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psnet.ahrq.gov/issue/hand-communications
January 04, 2017 - Multi-use Website
Hand-off Communications.
Citation Text:
DeRosier JM, Stalhandske E, Bagian JP, et al. Using health care Failure Mode and Effect Analysis: the VA National Center for Patient Safety's prospective risk analysis system.
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psnet.ahrq.gov/issue/nursing-handoffs-systematic-review-literature
January 08, 2025 - Review
Nursing handoffs: a systematic review of the literature.
Citation Text:
Riesenberg LA, Leitzsch J, Cunningham JM. Nursing handoffs: a systematic review of the literature. Am J Nurs. 2010;110(4):24-34; quiz 35-6. doi:10.1097/01.NAJ.0000370154.79857.09.
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psnet.ahrq.gov/issue/detecting-adverse-events-dermatologic-surgery
June 10, 2013 - Review
Detecting adverse events in dermatologic surgery.
Citation Text:
Pinney D, Pearce DJ, Feldman SR. Detecting adverse events in dermatologic surgery. Dermatol Surg. 2010;36(1):8-14. doi:10.1111/j.1524-4725.2009.01378.x.
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psnet.ahrq.gov/issue/injection-practices-among-clinicians-united-states-health-care-settings
January 06, 2017 - Study
Injection practices among clinicians in United States health care settings.
Citation Text:
Pugliese G, Gosnell C, Bartley JM, et al. Injection practices among clinicians in United States health care settings. Am J Infect Control. 2010;38(10):789-798. doi:10.1016/j.ajic.2010.09.00…
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psnet.ahrq.gov/issue/introduction-computerized-physician-order-entry-and-change-management-tertiary-pediatric
January 22, 2016 - Review
The introduction of computerized physician order entry and change management in a tertiary pediatric hospital.
Citation Text:
Upperman JS, Staley P, Friend K, et al. The introduction of computerized physician order entry and change management in a tertiary pediatric hospital. Pe…
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psnet.ahrq.gov/issue/handovers-or-icu
January 03, 2017 - Commentary
Handovers from the OR to the ICU.
Citation Text:
Bonifacio AS, Segall N, Barbeito A, et al. Handovers from the OR to the ICU. Int Anesthesiol Clin. 2013;51(1):43-61. doi:10.1097/AIA.0b013e31826f2b0e.
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psnet.ahrq.gov/issue/patient-safety-and-leadership-do-you-walk-walk
November 04, 2020 - Commentary
Patient safety and leadership: do you walk the walk?
Citation Text:
Jarrett MP. Patient Safety and Leadership: Do You Walk the Walk? J Healthc Manag. 2017;62(2):88-92. doi:10.1097/JHM-D-17-00005.
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psnet.ahrq.gov/issue/tangible-handoff-team-approach-advancing-structured-communication-labor-and-delivery
June 12, 2013 - Commentary
The tangible handoff: a team approach for advancing structured communication in labor and delivery.
Citation Text:
Block M, Ehrenworth JF, Cuce VM, et al. The tangible handoff: a team approach for advancing structured communication in labor and delivery. Jt Comm J Qual Patient…
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psnet.ahrq.gov/issue/postoperative-opioid-prescribing-getting-it-rightt
August 20, 2018 - Review
Emerging Classic
Postoperative opioid prescribing: Getting it RIGHTT.
Citation Text:
Yorkgitis BK, Brat GA. Postoperative opioid prescribing: Getting it RIGHTT. Am J Surg. 2018;215(4):707-711. doi:10.1016/j.amjsurg.2018.02.001.
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psnet.ahrq.gov/issue/effect-acgme-duty-hours-attending-physician-teaching-and-satisfaction
February 17, 2009 - Study
Effect of ACGME duty hours on attending physician teaching and satisfaction.
Citation Text:
Arora V, Meltzer DO. Effect of ACGME duty hours on attending physician teaching and satisfaction. Arch Intern Med. 2008;168(11):1226-8. doi:10.1001/archinte.168.11.1226.
