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  1. Evaluation of a redesign initiative in an internal-medicine residency. | PSNet

    psnet.ahrq.gov/issue/evaluation-redesign-initiative-internal-medicine-residency
    February 17, 2011 - Study Evaluation of a redesign initiative in an internal-medicine residency. Citation Text: McMahon GT, Katz JT, Thorndike ME, et al. Evaluation of a redesign initiative in an internal-medicine residency. N Engl J Med. 2010;362(14):1304-1311. doi:10.1056/NEJMsa0908136. Copy Citation …

  2. Can positivity promote safety? Psychological capital development combats cynicism and unsafe behavior. | PSNet

    psnet.ahrq.gov/issue/can-positivity-promote-safety-psychological-capital-development-combats-cynicism-and-unsafe
    June 09, 2011 - Study Can positivity promote safety? Psychological capital development combats cynicism and unsafe behavior. Citation Text: Stratman JL, Youssef-Morgan CM. Can positivity promote safety? Psychological capital development combats cynicism and unsafe behavior. Safety Sci. 2019;116:13-25. d…

  3. Assessment of adverse drug events among patients in a tertiary care medical center. | PSNet

    psnet.ahrq.gov/issue/assessment-adverse-drug-events-among-patients-tertiary-care-medical-center
    September 28, 2005 - Study Assessment of adverse drug events among patients in a tertiary care medical center. Citation Text: Johnston PE, France DJ, Byrne DW, et al. Assessment of adverse drug events among patients in a tertiary care medical center. Am J Health Syst Pharm. 2006;63(22):2218-27. Copy Cita…

  4. Chasing the 6-sigma: drawing lessons from the cockpit culture. | PSNet

    psnet.ahrq.gov/issue/chasing-6-sigma-drawing-lessons-cockpit-culture
    April 22, 2015 - Commentary Chasing the 6-sigma: drawing lessons from the cockpit culture. Citation Text: Hickey EJ, Halvorsen F, Laussen PC, et al. Chasing the 6-sigma: Drawing lessons from the cockpit culture. J Thorac Cardiovasc Surg. 2017;155(2). doi:10.1016/j.jtcvs.2017.09.097. Copy Citation F…

  5. Unintended harm associated with the Hospital Readmissions Reduction Program. | PSNet

    psnet.ahrq.gov/issue/unintended-harm-associated-hospital-readmissions-reduction-program
    August 20, 2018 - Commentary Unintended harm associated with the Hospital Readmissions Reduction Program. Citation Text: Fonarow GC. Unintended Harm Associated With the Hospital Readmissions Reduction Program. JAMA. 2018;320(24):2539-2541. doi:10.1001/jama.2018.19325. Copy Citation Format: D…

  6. Admission handoff communications: clinician's shared understanding of patient severity of illness and problems. | PSNet

    psnet.ahrq.gov/issue/admission-handoff-communications-clinicians-shared-understanding-patient-severity-illness-and
    May 31, 2017 - Study Admission handoff communications: clinician's shared understanding of patient severity of illness and problems. Citation Text: Brannen M, Cameron KA, Adler MD, et al. Admission Handoff Communications. J Patient Saf. 2009;5(4). doi:10.1097/pts.0b013e3181c029e5. Copy Citation …

  7. Embedding quality improvement and patient safety at Liverpool Women's NHS Foundation Trust. | PSNet

    psnet.ahrq.gov/issue/embedding-quality-improvement-and-patient-safety-liverpool-womens-nhs-foundation-trust
    September 09, 2008 - Commentary Embedding quality improvement and patient safety at Liverpool Women's NHS Foundation Trust. Citation Text: Scholefield H. Embedding quality improvement and patient safety at Liverpool Women's NHS Foundation Trust. Best Pract Res Clin Obstet Gynaecol. 2007;21(4):593-607. Co…

  8. Confusion—specimen mix-up in dermatopathology and measures to prevent and detect it. | PSNet

    psnet.ahrq.gov/issue/confusion-specimen-mix-dermatopathology-and-measures-prevent-and-detect-it
    February 12, 2020 - Review Confusion—specimen mix-up in dermatopathology and measures to prevent and detect it. Citation Text: Weyers W. Confusion-specimen mix-up in dermatopathology and measures to prevent and detect it. Dermatol Pract Concept. 2014;4(1):27-42. doi:10.5826/dpc.0401a04. Copy Citation …

  9. The missing link: dedicated patient safety education within top-ranked US nursing school curricula. | PSNet

    psnet.ahrq.gov/issue/missing-link-dedicated-patient-safety-education-within-top-ranked-us-nursing-school-curricula
    November 15, 2018 - Study The missing link: dedicated patient safety education within top-ranked US nursing school curricula. Citation Text: Howard JN. The missing link: dedicated patient safety education within top-ranked US nursing school curricula. J Patient Saf. 2010;6(3):165-71. Copy Citation F…

  10. The role of South--North partnerships in promoting shared learning and knowledge transfer. | PSNet

    psnet.ahrq.gov/issue/role-south-north-partnerships-promoting-shared-learning-and-knowledge-transfer
    July 29, 2020 - Commentary The role of South--North partnerships in promoting shared learning and knowledge transfer. Citation Text: Basu L, Pronovost P, Molello NE, et al. The role of South-North partnerships in promoting shared learning and knowledge transfer. Global Health. 2017;13(1):64. doi:10.1186…

