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  1. Reducing surgical errors: implementing a three-hinge approach to success. | PSNet

    psnet.ahrq.gov/issue/reducing-surgical-errors-implementing-three-hinge-approach-success
    December 08, 2021 - Commentary Reducing surgical errors: implementing a three-hinge approach to success. Citation Text: Landers R. Reducing surgical errors: implementing a three-hinge approach to success. AORN J. 2015;101(6):657-65. doi:10.1016/j.aorn.2015.04.013. Copy Citation Format: DOI Goo…

  2. One system's journey in creating a disclosure and apology program. | PSNet

    psnet.ahrq.gov/issue/one-systems-journey-creating-disclosure-and-apology-program
    May 27, 2011 - Commentary One system's journey in creating a disclosure and apology program. Citation Text: Peto RR, Tenerowicz LM, Benjamin EM, et al. One system's journey in creating a disclosure and apology program. Jt Comm J Qual Patient Saf. 2009;35(10):487-96. Copy Citation Format: …

  3. Preventing pressure ulcers: the goal is zero. | PSNet

    psnet.ahrq.gov/issue/preventing-pressure-ulcers-goal-zero
    September 30, 2010 - Commentary Preventing pressure ulcers: the goal is zero. Citation Text: Duncan KD. Preventing pressure ulcers: the goal is zero. Jt Comm J Qual Patient Saf. 2007;33(10):605-10. Copy Citation Format: Google Scholar PubMed BibTeX EndNote X3 XML EndNote 7 XML Endnote tagged Pu…

  4. Characteristics of Weekday and Weekend Hospital Admissions, 2007. | PSNet

    psnet.ahrq.gov/issue/characteristics-weekday-and-weekend-hospital-admissions-2007
    September 15, 2010 - Book/Report Characteristics of Weekday and Weekend Hospital Admissions, 2007. Citation Text: Characteristics of Weekday and Weekend Hospital Admissions, 2007. Ryan K, Levit K, Davis PH. HCUP Statistical Brief #87. Rockville, MD: Agency for Healthcare Research and Quality; March 2010.…

  5. Aging gracefully? Patient safety advocates call for ongoing skills assessments for older physicians. | PSNet

    psnet.ahrq.gov/issue/aging-gracefully-patient-safety-advocates-call-ongoing-skills-assessments-older-physicians
    June 07, 2023 - Commentary Aging gracefully? Patient safety advocates call for ongoing skills assessments for older physicians. Citation Text: McKenna M. Aging gracefully?: patient safety advocates call for ongoing skills assessments for older physicians. Ann Emerg Med. 2011;58(3):A15-A17. Copy Citati…

  6. The challenge of competency assessment of the late-career practitioner. | PSNet

    psnet.ahrq.gov/issue/challenge-competency-assessment-late-career-practitioner
    July 15, 2020 - Commentary The challenge of competency assessment of the late-career practitioner. Citation Text: Steffany M. The challenge of competency assessment of the late‐career practitioner. J Healthc Risk Manag. 2022;41(3):31-38. doi:10.1002/jhrm.21492. Copy Citation Format: DOI Go…

  7. Negotiating medical virtues: toward the development of a physician mistake disclosure model. | PSNet

    psnet.ahrq.gov/issue/negotiating-medical-virtues-toward-development-physician-mistake-disclosure-model
    June 14, 2017 - Commentary Negotiating medical virtues: toward the development of a physician mistake disclosure model. Citation Text: Hannawa AF. Negotiating medical virtues: toward the development of a physician mistake disclosure model. Health Comm. 2009;24(5):391-399. doi:10.1080/10410230903023279…

  8. Challenging the world: patient safety and health care-associated infection. | PSNet

    psnet.ahrq.gov/issue/challenging-world-patient-safety-and-health-care-associated-infection
    October 21, 2010 - Commentary Challenging the world: patient safety and health care-associated infection. Citation Text: Pittet D, Donaldson LJ. Challenging the world: patient safety and health care-associated infection. Int J Qual Health Care. 2006;18(1):4-8. Copy Citation Format: Google S…

  9. Latest Results From the "FIRST" Trial. | PSNet

    psnet.ahrq.gov/issue/latest-results-first-trial
    October 29, 2017 - Special or Theme Issue Latest Results From the "FIRST" Trial. Citation Text: Latest Results From the "FIRST" Trial. J Am Coll Surg. 2017;224:103-159. Copy Citation Save Save to your library Print Download PDF Share Facebook Twitter …

  10. Preventing vincristine administration errors: does evidence support minibag infusions? | PSNet

    psnet.ahrq.gov/issue/preventing-vincristine-administration-errors-does-evidence-support-minibag-infusions
    January 01, 2008 - Commentary Preventing vincristine administration errors: does evidence support minibag infusions? Citation Text: Mahon SM, Schulmeister L. Preventing Vincristine Administration Errors: Does Evidence Support Minibag Infusions? Clin J Oncol Nurs. 2006;10(2). doi:10.1188/06.cjon.271-273. …

