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  1. psnet.ahrq.gov/issue/insufficient-communication-about-medication-use-interface-between-hospital-and-primary-care
    February 03, 2021 - Study Insufficient communication about medication use at the interface between hospital and primary care. Citation Text: Glintborg B, Andersen SE, Dalhoff K. Insufficient communication about medication use at the interface between hospital and primary care. Qual Saf Health Care. 2007;1…
  2. psnet.ahrq.gov/issue/enhancing-pediatric-safety-using-simulation-assess-radiology-resident-preparedness
    July 08, 2009 - Study Enhancing pediatric safety: using simulation to assess radiology resident preparedness for anaphylaxis from intravenous contrast media. Citation Text: Gaca AM, Frush DP, Hohenhaus SM, et al. Enhancing pediatric safety: using simulation to assess radiology resident preparedness for …
  3. psnet.ahrq.gov/issue/medication-reconciliation-during-internal-hospital-transfer-and-impact-computerized
    October 15, 2008 - Study Medication reconciliation during internal hospital transfer and impact of computerized prescriber order entry. Citation Text: Lee JY, Leblanc K, Fernandes O, et al. Medication reconciliation during internal hospital transfer and impact of computerized prescriber order entry. Ann …
  4. psnet.ahrq.gov/issue/patient-identification-and-tube-labelling-call-harmonisation
    April 29, 2020 - Commentary Patient identification and tube labelling—a call for harmonisation. Citation Text: van Dongen-Lases EC, Cornes MP, Grankvist K, et al. Patient identification and tube labelling – a call for harmonisation. Clinical Chemistry and Laboratory Medicine (CCLM). 2016;54(7). doi:10.15…
  5. psnet.ahrq.gov/issue/optimizing-patient-handoff-between-ems-and-emergency-department
    April 24, 2018 - Study Optimizing the patient handoff between EMS and the emergency department. Citation Text: Meisel ZF, Shea JA, Peacock NJ, et al. Optimizing the patient handoff between emergency medical services and the emergency department. Ann Emerg Med. 2015;65(3):310-317.e1. doi:10.1016/j.annemer…
  6. psnet.ahrq.gov/issue/nonpunitive-medication-error-reporting-3-year-findings-one-hospitals-primum-non-nocere
    September 23, 2020 - Study Nonpunitive medication error reporting: 3-year findings from one hospital's primum non nocere initiative. Citation Text: Potylycki MJ, Kimmel SR, Ritter M, et al. Nonpunitive medication error reporting: 3-year findings from one hospital's Primum Non Nocere initiative. J Nurs Adm.…
  7. psnet.ahrq.gov/issue/using-six-sigma-reduce-medication-errors-home-delivery-pharmacy-service
    November 18, 2015 - Study Using Six Sigma to reduce medication errors in a home-delivery pharmacy service. Citation Text: Castle L, Franzblau-Isaac E, Paulsen J. Using Six Sigma to reduce medication errors in a home-delivery pharmacy service. Jt Comm J Qual Patient Saf. 2005;31(6):319-24. Copy Citation …
  8. psnet.ahrq.gov/issue/tasks-processes-case-changing-health-information-technology-improve-health-care
    February 10, 2015 - Commentary From tasks to processes: the case for changing health information technology to improve health care. Citation Text: Walker JM, Carayon P. From tasks to processes: the case for changing health information technology to improve health care. Health Aff (Millwood). 2009;28(2):467-…
  9. psnet.ahrq.gov/issue/use-personal-electronic-devices-nurse-anesthetists-and-effects-patient-safety
    June 16, 2021 - Study Use of personal electronic devices by nurse anesthetists and the effects on patient safety. Citation Text: Snoots LR, Wands BA. Use of Personal Electronic Devices by Nurse Anesthetists and the Effects on Patient Safety. AANA J. 2016;84(2):114-119. Copy Citation Format: …
  10. psnet.ahrq.gov/issue/patient-preferences-cases-inter-system-medical-error-discovery-imed
    November 02, 2018 - Study Patient preferences in cases of Inter-system Medical Error Discovery (IMED). Citation Text: Antunez AG, Saari A, Miller J, et al. Patient Preferences in Cases of Inter-system Medical Error Discovery (IMED). Ann Surg. 2021;273(3):516-522. doi:10.1097/SLA.0000000000003507. Copy Cit…
