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psnet.ahrq.gov/node/39765/psn-pdf
February 17, 2011 - ACGME duty-hour recommendations—a national survey
of residency program directors.
February 17, 2011
Antiel RM, Thompson SM, Reed DA, et al. ACGME duty-hour recommendations - a national survey of
residency program directors. N Engl J Med. 2010;363(8):e12. doi:10.1056/NEJMp1008305.
https://psnet.ahrq.gov/issue/acgme…
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psnet.ahrq.gov/node/43836/psn-pdf
March 11, 2015 - Hospital organisation, management, and structure for
prevention of health-care-associated infection: a
systematic review and expert consensus.
March 11, 2015
Zingg W, Holmes A, Dettenkofer M, et al. Hospital organisation, management, and structure for prevention
of health-care-associated infection: a systematic re…
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psnet.ahrq.gov/node/839835/psn-pdf
November 09, 2022 - Healthcare Quality and Safety Workforce Report: New
Imperatives for Quality and Safety Mean New Imperatives
for Workforce Development.
November 9, 2022
Chicago, IL: The National Association for Healthcare Quality; 2022.
https://psnet.ahrq.gov/issue/healthcare-quality-and-safety-workforce-report-new-imperatives-qua…
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psnet.ahrq.gov/node/867391/psn-pdf
December 18, 2024 - The influence of context on diagnostic reasoning: a
narrative synthesis of experimental findings.
December 18, 2024
Schmidt HG, Norman GR, Mamede S, et al. The influence of context on diagnostic reasoning: a narrative
synthesis of experimental findings. J Eval Clin Pract. 2024;30(6):1091-1101. doi:10.1111/jep.14023…
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psnet.ahrq.gov/node/33993/psn-pdf
March 02, 2011 - Improving patient care. My right knee.
March 2, 2011
Berwick DM. Improving patient care. My right knee. Ann Intern Med. 2005;142(2):121-5.
https://psnet.ahrq.gov/issue/improving-patient-care-my-right-knee
Dr. Donald Berwick writes this compelling piece as a personal reflection on the current deficiencies in
health…
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psnet.ahrq.gov/node/41247/psn-pdf
April 06, 2012 - Development of a pragmatic measure for evaluating and
optimizing rapid response systems.
April 6, 2012
Bonafide CP, Roberts KE, Priestley MA, et al. Development of a pragmatic measure for evaluating and
optimizing rapid response systems. Pediatrics. 2012;129(4):e874-81. doi:10.1542/peds.2011-2784.
https://psnet.ah…
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psnet.ahrq.gov/node/45246/psn-pdf
August 15, 2016 - Reliability of verbal handoff assessment and handoff
quality before and after implementation of a resident
handoff bundle.
August 15, 2016
Feraco AM, Starmer AJ, Sectish TC, et al. Reliability of Verbal Handoff Assessment and Handoff Quality
Before and After Implementation of a Resident Handoff Bundle. Acad Pediat…
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psnet.ahrq.gov/node/43598/psn-pdf
October 08, 2014 - Clinical faculty: taking the lead in teaching quality
improvement and patient safety.
October 8, 2014
Davis NL, Davis DA, Rayburn WF. Clinical faculty: taking the lead in teaching quality improvement and
patient safety. Am J Obstet Gynecol. 2014;211(3):215-215.e1. doi:10.1016/j.ajog.2014.05.043.
https://psnet.ahrq…
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psnet.ahrq.gov/node/46758/psn-pdf
April 12, 2019 - Association of hospitalist years of experience with
mortality in the hospitalized Medicare population.
April 12, 2019
Goodwin JS, Salameh H, Zhou J, et al. Association of Hospitalist Years of Experience With Mortality in the
Hospitalized Medicare Population. JAMA Intern Med. 2017;178(2). doi:10.1001/jamainternmed.2…
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psnet.ahrq.gov/node/45309/psn-pdf
July 13, 2016 - Development of an emergency department trigger tool
using a systematic search and modified Delphi process.
July 13, 2016
Griffey RT, Schneider RM, Adler L, et al. Development of an Emergency Department Trigger Tool Using a
Systematic Search and Modified Delphi Process. J Patient Saf. 2016;16(1):e11-e17.
doi:10.109…
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psnet.ahrq.gov/node/73958/psn-pdf
October 13, 2021 - Acting wisely in complex clinical situations: 'Mutual
safety' for clinicians as well as patients.
