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Clinic design for safety during the pandemic: safety or teamwork, can we only pick one? | PSNet

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November 11, 2015 - Commentary Clinic design for safety during the pandemic: safety or teamwork, can we only pick one? Citation Text: Lim L, Zimring CM, DuBose JR, et al. Clinic design for safety during the pandemic: safety or teamwork, can we only pick one? HERD. 2022;15(3):28-41. doi:10.1177/1937586722109…

Measuring the rate of manual transcription error in outpatient point-of-care testing. | PSNet

psnet.ahrq.gov/issue/measuring-rate-manual-transcription-error-outpatient-point-care-testing

August 20, 2018 - Study Measuring the rate of manual transcription error in outpatient point-of-care testing. Citation Text: Mays JA, Mathias PC. Measuring the rate of manual transcription error in outpatient point-of-care testing. J Am Med Inform Assoc. 2019;26(3):269-272. doi:10.1093/jamia/ocy170. Cop…

Appropriateness of commercially available and partially customized medication dosing alerts among pediatric patients. | PSNet

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July 16, 2015 - Study Appropriateness of commercially available and partially customized medication dosing alerts among pediatric patients. Citation Text: Stultz JS, Nahata MC. Appropriateness of commercially available and partially customized medication dosing alerts among pediatric patients. J Am Med …

A comprehensive quality assurance program for personnel and procedures in radiation oncology: value of voluntary error reporting and checklists. | PSNet

psnet.ahrq.gov/issue/comprehensive-quality-assurance-program-personnel-and-procedures-radiation-oncology-value

November 18, 2020 - Study A comprehensive quality assurance program for personnel and procedures in radiation oncology: value of voluntary error reporting and checklists. Citation Text: Kalapurakal JA, Zafirovski A, Smith J, et al. A comprehensive quality assurance program for personnel and procedures in …

Technical Evaluation, Testing, and Validation of the Usability of Electronic Health Records: Empirically Based Use Cases for Validating Safety-Enhanced Usability and Guidelines for Standardization. | PSNet

psnet.ahrq.gov/issue/technical-evaluation-testing-and-validation-usability-electronic-health-records-empirically

March 01, 2017 - Book/Report Technical Evaluation, Testing, and Validation of the Usability of Electronic Health Records: Empirically Based Use Cases for Validating Safety-Enhanced Usability and Guidelines for Standardization. Citation Text: Technical Evaluation, Testing, and Validation of the Usability …

Impact of Medicare's nonpayment program on hospital-acquired conditions. | PSNet

psnet.ahrq.gov/issue/impact-medicares-nonpayment-program-hospital-acquired-conditions

December 21, 2014 - Review Impact of Medicare's nonpayment program on hospital-acquired conditions. Citation Text: Thirukumaran CP, Glance LG, Temkin-Greener H, et al. Impact of Medicare's Nonpayment Program on Hospital-acquired Conditions. Med Care. 2017;55(5):447-455. doi:10.1097/MLR.0000000000000680. C…

Adverse events in women giving birth in a labor ward: a retrospective record review study. | PSNet

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April 14, 2021 - Study Adverse events in women giving birth in a labor ward: a retrospective record review study. Citation Text: Skoogh A, Hall-Lord ML, Bååth C, et al. Adverse events in women giving birth in a labor ward: a retrospective record review study. BMC Health Serv Res. 2021;21(1):1093. doi:10.…

Health system leaders' role in addressing racism: time to prioritize eliminating health care disparities. | PSNet

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March 20, 2019 - Commentary Health system leaders' role in addressing racism: time to prioritize eliminating health care disparities. Citation Text: Austin JM, Weeks K, Pronovost PJ. Health System Leaders’ Role in Addressing Racism: Time to Prioritize Eliminating Health Care Disparities. Jt Comm J Qual …

Validation of an electronic trigger to measure missed diagnosis of stroke in emergency departments. | PSNet

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May 18, 2022 - Study Validation of an electronic trigger to measure missed diagnosis of stroke in emergency departments. Citation Text: Vaghani V, Wei L, Mushtaq U, et al. Validation of an electronic trigger to measure missed diagnosis of stroke in emergency departments. J Am Med Inform Assoc. 2021;28(…

Overestimation of clinical diagnostic performance caused by low necropsy rates. | PSNet

psnet.ahrq.gov/issue/overestimation-clinical-diagnostic-performance-caused-low-necropsy-rates

February 09, 2011 - Study Overestimation of clinical diagnostic performance caused by low necropsy rates. Citation Text: Shojania KG, Burton EC, McDonald KM, et al. Overestimation of clinical diagnostic performance caused by low necropsy rates. Qual Saf Health Care. 2005;14(6):408-13. Copy Citation …

Care Deficiencies and Leaders' Inadequate Reviews of a Patient Who Died at the Lt. Col. Luke Weathers, Jr. VA Medical Center in Memphis, Tennessee. | PSNet

psnet.ahrq.gov/issue/care-deficiencies-and-leaders-inadequate-reviews-patient-who-died-lt-col-luke-weathers-jr-va