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psnet.ahrq.gov/issue/error-and-cognitive-bias-diagnostic-radiology
August 07, 2013 - Commentary
Error and cognitive bias in diagnostic radiology.
Citation Text:
Tee QX, Nambiar M, Stuckey S. Error and cognitive bias in diagnostic radiology. J Med Imaging Radiat Oncol. 2022;66(2):202-207. doi:10.1111/1754-9485.13320.
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psnet.ahrq.gov/issue/problem-5-whys
July 19, 2023 - Commentary
The problem with the '5 whys.'
Citation Text:
Card AJ. The problem with '5 whys'. BMJ Qual Saf. 2017;26(8):671-677. doi:10.1136/bmjqs-2016-005849.
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psnet.ahrq.gov/issue/differential-impact-crew-resource-management-program-according-professional-specialty
July 31, 2013 - Study
Differential impact of a crew resource management program according to professional specialty.
Citation Text:
Suva D, Haller G, Lübbeke A, et al. Differential impact of a crew resource management program according to professional specialty. Am J Med Qual. 2012;27(4):313-20. doi:1…
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psnet.ahrq.gov/issue/empowering-patient-safety-outreach-through-interprofessional-partnerships-educating-our
August 17, 2022 - Commentary
Empowering patient safety outreach through interprofessional partnerships: educating our communities.
Citation Text:
Walton L, Childs C, Egeland M, et al. Empowering Patient Safety Outreach Through Interprofessional Partnerships: Educating Our Communities. J Hosp Librariansh. …
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psnet.ahrq.gov/issue/story-behind-story-physician-skepticism-about-relying-clinical-information-technologies
July 14, 2010 - Study
The story behind the story: physician skepticism about relying on clinical information technologies to reduce medical errors.
Citation Text:
McAlearney AS, Chisolm DJ, Schweikhart S, et al. The story behind the story: physician skepticism about relying on clinical information tec…
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psnet.ahrq.gov/issue/what-do-we-know-about-financial-returns-investments-patient-safety-literature-review
April 06, 2011 - Review
What do we know about financial returns on investments in patient safety? A literature review.
Citation Text:
Schmidek JM, Weeks WB. What do we know about financial returns on investments in patient safety? A literature review. Jt Comm J Qual Patient Saf. 2005;31(12):690-699.
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psnet.ahrq.gov/issue/medical-resident-pharmacist-collaboration-improves-rate-medication-reconciliation
September 24, 2010 - Study
A medical resident–pharmacist collaboration improves the rate of medication reconciliation verification at discharge.
Citation Text:
Caroff DA, Bittermann T, Leonard CE, et al. A Medical Resident-Pharmacist Collaboration Improves the Rate of Medication Reconciliation Verification a…
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psnet.ahrq.gov/issue/medication-related-clinical-decision-support-computerized-provider-order-entry-systems-review
March 11, 2011 - Review
Medication-related clinical decision support in computerized provider order entry systems: a review.
Citation Text:
Kuperman GJ, Bobb A, Payne TH, et al. Medication-related clinical decision support in computerized provider order entry systems: a review. J Am Med Inform Assoc. 2…
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psnet.ahrq.gov/issue/critical-review-systems-approach-within-patient-safety-research
June 16, 2021 - Review
A critical review of the systems approach within patient safety research.
Citation Text:
Waterson P. A critical review of the systems approach within patient safety research. Ergonomics. 2009;52(10):1185-1195. doi:10.1080/00140130903042782.
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psnet.ahrq.gov/issue/collaborating-or-selling-patients-conceptual-framework-emergency-department-inpatient-handoff
December 21, 2017 - Commentary
Collaborating—or "selling" patients? A conceptual framework for emergency department-to-inpatient handoff negotiations.
Citation Text:
Hilligoss B, Mansfield JA, Patterson ES, et al. Collaborating-or "Selling" Patients? A Conceptual Framework for Emergency Department-to-Inpati…