-
psnet.ahrq.gov/node/50457/psn-pdf
October 09, 2019 - Combined SNA and LDA methods to understand adverse
medical events
October 9, 2019
Zhu L, Reychav I, McHaney R, et al. Combined SNA and LDA methods to understand adverse medical
events. Int J Risk Saf Med. 2019;30(3):129-153. doi:10.3233/JRS-180052.
https://psnet.ahrq.gov/issue/combined-sna-and-lda-methods-understa…
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psnet.ahrq.gov/node/36755/psn-pdf
May 04, 2014 - Journal reporting of medical errors: the wisdom of
Solomon, the bravery of Achilles, and the foolishness of
Pan.
May 4, 2014
Murphy JG, Stee LA, McEvoy MT, et al. Journal reporting of medical errors: the wisdom of Solomon, the
bravery of Achilles, and the foolishness of Pan. Chest. 2007;131(3):890-896. doi:10.1378…
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psnet.ahrq.gov/node/43877/psn-pdf
February 25, 2015 - Training situational awareness to reduce surgical errors
in the operating room.
February 25, 2015
Graafland M, Schraagen JMC, Boermeester MA, et al. Training situational awareness to reduce surgical
errors in the operating room. Br J Surg. 2015;102(1):16-23. doi:10.1002/bjs.9643.
https://psnet.ahrq.gov/issue/train…
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psnet.ahrq.gov/node/46036/psn-pdf
July 05, 2017 - Operational failures detected by frontline acute care
nurses.
July 5, 2017
Stevens KR, Engh EP, Tubbs-Cooley HL, et al. Operational Failures Detected by Frontline Acute Care
Nurses. Res Nurs Health. 2017;40(3):197-205. doi:10.1002/nur.21791.
https://psnet.ahrq.gov/issue/operational-failures-detected-frontline-acut…
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psnet.ahrq.gov/node/46465/psn-pdf
February 21, 2018 - Preventing mistransfusions: an evaluation of institutional
knowledge and a response.
February 21, 2018
MacDougall N, Dong F, Broussard L, et al. Preventing Mistransfusions: An Evaluation of Institutional
Knowledge and a Response. Anesth Analg. 2018;126(1):247-251. doi:10.1213/ANE.0000000000002443.
https://psnet.ah…
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psnet.ahrq.gov/node/46035/psn-pdf
May 17, 2017 - Economic impact of medication error: a systematic
review.
May 17, 2017
Walsh EK, Hansen CR, Sahm LJ, et al. Economic impact of medication error: a systematic review.
Pharmacoepidemiol Drug Saf. 2017;26(5):481-497. doi:10.1002/pds.4188.
https://psnet.ahrq.gov/issue/economic-impact-medication-error-systematic-review…
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psnet.ahrq.gov/node/35233/psn-pdf
August 10, 2005 - The influence of the causes and contexts of medical
errors on emergency medicine residents' responses to
their errors: an exploration.
August 10, 2005
Hobgood C, Hevia A, Tamayo-Sarver JH, et al. The influence of the causes and contexts of medical errors
on emergency medicine residents' responses to their errors: …
-
psnet.ahrq.gov/node/50743/psn-pdf
December 18, 2019 - Design of a safety dashboard for patients.
December 18, 2019
Gibson B, Butler J, Schnock KO, et al. Design of a safety dashboard for patients. Patient Educ Couns.
2019;103(4):741-747. doi:10.1016/j.pec.2019.10.021.
https://psnet.ahrq.gov/issue/design-safety-dashboard-patients
Patients and caregivers should be acti…
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psnet.ahrq.gov/node/42864/psn-pdf
January 15, 2014 - A unified model of patient safety (or "Who froze my
cheese?").
January 15, 2014
Coiera E, Collins S, Kuziemsky C. A unified model of patient safety (or "Who froze my cheese?"). BMJ.
2013;347:f7273. doi:10.1136/bmj.f7273.
https://psnet.ahrq.gov/issue/unified-model-patient-safety-or-who-froze-my-cheese
This comment…
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psnet.ahrq.gov/node/46687/psn-pdf
February 21, 2018 - Oversedation of a patient with obstructive sleep apnea
prior to imaging.
February 21, 2018
Blay E, Barnard C, Bilimoria KY. Oversedation of a Patient With Obstructive Sleep Apnea Prior to Imaging.
