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psnet.ahrq.gov/node/45788/psn-pdf
March 01, 2017 - Latest Results From the "FIRST" Trial.
March 1, 2017
J Am Coll Surg. 2017;224:103-159.
https://psnet.ahrq.gov/issue/latest-results-first-trial
The Flexibility in Duty Hour Requirements for Surgical Trainees (FIRST) trial examined residency program
response to duty hour rules. This special issue features studies ex…
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psnet.ahrq.gov/node/72645/psn-pdf
January 13, 2021 - The plague year. The mistakes and the struggles behind
America’s coronavirus tragedy.
January 13, 2021
Wright L. New Yorker. January 4, 2021;96(463):20-59.
https://psnet.ahrq.gov/issue/plague-year-mistakes-and-struggles-behind-americas-covid-19-tragedy
Uncertainty, misinformation, management gaps, and r…
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psnet.ahrq.gov/node/72754/psn-pdf
February 17, 2021 - Telehealth in the COVID-19 era: a balancing act to avoid
harm.
February 17, 2021
Reeves JJ, Ayers JW, Longhurst CA. Telehealth in the COVID-19 Era: a balancing act to avoid harm. J
Med Internet Res. 2021;23(2):e24785. doi:10.2196/24785.
https://psnet.ahrq.gov/issue/telehealth-covid-19-era-balancing-act-avoid-harm
…
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psnet.ahrq.gov/node/40017/psn-pdf
December 14, 2016 - Image Gently, Step Lightly: promoting radiation safety in
pediatric interventional radiology.
December 14, 2016
Sidhu M, Goske MJ, Connolly B, et al. Image Gently, Step Lightly: promoting radiation safety in pediatric
interventional radiology. AJR Am J Roentgenol. 2010;195(4):W299-301. doi:10.2214/AJR.09.3938.
htt…
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psnet.ahrq.gov/node/45379/psn-pdf
August 17, 2016 - A piece of my mind. How many have you done?
August 17, 2016
Reisman A. A PIECE OF MY MIND. How Many Have You Done? JAMA. 2016;316(5):491.
doi:10.1001/jama.2016.1996.
https://psnet.ahrq.gov/issue/piece-my-mind-how-many-have-you-done
This commentary explores transparency in response to patient and family inquiry reg…
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psnet.ahrq.gov/node/72801/psn-pdf
March 03, 2021 - Teamwork in the time of COVID-19.
March 3, 2021
Takizawa PA, Honan L, Brissette D, et al. Teamwork in the time of COVID?19. FASEB Bioadv.
2020;3(3):175-181. doi:10.1096/fba.2020-00093.
https://psnet.ahrq.gov/issue/teamwork-time-covid-19
The COVID-19 pandemic has led to wide-ranging changes in the health care syste…
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psnet.ahrq.gov/node/34695/psn-pdf
June 26, 2015 - Do house officers learn from their mistakes?
June 26, 2015
Wu AW, Folkman S, McPhee SJ, et al. Do house officers learn from their mistakes? JAMA.
1991;265(16):2089-94.
https://psnet.ahrq.gov/issue/do-house-officers-learn-their-mistakes
The authors report their 1991 survey on medical errors among internal medicine …
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psnet.ahrq.gov/node/849338/psn-pdf
May 24, 2023 - The impact of language barriers on patient care: a
pharmacy perspective.
May 24, 2023
Patel J. PM Healthcare Journal. Spring 2023(4):5-18.
https://psnet.ahrq.gov/issue/impact-language-barriers-patient-care-pharmacy-perspective
Language discordance is known to degrade medication safety. The article discusses an exa…
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psnet.ahrq.gov/node/866697/psn-pdf
September 11, 2024 - Patient Safety: Emerging Applications of Safety Science.
September 11, 2024
Cox C, Hughes H, Nicholls J. Patient Safety: Emerging Applications Of Safety Science. Somerset, UK:
Class Publishing; 2024. ISBN 9781801610834.
https://psnet.ahrq.gov/issue/patient-safety-emerging-applications-safety-science
Patient safety…
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psnet.ahrq.gov/node/37457/psn-pdf
February 15, 2011 - Benefits of direct observation in medication
administration to detect errors.
