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  1. Detection of Safety Hazards | PSNet

    psnet.ahrq.gov/primer/detection-safety-hazards
    March 30, 2022 - Detection of Safety Hazards Citation Text: Detection of Safety Hazards. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2019. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML EndNote 7 XML Endnote tagged PubMed…

  2. Electronic Health Records | PSNet

    psnet.ahrq.gov/primer/electronic-health-records
    March 15, 2025 - Electronic Health Records Citation Text: Electronic Health Records. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2019. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML EndNote 7 XML Endnote tagged PubMedId R…

  3. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/33600/psn-pdf
    June 16, 2024 - Patient Safety 101 June 16, 2024 Patient Safety 101. PSNet [internet]. 2019. https://psnet.ahrq.gov/primer/patient-safety-101 PSNet primers are regularly reviewed and updated by the UC Davis PSNet Editorial Team to ensure that they reflect current research and practice in the patient safety field. Last reviewed in…

  4. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/33582/psn-pdf
    September 15, 2024 - Detection of Safety Hazards September 15, 2024 Detection of Safety Hazards. PSNet [internet]. 2019. https://psnet.ahrq.gov/primer/detection-safety-hazards PSNet primers are regularly reviewed and updated by the UC Davis PSNet Editorial Team to ensure that they reflect current research and practice in the patient s…

  5. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/33568/psn-pdf
    June 15, 2024 - Root Cause Analysis June 15, 2024 Root Cause Analysis. PSNet [internet]. 2019. https://psnet.ahrq.gov/primer/root-cause-analysis PSNet primers are regularly reviewed and updated by the UC Davis PSNet Editorial Team to ensure that they reflect current research and practice in the patient safety field. Last reviewed…

  6. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49468/psn-pdf
    December 16, 2004 - Mark My Limb December 1, 2004 Jacott WE, O'Leary D. Mark My Limb. PSNet [internet]. 2004. https://psnet.ahrq.gov/web-mm/mark-my-limb The Case A patient went to the operating room (OR) for surgery on the lower leg. Per the Universal Protocol, the surgeon marked the proper leg prior to bringing the patient to the O…

  7. SafeMedicationUse.ca. | PSNet

    psnet.ahrq.gov/issue/safemedicationuseca
    October 10, 2012 - Multi-use Website SafeMedicationUse.ca. Citation Text: SafeMedicationUse.ca. Institute for Safe Medication Practices Canada; ISMP Canada. Copy Citation Save Save to your library Print Download PDF Share Facebook Twitter Linkedin …

  8. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/43972/psn-pdf
    November 03, 2015 - National hospital ratings systems share few common scores and may generate confusion instead of clarity. November 3, 2015 Austin M, Jha AK, Romano PS, et al. National hospital ratings systems share few common scores and may generate confusion instead of clarity. Health Aff (Millwood). 2015;34(3):423-430. doi:10.13…

  9. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/840259/psn-pdf
    November 16, 2022 - Clinician collaboration to improve clinical decision support: the Clickbusters initiative. November 16, 2022 Mc Coy AB, Russo EM, Johnson KB, et al. Clinician collaboration to improve clinical decision support: the Clickbusters initiative. J Am Med Inform Assoc. Epub 2022 Mar 4 https://psnet.ahrq.gov/innovation/cl…

  10. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/45887/psn-pdf
    August 15, 2018 - Association of changing hospital readmission rates with mortality rates after hospital discharge. August 15, 2018 Dharmarajan K, Wang Y, Lin Z, et al. Association of Changing Hospital Readmission Rates With Mortality Rates After Hospital Discharge. JAMA. 2017;318(3):270-278. doi:10.1001/jama.2017.8444. https://psn…