JAMA. 2018;319(5):495-496. doi:10.1001/jama.2017.22004.
https://psnet.ahrq.gov/issue/oversedation-patient-obstructive-…
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psnet.ahrq.gov/node/46332/psn-pdf
September 24, 2017 - Sharing the process of diagnostic decision making.
September 24, 2017
Brush JE, Brophy JM. Sharing the Process of Diagnostic Decision Making. JAMA Intern Med.
2017;177(9):1245-1246. doi:10.1001/jamainternmed.2017.1929.
https://psnet.ahrq.gov/issue/sharing-process-diagnostic-decision-making
Improving diagnosis has …
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psnet.ahrq.gov/node/41709/psn-pdf
September 26, 2012 - The effect of clinical history on accuracy of
electrocardiograph interpretation among doctors working
in emergency departments.
September 26, 2012
Cruz MF, Edwards J, Dinh MM, et al. The effect of clinical history on accuracy of electrocardiograph
interpretation among doctors working in emergency departments. Med …
-
psnet.ahrq.gov/node/43015/psn-pdf
May 29, 2014 - Team-training in healthcare: a narrative synthesis of the
literature.
May 29, 2014
Weaver SJ, Dy SM, Rosen MA. Team-training in healthcare: a narrative synthesis of the literature. BMJ
Qual Saf. 2014;23(5):359-72. doi:10.1136/bmjqs-2013-001848.
https://psnet.ahrq.gov/issue/team-training-healthcare-narrative-synthe…
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psnet.ahrq.gov/node/44452/psn-pdf
September 04, 2016 - Reflecting on diagnostic errors: taking a second look is
not enough.
September 4, 2016
Monteiro SD, Sherbino J, Patel A, et al. Reflecting on Diagnostic Errors: Taking a Second Look is Not
Enough. J Gen Intern Med. 2015;30(9):1270-4. doi:10.1007/s11606-015-3369-4.
https://psnet.ahrq.gov/issue/reflecting-diagnostic…
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psnet.ahrq.gov/node/46875/psn-pdf
March 07, 2018 - Improving medication-related clinical decision support.
March 7, 2018
Tolley CL, Slight SP, Husband AK, et al. Improving medication-related clinical decision support. Am J
Health Syst Pharm. 2018;75(4):239-246. doi:10.2146/ajhp160830.
https://psnet.ahrq.gov/issue/improving-medication-related-clinical-decision-suppo…
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psnet.ahrq.gov/node/34048/psn-pdf
May 27, 2011 - Computerized physician order entry: helpful or harmful?
May 27, 2011
Berger RG, Kichak JP. Computerized physician order entry: helpful or harmful? J Am Med Inform Assoc.
2004;11(2):100-3.
https://psnet.ahrq.gov/issue/computerized-physician-order-entry-helpful-or-harmful
The authors critically review the published …
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psnet.ahrq.gov/node/48025/psn-pdf
June 19, 2019 - Accuracy of a popular online symptom checker for
ophthalmic diagnoses.
June 19, 2019
Shen C, Nguyen M, Gregor A, et al. Accuracy of a Popular Online Symptom Checker for Ophthalmic
Diagnoses. JAMA Ophthalmol. 2019;137(6):690-692. doi:10.1001/jamaophthalmol.2019.0571.
https://psnet.ahrq.gov/issue/accuracy-popular-on…
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psnet.ahrq.gov/node/841197/psn-pdf
December 07, 2022 - Does malpractice liability promote patient safety? A
methodological excursion.
December 7, 2022
Saks MJ, Landsman S. Jurimetrics. 2022;62:397-419.
https://psnet.ahrq.gov/issue/does-malpractice-liability-promote-patient-safety-methodological-excursion
Malpractice liability is an unconfirmed driver for safety. This …
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psnet.ahrq.gov/node/35393/psn-pdf
April 06, 2011 - Multiplicity of medication safety terms, definitions and
functional meanings: when is enough enough?
April 6, 2011
Yu KH, Nation RL, Dooley MJ. Multiplicity of medication safety terms, definitions and functional meanings:
when is enough enough? Qual Saf Health Care. 2005;14(5):358-63.
https://psnet.ahrq.gov/issue/…
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psnet.ahrq.gov/node/35410/psn-pdf
September 11, 2009 - Intravenous medication safety and smart infusion
systems: lessons learned and future opportunities.
September 11, 2009
Keohane C, Hayes J, Saniuk C, et al. Intravenous medication safety and smart infusion systems: lessons
learned and future opportunities. J Infus Nurs. 2005;28(5):321-328.
https://psnet.ahrq.gov/is…