April 10, 2024 - Book/Report Care Deficiencies and Leaders' Inadequate Reviews of a Patient Who Died at the Lt. Col. Luke Weathers, Jr. VA Medical Center in Memphis, Tennessee. Citation Text: Care Deficiencies and Leaders' Inadequate Reviews of a Patient Who Died at the Lt. Col. Luke Weathers, Jr. VA Me…

The value from investments in health information technology at the U.S. Department of Veterans Affairs. | PSNet

psnet.ahrq.gov/issue/value-investments-health-information-technology-us-department-veterans-affairs

February 10, 2015 - Study The value from investments in health information technology at the U.S. Department of Veterans Affairs. Citation Text: Byrne CM, Mercincavage LM, Pan EC, et al. The value from investments in health information technology at the U.S. Department of Veterans Affairs. Health Aff (Millw…

Interpreting and coding causal relationships for quality and safety using ICD-11. | PSNet

psnet.ahrq.gov/issue/interpreting-and-coding-causal-relationships-quality-and-safety-using-icd-11

November 15, 2017 - Commentary Interpreting and coding causal relationships for quality and safety using ICD-11. Citation Text: Januel J-M, Southern DA, Ghali WA. Interpreting and coding causal relationships for quality and safety using ICD-11. BMC Med Inform Decis Mak. 2023;21(Suppl 6):385. doi:10.1186/s12…

Deficiencies in the Community Care Network Credentialing Process of a Former VA Surgeon and Veterans Health Administration Oversight Failures. | PSNet

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November 29, 2023 - Book/Report Deficiencies in the Community Care Network Credentialing Process of a Former VA Surgeon and Veterans Health Administration Oversight Failures. Citation Text: Deficiencies in the Community Care Network Credentialing Process of a Former VA Surgeon and Veterans Health Administra…

Perioperative COVID-19 defense: an evidence-based approach for optimization of infection control and operating room management. | PSNet

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November 30, 2012 - Commentary Classic Perioperative COVID-19 defense: an evidence-based approach for optimization of infection control and operating room management. Citation Text: Dexter F, Parra MC, Brown JR, et al. Perioperative COVID-19 defense: an evidence-based approach for …

Inadequate Outpatient Mental Health Triage and Care of a Patient at the Chico Community-Based Outpatient Clinic in California. | PSNet

psnet.ahrq.gov/issue/inadequate-outpatient-mental-health-triage-and-care-patient-chico-community-based-outpatient

November 29, 2023 - Book/Report Inadequate Outpatient Mental Health Triage and Care of a Patient at the Chico Community-Based Outpatient Clinic in California. Citation Text: Inadequate Outpatient Mental Health Triage and Care of a Patient at the Chico Community-Based Outpatient Clinic in California. Washing…

Role of pharmacist counseling in preventing adverse drug events after hospitalization. | PSNet

psnet.ahrq.gov/issue/role-pharmacist-counseling-preventing-adverse-drug-events-after-hospitalization

November 16, 2022 - Study Classic Role of pharmacist counseling in preventing adverse drug events after hospitalization. Citation Text: Schnipper JL, Kirwin JL, Cotugno MC, et al. Role of pharmacist counseling in preventing adverse drug events after hospitalization. Arch Intern M…

Undiagnosed cancer cases in the US during the first 10 months of the COVID-19 pandemic. | PSNet

psnet.ahrq.gov/issue/undiagnosed-cancer-cases-us-during-first-10-months-covid-19-pandemic

September 01, 2016 - Study Undiagnosed cancer cases in the US during the first 10 months of the COVID-19 pandemic. Citation Text: Burus T, Lei F, Huang B, et al. Undiagnosed cancer cases in the US during the first 10 months of the COVID-19 pandemic. JAMA Oncol. 2024;10(4):500-507. doi:10.1001/jamaoncol.2023.…

A novel approach for assessing bias during team-based clinical decision-making. | PSNet

psnet.ahrq.gov/issue/novel-approach-assessing-bias-during-team-based-clinical-decision-making

April 10, 2024 - Study A novel approach for assessing bias during team-based clinical decision-making. Citation Text: Pool N, Hebdon M, de Groot E, et al. A novel approach for assessing bias during team-based clinical decision-making. Front in Public Health. 2023;11:1014773. doi:10.3389/fpubh.2023.101477…

Impact of patient safety bundle and team-based training on obstetric hypertensive emergencies. | PSNet

psnet.ahrq.gov/issue/impact-patient-safety-bundle-and-team-based-training-obstetric-hypertensive-emergencies

July 21, 2021 - Study Impact of patient safety bundle and team-based training on obstetric hypertensive emergencies. Citation Text: Grogan L, Peterson E, Flatley M, et al. Impact of patient safety bundle and team-based training on obstetric hypertensive emergencies. Am J Perinatol. 2025;42(4):452-461. d…

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