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psnet.ahrq.gov/node/38521/psn-pdf
September 19, 2016 - Inpatient suicide: preventing a common sentinel event.
September 19, 2016
Tishler CL, Reiss NS. Inpatient suicide: preventing a common sentinel event. Gen Hosp Psychiatry.
2009;31(2):103-9. doi:10.1016/j.genhosppsych.2008.09.007.
https://psnet.ahrq.gov/issue/inpatient-suicide-preventing-common-sentinel-event
Suici…
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psnet.ahrq.gov/node/37789/psn-pdf
June 04, 2008 - The cost of nurse-sensitive adverse events.
June 4, 2008
Pappas SH. The cost of nurse-sensitive adverse events. J Nurs Adm. 2008;38(5):230-236.
doi:10.1097/01.NNA.0000312770.19481.ce.
https://psnet.ahrq.gov/issue/cost-nurse-sensitive-adverse-events
This study determined that the actual direct cost of an adverse ev…
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psnet.ahrq.gov/node/35270/psn-pdf
June 29, 2009 - Potentially inappropriate prescribing in elderly veterans:
are we using the wrong drug, wrong dose, or wrong
duration?
June 29, 2009
Pugh MJV, Fincke BG, Bierman AS, et al. Potentially Inappropriate Prescribing in Elderly Veterans: Are We
Using the Wrong Drug, Wrong Dose, or Wrong Duration? J Am Geriatr Soc. 2005;…
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psnet.ahrq.gov/node/44091/psn-pdf
January 04, 2019 - Isolation precautions for visitors.
January 4, 2019
Munoz-Price LS, Banach DB, Bearman G, et al. Isolation Precautions for Visitors. Infect Control Hosp
Epidemiol. 2015;36(7):747-758. doi:10.1017/ice.2015.67.
https://psnet.ahrq.gov/issue/isolation-precautions-visitors
This expert guidance provides recommendations …
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psnet.ahrq.gov/node/34788/psn-pdf
March 28, 2005 - Cost of medication-related problems at a university
hospital.
March 28, 2005
Schneider PJ; Gift MG; Lee YP; Rothermich EA; Sill BE
https://psnet.ahrq.gov/issue/cost-medication-related-problems-university-hospital
This study used retrospective chart review to determine estimated costs of defined medication-related
…
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psnet.ahrq.gov/node/34966/psn-pdf
June 22, 2009 - Agreement of expert judgment in causality assessment of
adverse drug reactions.
June 22, 2009
Arimone Y, Bégaud B, Miremont-Salamé G, et al. Agreement of expert judgment in causality assessment
of adverse drug reactions. Eur J Clin Pharmacol. 2005;61(3):169-73.
https://psnet.ahrq.gov/issue/agreement-expert-judgmen…
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psnet.ahrq.gov/node/38258/psn-pdf
April 14, 2011 - How often do physicians review medication charts on
ward rounds?
April 14, 2011
Looi KL, Black PN. How often do physicians review medication charts on ward rounds? BMC Clin
Pharmacol. 2008;8:9. doi:10.1186/1472-6904-8-9.
https://psnet.ahrq.gov/issue/how-often-do-physicians-review-medication-charts-ward-rounds
Thi…
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psnet.ahrq.gov/node/43846/psn-pdf
January 21, 2015 - Quantifying and monitoring overdiagnosis in cancer
screening: a systematic review of methods.
January 21, 2015
Carter JL, Coletti RJ, Harris RP. Quantifying and monitoring overdiagnosis in cancer screening: a
systematic review of methods. BMJ. 2015;350:g7773. doi:10.1136/bmj.g7773.
https://psnet.ahrq.gov/issue/qua…
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psnet.ahrq.gov/node/44832/psn-pdf
February 03, 2016 - Crowdsourcing diagnosis for patients with undiagnosed
illnesses: an evaluation of CrowdMed.
February 3, 2016
Meyer AND, Longhurst CA, Singh H. Crowdsourcing Diagnosis for Patients With Undiagnosed Illnesses:
An Evaluation of CrowdMed. J Med Internet Res. 2016;18(1):e12. doi:10.2196/jmir.4887.
https://psnet.ahrq.go…
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psnet.ahrq.gov/node/34647/psn-pdf
June 25, 2014 - Complexity science: the challenge of complexity in health
care.
June 25, 2014
Plsek PE, Greenhalgh T. Complexity science: The challenge of complexity in health care. BMJ.