  11. psnet.ahrq.gov/issue/passing-yo-mama-test
    February 15, 2023 - Commentary Passing the "Yo' Mama" test. Citation Text: Blair R. Passing the "Yo' Mama" test. Atlanta healthcare organization follows the beat of a different drummer in achieving 100 percent CPOE adoption. Health Manag Technol. 2006;27(6):14, 16, 18. Copy Citation Format: …
  12. psnet.ahrq.gov/issue/perspective-ten-thousand-hours-patient-safety-sooner-or-later
    June 23, 2009 - Commentary Perspective: ten thousand hours to patient safety, sooner or later. Citation Text: Pellegrini VD. Perspective: ten thousand hours to patient safety, sooner or later. Acad Med. 2012;87(2):164-7. doi:10.1097/ACM.0b013e31823f7202. Copy Citation Format: DOI Google…
  13. psnet.ahrq.gov/issue/utility-clinical-examination-diagnosis-emergency-department-patients-admitted-department
    April 06, 2022 - Study Utility of clinical examination in the diagnosis of emergency department patients admitted to the department of medicine of an academic hospital. Citation Text: Paley L, Zornitzki T, Cohen J, et al. Utility of clinical examination in the diagnosis of emergency department patients…
  14. psnet.ahrq.gov/issue/attitudinal-changes-resulting-repetitive-training-operating-room-personnel-using-high
    February 25, 2009 - Study Attitudinal changes resulting from repetitive training of operating room personnel using high-fidelity simulation at the point of care. Citation Text: Paige JT, Kozmenko V, Yang T, et al. Attitudinal changes resulting from repetitive training of operating room personnel using of …
  15. psnet.ahrq.gov/issue/inattentional-blindness-and-failures-rescue-deteriorating-patient-critical-care-emergency-and
    October 12, 2016 - Study Inattentional blindness and failures to rescue the deteriorating patient in critical care, emergency and perioperative settings: four case scenarios. Citation Text: Jones A, Johnstone M-J. Inattentional blindness and failures to rescue the deteriorating patient in critical care, em…
  16. psnet.ahrq.gov/issue/medication-assessments-care-managers-reveal-potential-safety-issues-homebound-older-adults
    August 18, 2021 - Study Medication assessments by care managers reveal potential safety issues in homebound older adults. Citation Text: Golden AG, Qiu D, Roos BA. Medication assessments by care managers reveal potential safety issues in homebound older adults. Ann Pharmacother. 2011;45(4):492-8. doi:10…
  17. psnet.ahrq.gov/issue/variation-rates-adverse-events-between-hospitals-and-hospital-departments
    July 26, 2011 - Study Variation in the rates of adverse events between hospitals and hospital departments. Citation Text: Zegers M, de Bruijne M, Spreeuwenberg P, et al. Variation in the rates of adverse events between hospitals and hospital departments. Int J Qual Health Care. 2011;23(2):126-33. doi:10…
  18. psnet.ahrq.gov/issue/if-only-failed-missed-and-absent-error-recovery-opportunities-medication-errors
    July 15, 2009 - Study If only...: failed, missed and absent error recovery opportunities in medication errors. Citation Text: Habraken MMP, van der Schaaf TW. If only..: failed, missed and absent error recovery opportunities in medication errors. Qual Saf Health Care. 2010;19(1):37-41. doi:10.1136/qsh…
  19. psnet.ahrq.gov/issue/use-simulation-assess-electronic-health-record-safety-intensive-care-unit-pilot-study
    December 10, 2014 - Study Use of simulation to assess electronic health record safety in the intensive care unit: a pilot study. Citation Text: March CA, Steiger D, Scholl G, et al. Use of simulation to assess electronic health record safety in the intensive care unit: a pilot study. BMJ Open. 2013;3(4). d…
  20. psnet.ahrq.gov/issue/discrepancies-between-prescribed-and-actual-pediatric-home-parenteral-nutrition-solutions
    November 11, 2009 - Study Discrepancies between prescribed and actual pediatric home parenteral nutrition solutions. Citation Text: Raphael BP, Murphy M, Gura KM, et al. Discrepancies Between Prescribed and Actual Pediatric Home Parenteral Nutrition Solutions. Nutr Clin Pract. 2016;31(5):654-658. doi:10.117…

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