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psnet.ahrq.gov/node/46556/psn-pdf
November 01, 2017 - So much care it hurts: unneeded scans, therapy, surgery
only add to patients' ills.
November 1, 2017
Szabo L. Kaiser Health News. October 23, 2017.
https://psnet.ahrq.gov/issue/so-much-care-it-hurts-unneeded-scans-therapy-surgery-only-add-patients-ills
Overdiagnosis and overtreatment present a challenge to patient…
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psnet.ahrq.gov/web-mm/missing-abscess-radiology-reads-digital-era
January 01, 2009 - SPOTLIGHT CASE
The Missing Abscess: Radiology Reads in the Digital Era
Citation Text:
Siegel EL. The Missing Abscess: Radiology Reads in the Digital Era. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2017.
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www.ahrq.gov/hai/tools/surgery/modules/implementation/opt-briefings-slides.html
December 01, 2017 - Optimize Briefings and Debriefings: Slide Presentation
AHRQ Safety Program for Surgery
Slide 1: AHRQ Safety Program for Surgery—Implementation
Optimize Briefings and Debriefings
Slide 2: Learning Objectives
Describe characteristics of effective briefings and debriefings.
Present the evidence bas…
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psnet.ahrq.gov/web-mm/hemorrhagic-shock-after-elective-spine-surgery-failure-rescue-after-limited-response-nursing
October 31, 2023 - SPOTLIGHT CASE
Hemorrhagic Shock after Elective Spine Surgery: Failure to Rescue after Limited Response to Nursing Concerns.
Citation Text:
Zakaluzny S. Hemorrhagic Shock after Elective Spine Surgery: Failure to Rescue after Limited Response to Nursing Concerns.. PSNet [internet]. Rockville (MD):…
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psnet.ahrq.gov/issue/probabilistic-risk-assessment-accidental-abo-incompatible-thoracic-organ-transplantation-and
June 24, 2020 - Study
Probabilistic risk assessment of accidental ABO-incompatible thoracic organ transplantation before and after 2003.
Citation Text:
Cook RI, Wreathall J, Smith A, et al. Probabilistic risk assessment of accidental ABO-incompatible thoracic organ transplantation before and after 200…
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psnet.ahrq.gov/issue/anticipated-consequences-2011-duty-hours-standards-views-internal-medicine-and-surgery
August 22, 2018 - Study
Anticipated consequences of the 2011 duty hours standards: views of internal medicine and surgery program directors.
Citation Text:
Shea JA, Willett LL, Borman KR, et al. Anticipated consequences of the 2011 duty hours standards: views of internal medicine and surgery program dire…
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psnet.ahrq.gov/issue/postsurgical-prescriptions-opioid-naive-patients-and-association-overdose-and-misuse
October 19, 2022 - Study
Classic
Postsurgical prescriptions for opioid naive patients and association with overdose and misuse: retrospective cohort study.
Citation Text:
Brat GA, Agniel D, Beam A, et al. Postsurgical prescriptions for opioid naive patients and association with ov…
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psnet.ahrq.gov/issue/prospective-study-paediatric-cardiac-surgical-microsystems-assessing-relationships-between
February 14, 2024 - Study
A prospective study of paediatric cardiac surgical microsystems: assessing the relationships between non-routine events, teamwork and patient outcomes.
Citation Text:
Schraagen JM, Schouten T, Smit M, et al. A prospective study of paediatric cardiac surgical microsystems: assessi…
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psnet.ahrq.gov/issue/learning-experience-qualitative-study-surgeons-perspectives-reporting-and-dealing-serious
June 12, 2024 - Study
Learning from experience: a qualitative study of surgeons' perspectives on reporting and dealing with serious adverse events.
Citation Text:
Øyri SF, Søreide K, Søreide E, et al. Learning from experience: a qualitative study of surgeons’ perspectives on reporting and dealing with s…
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psnet.ahrq.gov/issue/good-people-who-try-their-best-can-have-problems-recognition-human-factors-and-how-minimise
October 29, 2017 - Review
Good people who try their best can have problems: recognition of human factors and how to minimise error.
Citation Text:
Brennan PA, Mitchell DA, Holmes S, et al. Good people who try their best can have problems: recognition of human factors and how to minimise error. Br J Oral Ma…
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psnet.ahrq.gov/issue/enhancing-surgical-safety-using-digital-multimedia-technology
October 09, 2013 - Study
Enhancing surgical safety using digital multimedia technology.
