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  1. Establishing psychological safety in clinical supervision: multi-professional perspectives. | PSNet

    psnet.ahrq.gov/issue/establishing-psychological-safety-clinical-supervision-multi-professional-perspectives
    October 13, 2021 - Commentary Establishing psychological safety in clinical supervision: multi-professional perspectives. Citation Text: Lee EH, Pitts S, Pignataro S, et al. Establishing psychological safety in clinical supervision: multi‐professional perspectives. Clin Teach. 2022;19(2):71-78. doi:10.1111…

  2. A systematic review of simulation for multidisciplinary team training in operating rooms. | PSNet

    psnet.ahrq.gov/issue/systematic-review-simulation-multidisciplinary-team-training-operating-rooms
    November 17, 2014 - Review A systematic review of simulation for multidisciplinary team training in operating rooms. Citation Text: Cumin D, Boyd MJ, Webster CS, et al. A systematic review of simulation for multidisciplinary team training in operating rooms. Simul Healthc. 2013;8(3):171-179. doi:10.1097/S…

  3. The SQUIRE Guidelines: an evaluation from the field, 5 years post release. | PSNet

    psnet.ahrq.gov/issue/squire-guidelines-evaluation-field-5-years-post-release
    November 18, 2016 - Study The SQUIRE Guidelines: an evaluation from the field, 5 years post release. Citation Text: Davies L, Batalden P, Davidoff F, et al. The SQUIRE Guidelines: an evaluation from the field, 5 years post release. BMJ Qual Saf. 2015;24(12):769-75. doi:10.1136/bmjqs-2015-004116. Copy Cita…

  4. Association of overlapping surgery with patient outcomes in a large series of neurosurgical cases. | PSNet

    psnet.ahrq.gov/issue/association-overlapping-surgery-patient-outcomes-large-series-neurosurgical-cases
    November 16, 2022 - Study Association of overlapping surgery with patient outcomes in a large series of neurosurgical cases. Citation Text: Howard BM, Holland CM, Mehta C, et al. Association of Overlapping Surgery With Patient Outcomes in a Large Series of Neurosurgical Cases. JAMA Surg. 2018;153(4):313-321…

  5. Getting the board on board: engaging hospital boards in quality and patient safety. | PSNet

    psnet.ahrq.gov/issue/getting-board-board-engaging-hospital-boards-quality-and-patient-safety
    November 23, 2016 - Study Getting the board on board: engaging hospital boards in quality and patient safety. Citation Text: Joshi MS, Hines S. Getting the board on board: Engaging hospital boards in quality and patient safety. Jt Comm J Qual Patient Saf. 2006;32(4):179-87. Copy Citation Format: …

  6. Shape matters: a neglected feature of medication safety: why regulating the shape of medication containers can improve medication safety. | PSNet

    psnet.ahrq.gov/issue/shape-matters-neglected-feature-medication-safety-why-regulating-shape-medication-containers
    December 09, 2020 - Commentary Shape matters: a neglected feature of medication safety: why regulating the shape of medication containers can improve medication safety. Citation Text: Bitan Y, Nunnally M. Shape matters: a neglected feature of medication safety: why regulating the shape of medication contain…

  7. Survey of the national drug shortage effect on anesthesia and patient safety: a patient perspective. | PSNet

    psnet.ahrq.gov/issue/survey-national-drug-shortage-effect-anesthesia-and-patient-safety-patient-perspective
    May 23, 2018 - Study Survey of the national drug shortage effect on anesthesia and patient safety: a patient perspective. Citation Text: Hsia IK-H, Dexter F, Logvinov I, et al. Survey of the National Drug Shortage Effect on Anesthesia and Patient Safety: A Patient Perspective. Anesth Analg. 2015;121(2)…

  8. A review of healthcare failure mode and effects analysis (HFMEA) in radiotherapy. | PSNet

    psnet.ahrq.gov/issue/review-healthcare-failure-mode-and-effects-analysis-hfmea-radiotherapy
    June 13, 2011 - Review A review of healthcare failure mode and effects analysis (HFMEA) in radiotherapy. Citation Text: Giardina M, Cantone MC, Tomarchio E, et al. A Review of Healthcare Failure Mode and Effects Analysis (HFMEA) in Radiotherapy. Health Phys. 2016;111(4):317-26. doi:10.1097/HP.0000000000…

  9. Pathologists' perspectives on disclosing harmful pathology error. | PSNet

    psnet.ahrq.gov/issue/pathologists-perspectives-disclosing-harmful-pathology-error
    January 22, 2020 - Study Pathologists' perspectives on disclosing harmful pathology error. Citation Text: Dintzis SM, Clennon EK, Prouty CD, et al. Pathologists' Perspectives on Disclosing Harmful Pathology Error. Arch Pathol Lab Med. 2017;141(6):841-845. doi:10.5858/arpa.2016-0136-OA. Copy Citation …

  10. AHRQ Safety Program for Perinatal Care: Culture Check-Up Tool (doc file)

    www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/perinatal-care/modules/teamwork/supporting/culture-checkup-tool.docx
    May 01, 2017 - AHRQ Safety Program for Perinatal Care: Culture Check-Up Tool AHRQ Safety Program for Perinatal Care Culture Checkup Tool Culture Checkup Tool Problem statement: Improving safety culture in a patient care area takes time. What is culture? Attitudes reflect the norms, values, and beliefs in the unit and, in turn, cre…

