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psnet.ahrq.gov/web-mm/slippery-slide-life
January 21, 2017 - A multidisciplinary model for reviewing severe maternal morbidity cases and teaching residents
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www.ahrq.gov/sites/default/files/wysiwyg/talkingquality/resources/podcasts_webinars/Rating_the_Raters_2011_06_15_Transcript.pdf
January 01, 2011 - been interested to think about a
scenario where we can actually see the patients or family members or residents
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psnet.ahrq.gov/perspective/conversation-john-d-birkmeyer-md
January 31, 2024 - We see that with surgical residents, and to a lesser degree we're also aware that some practicing surgeons … Not simply to evaluate surgical residents as they progress through their training, but that could perhaps
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hcup-us.ahrq.gov/reports/statbriefs/sb253-Influenza-Hospitalizations-ED-Visits-2006-2016.pdf
January 01, 2016 - For instance, the rate of inpatient stays involving influenza for
residents of the lowest versus highest
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psnet.ahrq.gov/node/841150/psn-pdf
December 07, 2022 - Quality improvement as a primary approach to change in
healthcare: a precarious, self-limiting choice?
December 7, 2022
Mandel KE, Cady SH. Quality improvement as a primary approach to change in healthcare: a precarious,
self-limiting choice? BMJ Qual Saf. 2022;31(12):860-866. doi:10.1136/bmjqs-2021-014447.
https:…
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psnet.ahrq.gov/node/844049/psn-pdf
February 08, 2023 - A scoping review of adverse incidents research in aged
care homes: learnings, gaps, and challenges.
February 8, 2023
St Clair B, Jorgensen M, Nguyen A, et al. A scoping review of adverse incidents research in aged care
homes: learnings, gaps, and challenges. Gerontol Geriatr Med. 2022;8:23337214221144192.
doi:10.1…
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psnet.ahrq.gov/node/73604/psn-pdf
August 18, 2021 - The effect of providing staff training and enhanced
support to care homes on care processes, safety climate
and avoidable harms: evaluation of a care home quality
improvement programme in England.
August 18, 2021
Damery S, Flanagan S, Jones J, et al. The effect of providing staff training and enhanced support to c…
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psnet.ahrq.gov/node/73281/psn-pdf
May 19, 2021 - Measuring safety in older adult care homes: a scoping
review of the international literature.
May 19, 2021
Rand S, Smith N, Jones K, et al. Measuring safety in older adult care homes: a scoping review of the
international literature. BMJ Open. 2021;11(3):e043206. doi:10.1136/bmjopen-2020-043206.
https://psnet.ahrq…
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psnet.ahrq.gov/node/60848/psn-pdf
January 01, 2022 - Adverse events related to accidental unintentional
ingestions from cough and cold medications in children.
August 26, 2020
Wang GS, Reynolds KM, Banner W, et al. Adverse events related to accidental unintentional ingestions
from cough and cold medications in children. Pediatr Emerg Care. 2022;38(1):e100-e104.
doi:…
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psnet.ahrq.gov/node/42238/psn-pdf
July 02, 2014 - Teaching medical error disclosure to physicians-in-
training: a scoping review.
July 2, 2014
Stroud L, Wong BM, Hollenberg E, et al. Teaching medical error disclosure to physicians-in-training: a
scoping review. Acad Med. 2013;88(6):884-92. doi:10.1097/ACM.0b013e31828f898f.
https://psnet.ahrq.gov/issue/teaching-me…
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psnet.ahrq.gov/node/846757/psn-pdf
March 29, 2023 - Managing interruptions to improve diagnostic decision-
making: strategies and recommended research agenda.
March 29, 2023
Sloane JF, Donkin C, Newell BR, et al. Managing interruptions to improve diagnostic decision-making:
strategies and recommended research agenda. J Gen Intern Med. 2023;38(6):1526-1531.
doi:10.1…
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psnet.ahrq.gov/node/46606/psn-pdf
July 10, 2019 - Implementation of a mock root cause analysis to provide
simulated patient safety training.
July 10, 2019
Murphy M, Duff J, Whitney J, et al. Implementation of a mock root cause analysis to provide simulated
patient safety training. BMJ Open Qual. 2017;6(2). doi:10.1136/bmjoq-2017-000096.
https://psnet.ahrq.gov/iss…
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psnet.ahrq.gov/node/844543/psn-pdf
February 15, 2023 - The evolving curriculum in quality improvement and
patient safety in undergraduate and graduate medical
education: a scoping review.
February 15, 2023
Li CJ, Nash DB. The evolving curriculum in quality improvement and patient safety in undergraduate and
graduate medical education: a scoping review. Am J Med Qual. …
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psnet.ahrq.gov/node/45337/psn-pdf
August 15, 2016 - Nurse workload and inexperienced medical staff members
are associated with seasonal peaks in severe adverse
events in the adult medical intensive care unit: a seven-
year prospective study.
August 15, 2016
Faisy C, Davagnar C, Ladiray D, et al. Nurse workload and inexperienced medical staff members are
associated…
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psnet.ahrq.gov/node/61118/psn-pdf
January 01, 2021 - Bracing for the storm: one health care system's planning
for the COVID-19 surge.
November 11, 2020
Kim CS, Meo N, Little D, et al. Bracing for the storm: one health care system's planning for the COVID-19
surge. Jt Comm J Qual Patient Saf. 2021;47(1):60-68. doi:10.1016/j.jcjq.2020.09.007.
https://psnet.ahrq.gov/is…
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psnet.ahrq.gov/node/50732/psn-pdf
December 11, 2019 - Association between physician depressive symptoms and
medical errors: A systematic review and meta-analysis
December 11, 2019
Pereira-Lima K, Mata DA, Loureiro SR, et al. Association Between Physician Depressive Symptoms and
Medical Errors: A Systematic Review and Meta-analysis. JAMA Netw Open. 2019;2(11):e1916097.…
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psnet.ahrq.gov/node/36784/psn-pdf
February 24, 2011 - The many faces of error disclosure: a common set of
elements and a definition.
February 24, 2011
Fein SP, Hilborne LH, Spiritus EM, et al. The many faces of error disclosure: a common set of elements
and a definition. J Gen Intern Med. 2007;22(6):755-761.
https://psnet.ahrq.gov/issue/many-faces-error-disclosure-co…
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psnet.ahrq.gov/node/43666/psn-pdf
March 14, 2016 - Interdisciplinary Quality Improvement Conference: using
a revised morbidity and mortality format to focus on
systems-based patient safety issues in a VA hospital:
design and outcomes.
March 14, 2016
Gerstein WH, Ledford J, Cooper J, et al. Interdisciplinary Quality Improvement Conference: using a revised
morbidit…
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psnet.ahrq.gov/node/74152/psn-pdf
December 08, 2021 - Adverse events and their contributors among older adults
during skilled nursing stays for rehabilitation: a scoping
review.
December 8, 2021
Okpalauwaekwe U, Tzeng H-M. Adverse events and their contributors among older adults during skilled
nursing stays for rehabilitation: a scoping review. Patient Relat Outcome …
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psnet.ahrq.gov/node/37047/psn-pdf
September 30, 2011 - Briefing and debriefing in the operating room using
fighter pilot crew resource management.
September 30, 2011
McGreevy JM, Otten TD. Briefing and debriefing in the operating room using fighter pilot crew resource
management. J Am Coll Surg. 2007;205(1):169-76.
https://psnet.ahrq.gov/issue/briefing-and-debriefing-…