-events-10-year-analysis Many medications remain a…
  11. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/34813/psn-pdf
    July 10, 2008 - Hospital admissions due to adverse drug reactions: a report from the Boston Collaborative Drug Surveillance Program. July 10, 2008 Miller RR. Hospital admissions due to adverse drug reactions. A report from the Boston Collaborative Drug Surveillance Program. Arch Intern Med. 1974;134(2):219-23. https://psnet.ahrq…
  12. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/35909/psn-pdf
    October 07, 2008 - Committed to Safety: Ten Case Studies on Reducing Harm to Patients. October 7, 2008 McCarthy D, Blumenthal D. New York, NY: Commonwealth Fund; 2006. https://psnet.ahrq.gov/issue/committed-safety-ten-case-studies-reducing-harm-patients This report presents ten case studies to illustrate interventions that address p…
  13. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/36795/psn-pdf
    August 26, 2011 - Surgical specimen identification errors: a new measure of quality in surgical care. August 26, 2011 Makary MA, Epstein J, Pronovost P, et al. Surgical specimen identification errors: a new measure of quality in surgical care. Surgery. 2007;141(4):450-5. https://psnet.ahrq.gov/issue/surgical-specimen-identification…
  14. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/34693/psn-pdf
    February 10, 2011 - Effect of outcome on physician judgments of appropriateness of care. February 10, 2011 Caplan RA, Posner KL, Cheney FW. Effect of outcome on physician judgments of appropriateness of care. JAMA. 1991;265(15):1957-60. https://psnet.ahrq.gov/issue/effect-outcome-physician-judgments-appropriateness-care The authors …
  15. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/46319/psn-pdf
    August 09, 2017 - Opioids in Medicare Part D: Concerns About Extreme Use and Questionable Prescribing. August 9, 2017 Office of the Inspector General. Washington, DC: US Department of Health and Human Services; July 2017. Report No. OEI-02-17-00250. https://psnet.ahrq.gov/issue/opioids-medicare-part-d-concerns-about-extreme-use-and…
  16. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/34013/psn-pdf
    December 22, 2008 - Defining and measuring patient safety. December 22, 2008 Pronovost P, Thompson DA, Holzmueller CG, et al. Defining and measuring patient safety. Crit Care Clin. 2005;21(1):1-19, vii. https://psnet.ahrq.gov/issue/defining-and-measuring-patient-safety This review discusses the increasing demand for improving patient…
  17. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/60814/psn-pdf
    August 19, 2020 - Missed acute myocardial infarction in the emergency department-standardizing measurement of misdiagnosis- related harms using the SPADE method. August 19, 2020 Sharp AL, Baecker A, Nassery N, et al. Missed acute myocardial infarction in the emergency department–standardizing measurement of misdiagnosis-related har…
  18. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/47876/psn-pdf
    March 27, 2019 - Evaluation of medication errors at the transition of care from an ICU to non-ICU location. March 27, 2019 Tully AP, Hammond DA, Li C, et al. Evaluation of Medication Errors at the Transition of Care From an ICU to Non-ICU Location. Crit Care Med. 2019;47(4):543-549. doi:10.1097/CCM.0000000000003633. https://psnet.…
  19. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/764396/psn-pdf
    March 02, 2022 - Family Input for Quality and Safety (FIQS): using mobile technology for in-hospital reporting from families and patients. March 2, 2022 Bardach NS, Stotts JR, Fiore DM, et al. Family Input for Quality and Safety (FIQS): Using mobile technology for in?hospital reporting from families and patients. J Hosp Med. 2022;…
  20. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/73130/psn-pdf
    January 01, 2022 - Improving peripherally inserted central catheter appropriateness and reducing device-related complications: a quasiexperimental study in 52 Michigan hospitals. April 14, 2021 Chopra V, O'Malley M, Horowitz J, et al. Improving peripherally inserted central catheter appropriateness and reducing device-related compl…

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