  11. Organizational ambidexterity and the hybrid middle manager: the case of patient safety in UK hospitals. | PSNet

    psnet.ahrq.gov/issue/organizational-ambidexterity-and-hybrid-middle-manager-case-patient-safety-uk-hospitals
    January 29, 2014 - Study Organizational ambidexterity and the hybrid middle manager: the case of patient safety in UK hospitals. Citation Text: Burgess N, Strauss K, Currie G, et al. Organizational Ambidexterity and the Hybrid Middle Manager: The Case of Patient Safety in UK Hospitals. Hum Resour Manage. 2…

  12. Insights from the sharp end of intravenous medication errors: implications for infusion pump technology. | PSNet

    psnet.ahrq.gov/issue/insights-sharp-end-intravenous-medication-errors-implications-infusion-pump-technology
    January 23, 2017 - Study Insights from the sharp end of intravenous medication errors: implications for infusion pump technology. Citation Text: Husch M. Insights from the sharp end of intravenous medication errors: implications for infusion pump technology. Quality and Safety in Health Care. 2005;14(2).…

  13. Identifying risks and opportunities in outpatient surgical patient safety: a qualitative analysis of Veterans Health Administration staff perceptions. | PSNet

    psnet.ahrq.gov/issue/identifying-risks-and-opportunities-outpatient-surgical-patient-safety-qualitative-analysis
    November 10, 2010 - Study Identifying risks and opportunities in outpatient surgical patient safety: a qualitative analysis of Veterans Health Administration staff perceptions. Citation Text: Mull HJ, Rosen AK, Charns MP, et al. Identifying Risks and Opportunities in Outpatient Surgical Patient Safety: A Qu…

  14. Frequency of passive EHR alerts in the ICU: another form of alert fatigue? | PSNet

    psnet.ahrq.gov/issue/frequency-passive-ehr-alerts-icu-another-form-alert-fatigue
    January 23, 2017 - Study Frequency of passive EHR alerts in the ICU: another form of alert fatigue? Citation Text: Kizzier-Carnahan V, Artis KA, Mohan V, et al. Frequency of Passive EHR Alerts in the ICU: Another Form of Alert Fatigue? J Patient Saf. 2019;15(3):246-250. doi:10.1097/PTS.0000000000000270. …

  15. Potentially Preventable Readmissions: Conceptual Framework To Rethink the Role of Primary Care: Executive Summary (pdf file)

    www.ahrq.gov/sites/default/files/wysiwyg/patient-safety/rev-preventablereadm-primcare-es.pdf
    March 01, 2020 - Potentially Preventable Readmissions: Conceptual Framework To Rethink the Role of Primary Care: Executive Summary Potentially Preventable Readmissions: Conceptual Framework To Rethink the Role of Primary Care Executive Summary Prepared for: Agency for Healthcare Research and Quality U.S. Department of H…

  16. Endnotes | Agency for Healthcare Research and Quality

    www.ahrq.gov/policymakers/chipra/demoeval/what-we-learned/implementation-guides/implementation-guide1/impguide1ref.html
    March 01, 2019 - Endnotes Implementation Guide Number 1 This Implementation Guide includes suggested steps and tips for implementing initiatives for improving child health care quality from the CMS-funded national evaluation of the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA) Quality Demonstration …

  17. Adoption of health information technology for medication safety in US hospitals, 2006. | PSNet

    psnet.ahrq.gov/issue/adoption-health-information-technology-medication-safety-us-hospitals-2006
    August 07, 2013 - Study Adoption of health information technology for medication safety in US hospitals, 2006. Citation Text: Furukawa MF, Raghu TS, Spaulding TJ, et al. Adoption of health information technology for medication safety in U.S. Hospitals, 2006. Health Aff (Millwood). 2008;27(3):865-75. doi…

  18. Older folks in hospitals: the contributing factors and recommendations for incident prevention. | PSNet

    psnet.ahrq.gov/issue/older-folks-hospitals-contributing-factors-and-recommendations-incident-prevention
    April 13, 2022 - Study Older folks in hospitals: the contributing factors and recommendations for incident prevention. Citation Text: Mansah M, Griffiths R, Fernandez R, et al. Older folks in hospitals: the contributing factors and recommendations for incident prevention. J Patient Saf. 2014;10(3):146-53…

  19. Follow-up Visits for Children Who Are Obese or Overweight with a Weight-Related Comorbidity: Table 4 (pdf file)

    www.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/chronic/chipra-0242-table4.pdf
    January 01, 2010 - Follow-up Visits for Children Who Are Obese or Overweight with a Weight-Related Comorbidity: Table 4 Table 4: Evidence for Follow-up Visits for Children Who Are Overweight Type of Evidence Key Findings Level of Evidence (USPSTF Ranking*) Citations Expert recommendation The complexity of tre…

  20. Impact of crisis resource management simulation-based training for interprofessional and interdisciplinary teams: a systematic review. | PSNet

    psnet.ahrq.gov/issue/impact-crisis-resource-management-simulation-based-training-interprofessional-and
    November 13, 2019 - Review Impact of crisis resource management simulation-based training for interprofessional and interdisciplinary teams: a systematic review. Citation Text: Fung L, Boet S, Bould D, et al. Impact of crisis resource management simulation-based training for interprofessional and interdisci…
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