  11. A method for prioritizing interventions following root cause analysis (RCA): lessons from philosophy. | PSNet

    psnet.ahrq.gov/issue/method-prioritizing-interventions-following-root-cause-analysis-rca-lessons-philosophy
    March 11, 2015 - Commentary A method for prioritizing interventions following root cause analysis (RCA): lessons from philosophy. Citation Text: Boyd M. A method for prioritizing interventions following root cause analysis (RCA): lessons from philosophy. J Eval Clin Pract. 2015;21(3):461-9. doi:10.1111/j…

  12. The Expert Panel Report to Texas Health Resources Leadership on the 2014 Ebola Events. | PSNet

    psnet.ahrq.gov/issue/expert-panel-report-texas-health-resources-leadership-2014-ebola-events
    February 10, 2016 - Book/Report The Expert Panel Report to Texas Health Resources Leadership on the 2014 Ebola Events. Citation Text: The Expert Panel Report to Texas Health Resources Leadership on the 2014 Ebola Events. Cortese D, Abbott P, Chassin M, Lyon GM III, Riley WJ. Dallas, TX: Texas Health Resourc…

  13. Setting quality and safety priorities in a target-rich environment: an academic medical center's challenge. | PSNet

    psnet.ahrq.gov/issue/setting-quality-and-safety-priorities-target-rich-environment-academic-medical-centers
    September 24, 2018 - Study Setting quality and safety priorities in a target-rich environment: an academic medical center's challenge. Citation Text: Mort E, Demehin AA, Marple KB, et al. Setting quality and safety priorities in a target-rich environment: an academic medical center's challenge. Acad Med. 20…

  14. The safety journal: lessons learned with an error reporting tool to stimulate systems thinking. | PSNet

    psnet.ahrq.gov/issue/safety-journal-lessons-learned-error-reporting-tool-stimulate-systems-thinking
    January 21, 2019 - Study The safety journal: lessons learned with an error reporting tool to stimulate systems thinking. Citation Text: Singh R, Naughton B, Singh A, et al. The Safety Journal. J Patient Saf. 2007;3(3):135-141. doi:10.1097/0b013e31814258db. Copy Citation Format: DOI Google S…

  15. "Just like EKGs!" Should EEGs undergo a confirmatory interpretation by a clinical neurophysiologist? | PSNet

    psnet.ahrq.gov/issue/just-ekgs-should-eegs-undergo-confirmatory-interpretation-clinical-neurophysiologist
    November 09, 2022 - Commentary "Just like EKGs!" Should EEGs undergo a confirmatory interpretation by a clinical neurophysiologist? Citation Text: Benbadis SR. "Just like EKGs!" Should EEGs undergo a confirmatory interpretation by a clinical neurophysiologist? Neurology. 2013;80(1 Suppl 1):S47-51. doi:10.1…

  16. The medication kit conundrum: considerations to enhance safety and efficiency. | PSNet

    psnet.ahrq.gov/issue/medication-kit-conundrum-considerations-enhance-safety-and-efficiency
    June 07, 2017 - Commentary The medication kit conundrum: considerations to enhance safety and efficiency. Citation Text: Arthur KJ, Fuller J, Dossett HA, et al. The medication kit conundrum: considerations to enhance safety and efficiency. Am J Health Syst Pharm. 2024;Epub Sep 4. doi:10.1093/ajhp/zxae23…

  17. Using care bundles to reduce in-hospital mortality: quantitative survey. | PSNet

    psnet.ahrq.gov/issue/using-care-bundles-reduce-hospital-mortality-quantitative-survey
    April 25, 2018 - Study Using care bundles to reduce in-hospital mortality: quantitative survey. Citation Text: Robb E, Jarman B, Suntharalingam G, et al. Using care bundles to reduce in-hospital mortality: quantitative survey. BMJ. 2010;340:c1234. doi:10.1136/bmj.c1234. Copy Citation Format: …

  18. Targeted communication intervention using nursing crew resource management principles. | PSNet

    psnet.ahrq.gov/issue/targeted-communication-intervention-using-nursing-crew-resource-management-principles
    August 12, 2015 - Study Targeted communication intervention using nursing crew resource management principles. Citation Text: Tschannen D, McClish D, Aebersold M, et al. Targeted communication intervention using nursing crew resource management principles. J Nurs Care Qual. 2015;30(1):7-11. doi:10.1097/NC…

  19. Citing harms, momentum grows to remove race from clinical algorithms. | PSNet

    psnet.ahrq.gov/issue/citing-harms-momentum-grows-remove-race-clinical-algorithms
    January 31, 2011 - Commentary Citing harms, momentum grows to remove race from clinical algorithms. Citation Text: Kuehn BM. Citing harms, momentum grows to remove race from clinical algorithms. JAMA. 2024;331(6):463-465. doi:10.1001/jama.2023.25530. Copy Citation Format: DOI Google Scholar B…

  20. Medication reconciliation in the emergency department: opportunities for workflow redesign. | PSNet

    psnet.ahrq.gov/issue/medication-reconciliation-emergency-department-opportunities-workflow-redesign
    August 04, 2021 - Commentary Medication reconciliation in the emergency department: opportunities for workflow redesign. Citation Text: Hummel J, Evans PC, Lee H. Medication reconciliation in the emergency department: opportunities for workflow redesign. Qual Saf Health Care. 2010;19(6):531-5. doi:10.11…
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