  11. Malpractice reform—opportunities for leadership by health care institutions and liability insurers. | PSNet

    psnet.ahrq.gov/issue/malpractice-reform-opportunities-leadership-health-care-institutions-and-liability-insurers
    December 19, 2018 - Commentary Malpractice reform—opportunities for leadership by health care institutions and liability insurers. Citation Text: Mello MM, Gallagher TH. Malpractice reform--opportunities for leadership by health care institutions and liability insurers. N Engl J Med. 2010;362(15):1353-6. …

  12. Reducing medical errors and adverse events. | PSNet

    psnet.ahrq.gov/issue/reducing-medical-errors-and-adverse-events
    March 21, 2012 - Review Reducing medical errors and adverse events. Citation Text: Pham JC, Aswani MS, Rosen MA, et al. Reducing medical errors and adverse events. Annu Rev Med. 2012;63:447-63. doi:10.1146/annurev-med-061410-121352. Copy Citation Format: DOI Google Scholar PubMed BibTeX E…

  13. Improving patient safety through transparency. | PSNet

    psnet.ahrq.gov/issue/improving-patient-safety-through-transparency
    September 04, 2024 - Commentary Improving patient safety through transparency. Citation Text: Kachalia A. Improving patient safety through transparency. N Engl J Med. 2013;369(18):1677-9. doi:10.1056/NEJMp1303960. Copy Citation Format: DOI Google Scholar PubMed BibTeX EndNote X3 XML EndNote 7 X…

  14. Hospital Reporting Program: Annual Summary. | PSNet

    psnet.ahrq.gov/issue/hospital-reporting-program-annual-summary
    August 17, 2022 - Book/Report Hospital Reporting Program: Annual Summary. Citation Text: Hospital Reporting Program: Annual Summary. Portland, OR: Oregon Patient Safety Commission. Copy Citation Save Save to your library Print Download PDF Share Facebook …

  15. Implementing AORN recommended practices for medication safety. | PSNet

    psnet.ahrq.gov/issue/implementing-aorn-recommended-practices-medication-safety
    January 19, 2011 - Commentary Implementing AORN recommended practices for medication safety. Citation Text: Hicks RW, Wanzer LJ, Denholm B. Implementing AORN recommended practices for medication safety. AORN J. 2012;96(6):605-22. doi:10.1016/j.aorn.2012.09.012. Copy Citation Format: DOI Goog…

  16. Wrong-site surgery. | PSNet

    psnet.ahrq.gov/issue/wrong-site-surgery-1
    September 02, 2020 - Commentary Wrong-site surgery. Citation Text: Engelhardt KE, Barnard C, Bilimoria KY. Wrong-Site Surgery. JAMA. 2017;318(20):2033-2034. doi:10.1001/jama.2017.17177. Copy Citation Format: DOI Google Scholar PubMed BibTeX EndNote X3 XML EndNote 7 XML Endnote tagged PubMedId R…

  17. Leadership oversight for patient safety programs: an essential element. | PSNet

    psnet.ahrq.gov/issue/leadership-oversight-patient-safety-programs-essential-element
    October 03, 2017 - Commentary Leadership oversight for patient safety programs: an essential element. Citation Text: Moffatt-Bruce SD, Clark S, DiMaio M, et al. Leadership Oversight for Patient Safety Programs: An Essential Element. Ann Thorac Surg. 2017;105(2):351-356. doi:10.1016/j.athoracsur.2017.11.021…

  18. Complementary telephone strategies to improve postdischarge communication. | PSNet

    psnet.ahrq.gov/issue/complementary-telephone-strategies-improve-postdischarge-communication
    July 02, 2014 - Commentary Complementary telephone strategies to improve postdischarge communication. Citation Text: Rennke S, Kesh S, Neeman N, et al. Complementary telephone strategies to improve postdischarge communication. Am J Med. 2012;125(1):28-30. doi:10.1016/j.amjmed.2011.05.011. Copy Citat…

  19. Fatal mistakes: why do ten-fold medication errors in children keep happening? | PSNet

    psnet.ahrq.gov/issue/fatal-mistakes-why-do-ten-fold-medication-errors-children-keep-happening
    April 21, 2021 - Newspaper/Magazine Article Fatal mistakes: why do ten-fold medication errors in children keep happening? Citation Text: Fatal mistakes: why do ten-fold medication errors in children keep happening? Parry C. The Pharmaceutical Journal.  April 22 2021. Copy Citation …

  20. Characteristics of medication errors made by students during the administration phase: a descriptive study. | PSNet

    psnet.ahrq.gov/issue/characteristics-medication-errors-made-students-during-administration-phase-descriptive-study
    July 13, 2009 - Study Characteristics of medication errors made by students during the administration phase: a descriptive study. Citation Text: Wolf ZR, Hicks RW, Serembus JF. Characteristics of medication errors made by students during the administration phase: a descriptive study. J Prof Nurs. 2006…
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