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  1. psnet.ahrq.gov/sites/default/files/2024-03/uterine_artery_injury.pdf
    January 01, 2024 - Microsoft PowerPoint - Spotlight Case_Uterine Artery Injury during Cesarean Delivery - FINAL.pptx Spotlight Uterine Artery Injury during Cesarean Delivery Leads to Cardiac Arrests and Emergency Hysterectomy Source and Credits • This presentation is based on the March 2024 AHRQ WebM&M Spotlight Case o See the ful…
  2. psnet.ahrq.gov/issue/identifying-electronic-health-record-contributions-diagnostic-error-ambulatory-settings
    January 25, 2023 - Study Identifying electronic health record contributions to diagnostic error in ambulatory settings through legal claims analysis. Citation Text: Krevat S, Samuel S, Boxley C, et al. Identifying electronic health record contributions to diagnostic error in ambulatory settings through leg…
  3. psnet.ahrq.gov/web-mm/palliative-care-comfort-vs-harm
    December 04, 2016 - SPOTLIGHT CASE Palliative Care: Comfort vs. Harm Citation Text: Jox RJ. Palliative Care: Comfort vs. Harm. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2017. Copy Citation Format: Google Scholar BibTeX EndN…
  4. psnet.ahrq.gov/issue/oversight-hearing-recent-patient-safety-issues
    November 06, 2019 - Congressional Testimony Oversight Hearing on Recent Patient Safety Issues. Citation Text: Oversight Hearing on Recent Patient Safety Issues. U.S. Department of Veterans Affairs. Hearing before the Committee on Veterans’ Affairs, House of Representatives, Subcommittee on Oversight and…
  5. psnet.ahrq.gov/issue/reforming-veterans-health-administration-beyond-palliation-symptoms
    May 11, 2019 - Commentary Reforming the Veterans Health Administration—beyond palliation of symptoms. Citation Text: Giroir BP, Wilensky GR. Reforming the Veterans Health Administration--Beyond Palliation of Symptoms. N Engl J Med. 2015;373(18):1693-5. doi:10.1056/NEJMp1511438. Copy Citation Form…
  6. psnet.ahrq.gov/issue/lessons-learned-building-culture-patient-safety-within-veterans-health-administration
    November 06, 2019 - Congressional Testimony Lessons Learned? Building a Culture of Patient Safety Within the Veterans Health Administration. Citation Text: Lessons Learned? Building a Culture of Patient Safety Within the Veterans Health Administration. US House of Representatives Committee on Veterans' Affa…
  7. psnet.ahrq.gov/issue/national-survey-safe-practice-epidural-analgesia-obstetric-units
    July 28, 2021 - Study A national survey of safe practice with epidural analgesia in obstetric units. Citation Text: Jones R, Swales HA, Lyons GR. A national survey of safe practice with epidural analgesia in obstetric units. Anaesthesia. 2008;63(5):516-9. doi:10.1111/j.1365-2044.2007.05398.x. Copy C…
  8. psnet.ahrq.gov/issue/action-planning-tool-ahrq-surveys-patient-safety-culture
    February 12, 2019 - Toolkit Action Planning Tool for the AHRQ Surveys on Patient Safety Culture. Citation Text: Action Planning Tool for the AHRQ Surveys on Patient Safety Culture. Yount N, Edelman S, Sorra J, et al. Rockville, MD: Agency for Healthcare Research and Quality; November 2022. AHRQ Publication …
  9. psnet.ahrq.gov/issue/missed-diagnoses-urologists-resulting-malpractice-payment
    November 21, 2021 - Study Missed diagnoses by urologists resulting in malpractice payment. Citation Text: Badger WJ, Moran ME, Abraham C, et al. Missed diagnoses by urologists resulting in malpractice payment. J Urol. 2007;178(6):2537-9. Copy Citation Format: Google Scholar PubMed BibTeX End…
  10. psnet.ahrq.gov/issue/evaluating-handheld-decision-support-device-pediatric-intensive-care-settings
    January 18, 2023 - Study Evaluating a handheld decision support device in pediatric intensive care settings. Citation Text: Evaluating a handheld decision support device in pediatric intensive care settings. Reynolds TL, DeLucia PR, Esquibel KA, et al. JAMIA Open. 2019;2:49-61. Copy Citation …