  11. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/46122/psn-pdf
    January 01, 2021 - Leapfrog Hospital Safety Score, Magnet designation, and healthcare-associated infections in United States hospitals. December 21, 2017 Pakyz AL, Wang H, Ozcan YA, et al. Leapfrog Hospital Safety Score, Magnet Designation, and Healthcare- Associated Infections in United States Hospitals. J Patient Saf. 2021;17(6):4…

  12. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/845356/psn-pdf
    March 29, 2023 - A novel approach for engagement in team training in high-technology surgery: the robotic-assisted surgery olympics. March 29, 2023 Cohen TN, Anger JT, Kanji FF, et al. A novel approach for engagement in team training in high-technology surgery: the robotic-assisted surgery olympics. J Patient Saf. 2022;18(6):570-5…

  13. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/45036/psn-pdf
    February 15, 2017 - Adverse Events in Rehabilitation Hospitals: National Incidence Among Medicare Beneficiaries. February 15, 2017 Levinson DR. Washington, DC: US Department of Health and Human Services, Office of the Inspector General; July 2016. Report No. OEI-06-14-00110. https://psnet.ahrq.gov/issue/adverse-events-rehabilitation-…

  14. Swiss Cheese Model | PSNet

    psnet.ahrq.gov/taxonomy/term/3460
    September 15, 2025 - Swiss Cheese Model Reason developed the "Swiss cheese model" to illustrate how analyses of major accidents and catastrophic systems failures tend to reveal multiple, smaller failures leading up to the actual hazard. In the model, each slice of cheese represents a safety barrier or precaution relevant to a particular …

  15. Suicide Prevention | PSNet

    psnet.ahrq.gov/perspective/suicide-prevention
    March 24, 2025 - Suicide Prevention Edwin Boudreaux, PhD; Bryan Gale, MA; Sarah Mossburg, PhD | March 25, 2025  Also Read the Conversation View more articles from the same authors. Citation Text: Boudreaux E, Gale B, Mossburg SE. Suicide Prevention. PSNet [internet]. Rockville (…

  16. In Conversation with Edwin Boudreaux about Suicide Prevention | PSNet

    psnet.ahrq.gov/perspective/conversation-edwin-boudreaux-about-suicide-prevention
    March 25, 2025 - In Conversation with Edwin Boudreaux about Suicide Prevention Edwin Boudreaux, PhD; Bryan Gale, MA; Sarah Mossburg, Phd | March 24, 2025  Also Read the Essay View more articles from the same authors. Citation Text: Boudreaux E, Gale B, Mossburg SE. In Conversati…

  17. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/852698/psn-pdf
    August 30, 2023 - The e-Autopsy/e-Biopsy: A Systematic Chart Review to Increase Safety and Diagnostic Accuracy Innovation August 30, 2023 https://psnet.ahrq.gov/innovation/e-autopsye-biopsy-systematic-chart-review-increase-safety-and- diagnostic-accuracy Summary Addressing diagnostic errors to improve outcomes and patient safety h…

  18. A "Reflexive" Diagnosis in Primary Care | PSNet

    psnet.ahrq.gov/web-mm/reflexive-diagnosis-primary-care
    April 01, 2008 - SPOTLIGHT CASE A "Reflexive" Diagnosis in Primary Care Citation Text: Betjemann J, Josephson AS. A "Reflexive" Diagnosis in Primary Care. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2014. Copy Citation Format: …

  19. Dangerous Shift | PSNet

    psnet.ahrq.gov/web-mm/dangerous-shift
    July 24, 2013 - SPOTLIGHT CASE Dangerous Shift Citation Text: Patterson ES. Dangerous Shift. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2008. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML EndNote 7 XML Endno…

  20. Order Interrupted by Text: Multitasking Mishap | PSNet

    psnet.ahrq.gov/web-mm/order-interrupted-text-multitasking-mishap
    August 21, 2015 - SPOTLIGHT CASE Order Interrupted by Text: Multitasking Mishap Citation Text: Halamka J. Order Interrupted by Text: Multitasking Mishap. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2011. Copy Citation Format: …
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