February 15, 2011
Diaz-Navarlaz T, Pronovost P, Beortegui E, et al. Benefits of Direct Observation in Medication
Administration to Detect Errors. J Patient Saf. 2009;3(4). doi:10.1097/pts.0b013e31815b4cc3.
https://psnet.ahrq.gov/issue/be…
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psnet.ahrq.gov/node/840164/psn-pdf
November 16, 2022 - Medical error and vulnerable communities.
November 16, 2022
Jean-Pierre P. Boston U Law Rev. 2022; 102(1):327-392.
https://psnet.ahrq.gov/issue/medical-error-and-vulnerable-communities
Bias and discrimination are receiving overdue attention as primary barriers to patient safety. This article
discusses medical erro…
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psnet.ahrq.gov/node/44835/psn-pdf
January 01, 2019 - The potential of Twitter as a data source for patient
safety.
January 27, 2016
Nakhasi A, Bell SG, Passarella RJ, et al. The Potential of Twitter as a Data Source for Patient Safety. J
Patient Saf. 2019;15(4):e32-e35. doi:10.1097/PTS.0000000000000253.
https://psnet.ahrq.gov/issue/potential-twitter-data-source-pati…
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psnet.ahrq.gov/node/36500/psn-pdf
January 07, 2011 - Development and implementation of a patient safety
program in an academic, urban emergency department.
January 7, 2011
Blank FSJ, Henneman PL, Maynard AM, et al. Development and implementation of a patient safety
program in an academic, urban emergency department. Journal of emergency nursing: JEN : official
publi…
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psnet.ahrq.gov/node/42974/psn-pdf
September 07, 2016 - Chemotherapy drug shortages in pediatric oncology: a
consensus statement.
September 7, 2016
Decamp M, Joffe S, Fernandez C, et al. Chemotherapy drug shortages in pediatric oncology: a consensus
statement. Pediatrics. 2014;133(3):e716-24. doi:10.1542/peds.2013-2946.
https://psnet.ahrq.gov/issue/chemotherapy-drug-sh…
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psnet.ahrq.gov/node/36323/psn-pdf
November 14, 2018 - Our long journey towards a safety-minded just culture.
Part II: where we're going.
November 14, 2018
ISMP Medication Safety Alert! Acute Care Edition. September 21, 2006;11:1-2.
https://psnet.ahrq.gov/issue/our-long-journey-towards-safety-minded-just-culture-part-ii-where-were-going
This second part of this series…
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psnet.ahrq.gov/node/35982/psn-pdf
September 17, 2010 - Follow-up study of medication errors reported to the
Vaccine Adverse Event Reporting System (VAERS).
September 17, 2010
Varricchio F, Reed J, Group VAERSW. Follow-up study of medication errors reported to the vaccine
adverse event reporting system (VAERS). South Med J. 2006;99(5):486-9.
https://psnet.ahrq.gov/issu…
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psnet.ahrq.gov/node/38278/psn-pdf
January 15, 2009 - The impact of introducing medical emergency team
system on the documentations of vital signs.
January 15, 2009
Chen J, Hillman KM, Bellomo R, et al. The impact of introducing medical emergency team system on the
documentations of vital signs. Resuscitation. 2008;80(1). doi:10.1016/j.resuscitation.2008.10.009.
http…
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psnet.ahrq.gov/node/44363/psn-pdf
May 05, 2018 - Selection of incorrect medication pump leads to
chemotherapy overdose.
May 5, 2018
ISMP Canada. August 26, 2015;15:1-4.
https://psnet.ahrq.gov/issue/selection-incorrect-medication-pump-leads-chemotherapy-overdose
Checklists are cognitive aids that help clinicians remember important steps to ensure safe practice. I…
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psnet.ahrq.gov/node/72685/psn-pdf
January 27, 2021 - Human Factors and Ergonomics in Healthcare.
January 27, 2021
Carayon P, Hignett S, Albolino S eds. Int J Qual Health Care. 2021;33(Supp1):1-71.
https://psnet.ahrq.gov/issue/human-factors-and-ergonomics-healthcare
Human factors approaches have been identified as one of the primary vehicles to create las…
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psnet.ahrq.gov/node/37920/psn-pdf
May 24, 2015 - Functional health literacy and understanding of
medications at discharge.
May 24, 2015
Maniaci MJ, Heckman MG, Dawson NL. Functional health literacy and understanding of medications at
discharge. Mayo Clin Proc. 2008;83(5):554-8. doi:10.4065/83.5.554.
https://psnet.ahrq.gov/issue/functional-health-literacy-and-und…