Citation Text:
Dixon JL, Mukhopadhyay D, Hunt J, et al. Enhancing surgical safety using digital multimedia technology. Am J Surg. 2016;211(6):1095-8. doi:10.1016/j.amjsurg.2015.08.023.
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psnet.ahrq.gov/issue/mobilising-or-standing-still-narrative-review-surgical-safety-checklist-knowledge-developed
August 21, 2019 - Review
Mobilising or standing still? A narrative review of Surgical Safety Checklist knowledge as developed in 25 highly cited papers from 2009 to 2016.
Citation Text:
Mitchell B, Cristancho S, Nyhof BB, et al. Mobilising or standing still?A narrative review of Surgical Safety Checklist …
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psnet.ahrq.gov/issue/detecting-adverse-events-surgery-comparing-events-detected-veterans-health-administration
June 20, 2011 - Study
Detecting adverse events in surgery: comparing events detected by the Veterans Health Administration Surgical Quality Improvement Program and the Patient Safety Indicators.
Citation Text:
Mull HJ, Borzecki A, Loveland S, et al. Detecting adverse events in surgery: comparing events …
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psnet.ahrq.gov/issue/patient-handover-surgery-intensive-care-using-formula-1-pit-stop-and-aviation-models-improve
October 03, 2011 - Study
Patient handover from surgery to intensive care: using Formula 1 pit-stop and aviation models to improve safety and quality.
Citation Text:
Catchpole K, de Leval MR, McEwan A, et al. Patient handover from surgery to intensive care: using Formula 1 pit-stop and aviation models to …
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psnet.ahrq.gov/issue/surgeon-specific-mortality-data-disguise-wider-failings-delivery-safe-surgical-services
March 09, 2022 - Study
Surgeon-specific mortality data disguise wider failings in delivery of safe surgical services.
Citation Text:
Westaby S, De Silva R, Petrou M, et al. Surgeon-specific mortality data disguise wider failings in delivery of safe surgical services. Eur J Cardiothorac Surg. 2015;47(2):3…
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psnet.ahrq.gov/issue/surgeons-and-systems-working-together-drive-safety-and-quality
February 02, 2022 - Commentary
Surgeons and systems working together to drive safety and quality.
Citation Text:
Hawkins RB, Nallamothu BK. Surgeons and systems working together to drive safety and quality. BMJ Qual Saf. 2023;32(4):181-184. doi:10.1136/bmjqs-2022-015045.
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psnet.ahrq.gov/issue/interprofessional-staff-perspectives-adoption-or-black-box-technology-and-simulations-improve
May 21, 2009 - Study
Interprofessional staff perspectives on the adoption of OR black box technology and simulations to improve patient safety: a multi-methods survey.
Citation Text:
Campbell K, Gardner A, Scott DJ, et al. Interprofessional staff perspectives on the adoption of or black box technology …
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psnet.ahrq.gov/issue/defining-optimal-length-opioid-pain-medication-prescription-after-common-surgical-procedures
August 15, 2018 - Study
Defining optimal length of opioid pain medication prescription after common surgical procedures.
Citation Text:
Scully RE, Schoenfeld AJ, Jiang W, et al. Defining Optimal Length of Opioid Pain Medication Prescription After Common Surgical Procedures. JAMA Surg. 2018;153(1):37-43. d…
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psnet.ahrq.gov/issue/variations-surgical-safety-according-affiliation-status-top-ranked-cancer-hospital
April 24, 2019 - Study
Variations in surgical safety according to affiliation status with a top-ranked cancer hospital.
Citation Text:
Resio BJ, Hoag JR, Chiu AS, et al. Variations in Surgical Safety According to Affiliation Status With a Top-Ranked Cancer Hospital. JAMA Oncol. 2019;5(9):1359-1362. doi:1…
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psnet.ahrq.gov/issue/association-hospital-participation-surgical-outcomes-monitoring-program-inpatient
August 20, 2018 - Study
Association of hospital participation in a surgical outcomes monitoring program with inpatient complications and mortality.
Citation Text:
Etzioni DA, Wasif N, Dueck AC, et al. Association of hospital participation in a surgical outcomes monitoring program with inpatient complicati…