October 13, 2021
Dornan T, Lee C, Findlay-White F, et al. Acting wisely in complex clinical situations: ‘Mutual safety’ for
clinicians as well as patients. Med Teach. 2021;43(12):1419-1429. doi:10.1080/0142159x.2021.19…
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psnet.ahrq.gov/node/39841/psn-pdf
December 18, 2014 - Emergency department visits for medical
device–associated adverse events among children.
December 18, 2014
Wang C, Hefflin B, Cope JU, et al. Emergency department visits for medical device-associated adverse
events among children. Pediatrics. 2010;126(2):247-59. doi:10.1542/peds.2010-0528.
https://psnet.ahrq.gov/i…
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psnet.ahrq.gov/node/44582/psn-pdf
January 23, 2017 - Chemotherapy regimen checks performed by pharmacists
contribute to safe administration of chemotherapy.
January 23, 2017
Suzuki S, Chan A, Nomura H, et al. Chemotherapy regimen checks performed by pharmacists contribute to
safe administration of chemotherapy. J Oncol Pract. 2017;23(1):18-25. doi:10.1177/10781552156…
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psnet.ahrq.gov/node/867389/psn-pdf
December 18, 2024 - Identifying missed care in pediatric nursing: a scoping
review.
December 18, 2024
Maffeo M, Parente E, Ciofi D. Identifying missed care in pediatric nursing: a scoping review. J Pediatr Nurs.
2024;80:115-120. doi:10.1016/j.pedn.2024.11.017.
https://psnet.ahrq.gov/issue/identifying-missed-care-pediatric-nursing-sco…
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psnet.ahrq.gov/node/37911/psn-pdf
July 16, 2008 - Emergency medical services provider perceptions of the
nature of adverse events and near-misses in out-of-
hospital care: an ethnographic view.
July 16, 2008
Fairbanks RJ, Crittenden CN, O’Gara KG, et al. Emergency Medical Services Provider Perceptions of the
Nature of Adverse Events and Near-misses in Out-of-hos…
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psnet.ahrq.gov/node/35130/psn-pdf
March 11, 2011 - A trial of automated decision support alerts for
contraindicated medications using computerized
physician order entry.
March 11, 2011
Galanter W, Didomenico RJ, Polikaitis A. A trial of automated decision support alerts for contraindicated
medications using computerized physician order entry. J Am Med Inform Assoc…
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psnet.ahrq.gov/node/47931/psn-pdf
January 01, 2020 - Managing risk in hazardous conditions: improvisation is
not enough.
July 24, 2019
Amalberti R, Vincent CA. Managing risk in hazardous conditions: improvisation is not enough. BMJ Qual
Saf. 2020;29(1):60-63. doi:10.1136/bmjqs-2019-009443.
https://psnet.ahrq.gov/issue/managing-risk-hazardous-conditions-improvisation…
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psnet.ahrq.gov/node/50398/psn-pdf
October 02, 2019 - Sepsis quality in safety-net hospitals: an analysis of
Medicare's SEP-1 performance measure.
October 2, 2019
Barbash IJ, Kahn JM. Sepsis quality in safety-net hospitals: An analysis of Medicare's SEP-1 performance
measure. J Crit Care. 2019;54:88-93. doi:10.1016/j.jcrc.2019.08.009.
https://psnet.ahrq.gov/issue/sep…
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psnet.ahrq.gov/node/48160/psn-pdf
January 01, 2020 - Engaging the patient and family in the surgical safety
process utilizing SafeStart.
August 28, 2019
Elger BM, Esparaz JR, Nierstedt RT, et al. Engaging the patient and family in the surgical safety process
utilizing. J Pediatr Surg. 2020;55(4). doi:10.1016/j.jpedsurg.2019.06.012.
https://psnet.ahrq.gov/issue/engag…
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psnet.ahrq.gov/node/60630/psn-pdf
June 24, 2020 - Education is “predictably disappointing” and should
never be relied upon alone to improve safety.
June 24, 2020
ISMP Medication Safety Alert! Acute care edition. June 4, 2020;25(11):1-4.
https://psnet.ahrq.gov/issue/education-predictably-disappointing-and-should-never-be-relied-upon-alone-
improve-safety
Interven…