2001;323(7313):625-628.
https://psnet.ahrq.gov/issue/complexity-science-challenge-complexity-health-care
This article explores the science of h…
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psnet.ahrq.gov/node/34951/psn-pdf
February 28, 2011 - Ambiguity and workarounds as contributors to medical
error.
February 28, 2011
Spear SJ, Schmidhofer M. Ambiguity and workarounds as contributors to medical error. Ann Intern Med.
2005;142(8):627-630.
https://psnet.ahrq.gov/issue/ambiguity-and-workarounds-contributors-medical-error
This commentary discusses the ro…
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psnet.ahrq.gov/node/46767/psn-pdf
January 17, 2018 - What this computer needs is a physician: humanism and
artificial intelligence.
January 17, 2018
Verghese A, Shah NH, Harrington RA. What This Computer Needs Is a Physician: Humanism and Artificial
Intelligence. JAMA. 2018;319(1):19-20. doi:10.1001/jama.2017.19198.
https://psnet.ahrq.gov/issue/what-computer-needs-p…
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psnet.ahrq.gov/node/50909/psn-pdf
February 19, 2020 - Time to take hearing loss seriously.
February 19, 2020
Blustein J, Wallhagen MI, Weinstein BE, et al. Time to take hearing loss seriously. Jt Comm J Qual Patient
Saf. 2019;46(1):53-58. doi:10.1016/j.jcjq.2019.10.003.
https://psnet.ahrq.gov/issue/time-take-hearing-loss-seriously
The authors of this narrative review…
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psnet.ahrq.gov/node/44495/psn-pdf
September 30, 2015 - Impact of laws aimed at healthcare-associated infection
reduction: a qualitative study.
September 30, 2015
Stone PW, Pogorzelska-Maziarz M, Reagan J, et al. Impact of laws aimed at healthcare-associated
infection reduction: a qualitative study. BMJ Qual Saf. 2015;24(10):637-44. doi:10.1136/bmjqs-2014-
003921.
htt…
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psnet.ahrq.gov/node/34726/psn-pdf
April 19, 2011 - How house officers cope with their mistakes.
April 19, 2011
Wu AW, Folkman S, McPhee SJ, et al. How house officers cope with their mistakes. West J Med.
1993;159(5):565-569.
https://psnet.ahrq.gov/issue/how-house-officers-cope-their-mistakes
In this article, the authors report on how house officers cope with their…
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psnet.ahrq.gov/node/46592/psn-pdf
December 19, 2017 - The evolution of procedural competency in internal
medicine training.
December 19, 2017
Sacks CA, Alba GA, Miloslavsky EM. The Evolution of Procedural Competency in Internal Medicine
Training. JAMA Intern Med. 2017;177(12):1713-1714. doi:10.1001/jamainternmed.2017.5014.
https://psnet.ahrq.gov/issue/evolution-proce…
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psnet.ahrq.gov/node/72537/psn-pdf
December 02, 2020 - Automation failures and patient safety.
December 2, 2020
Ruskin KJ, Ruskin AC, O’Connor M. Automation failures and patient safety. Curr Opin Anaesthesiol.
2020;33(6):788-792. doi:10.1097/aco.0000000000000935.
https://psnet.ahrq.gov/issue/automation-failures-and-patient-safety
Task automation in medicine is a core …
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psnet.ahrq.gov/node/46958/psn-pdf
March 28, 2018 - Disposal of paper records containing personal
information in hospitals.
March 28, 2018
Ramjist JK, Coburn N, Urbach DR, et al. Disposal of Paper Records Containing Personal Information in
Hospitals. JAMA. 2018;319(11):1162-1163. doi:10.1001/jama.2017.21533.
https://psnet.ahrq.gov/issue/disposal-paper-records-conta…
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psnet.ahrq.gov/node/43335/psn-pdf
July 09, 2014 - Wake Up Safe and root cause analysis: quality
improvement in pediatric anesthesia.
July 9, 2014
Tjia I, Rampersad S, Varughese AM, et al. Wake Up Safe and root cause analysis: quality improvement in
pediatric anesthesia. Anesth Analg. 2014;119(1):122-136. doi:10.1213/ANE.0000000000000266.
https://psnet.ahrq.gov/is…
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psnet.ahrq.gov/node/35109/psn-pdf
November 03, 2015 - Evaluation of the implementation of the alert issued by
the UK National Patient Safety Agency on the storage and
handling of potassium chloride concentrate solution.
November 3, 2015
Lankshear AJ, Sheldon TA, Lowson K, et al. Evaluation of the implementation of the alert issued by the UK
National Patient Safety Ag…