  11. psnet.ahrq.gov/issue/addressing-health-care-disparities-improving-quality-and-safety
    January 27, 2021 - Sentinel Event Alerts Addressing health care disparities by improving quality and safety. Citation Text: Addressing health care disparities by improving quality and safety. Sentinel Event Alert. Nov 10 2021;(64):1-7. Copy Citation Save Save to your library …
  12. psnet.ahrq.gov/issue/national-patient-safety-agency-combining-stories-statistics-minimise-harm
    November 18, 2020 - Study National Patient Safety Agency: combining stories with statistics to minimise harm. Citation Text: Lamont T, Scarpello J. National Patient Safety Agency: combining stories with statistics to minimise harm. BMJ. 2009;339:b4489. doi:10.1136/bmj.b4489. Copy Citation Format: …
  13. psnet.ahrq.gov/issue/evidence-brief-implementation-high-reliability-organization-principles
    November 11, 2020 - Book/Report Evidence Brief: Implementation of High Reliability Organization Principles. Citation Text: Evidence Brief: Implementation of High Reliability Organization Principles. Veazie S, Peterson K, Bourne D. Washington DC: United States Department of Veterans Affairs; May 2019. …
  14. psnet.ahrq.gov/issue/positive-deviance-new-tool-infection-prevention-and-patient-safety
    March 09, 2022 - Commentary Positive deviance: a new tool for infection prevention and patient safety. Citation Text: Marra AR, Santos OFPD, Neto MC, et al. Positive Deviance: A New Tool for Infection Prevention and Patient Safety. Curr Infect Dis Rep. 2013. Copy Citation Format: Google Sch…
  15. psnet.ahrq.gov/issue/lessons-covid-war-investigative-report
    March 09, 2022 - Book/Report Lessons from the Covid War: An Investigative Report. Citation Text: Lessons from the Covid War: An Investigative Report. Covid Crisis Group. New York: Public Affairs; 2023. ISBN‏: ‎9781541703803. Copy Citation Save Save to your library Print …
  16. psnet.ahrq.gov/issue/top-10-list-safe-and-effective-sign-out
    April 12, 2019 - Commentary The top 10 list for a safe and effective sign-out. Citation Text: Kemp CD, Bath JM, Berger J, et al. The top 10 list for a safe and effective sign-out. Arch Surg. 2008;143(10):1008-10. doi:10.1001/archsurg.143.10.1008. Copy Citation Format: DOI Google Scholar P…
  17. psnet.ahrq.gov/issue/factors-impacting-physician-use-information-charted-others
    September 18, 2019 - Study Factors impacting physician use of information charted by others. Citation Text: Factors impacting physician use of information charted by others. Zozus MN, Penning M, Hammond WE. JAMIA Open. 2019;2:107-114. Copy Citation Save Save to your library Prin…
  18. psnet.ahrq.gov/issue/objective-study-impact-electronic-medical-record-outcomes-trauma-patients
    October 13, 2018 - Study An objective study of the impact of the electronic medical record on outcomes in trauma patients. Citation Text: Schenarts PJ, Goettler CE, White MA, et al. An objective study of the impact of the electronic medical record on outcomes in trauma patients. Am Surg. 2012;78(11):1249…
  19. psnet.ahrq.gov/issue/healthcare-staff-wellbeing-burnout-and-patient-safety-systematic-review
    November 13, 2024 - Review Healthcare staff wellbeing, burnout, and patient safety: a systematic review. Citation Text: Hall LH, Johnson J, Watt I, et al. Healthcare Staff Wellbeing, Burnout, and Patient Safety: A Systematic Review. PLoS One. 2016;11(7):e0159015. doi:10.1371/journal.pone.0159015. Copy Cit…
  20. psnet.ahrq.gov/issue/anticoagulation-associated-adverse-drug-events
    July 26, 2023 - Study Anticoagulation-associated adverse drug events. Citation Text: Piazza G, Nguyen TN, Cios D, et al. Anticoagulation-associated Adverse Drug Events. Am J Med. 2011;124(12). doi:10.1016/j.amjmed.2011.06.009. Copy Citation Format: DOI Google Scholar BibTeX EndNote X3 XM…

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