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psnet.ahrq.gov/issue/system-wide-hospital-child-maltreatment-patient-safety-program
September 15, 2021 - Study
A system-wide hospital child maltreatment patient safety program.
Citation Text:
Hansen J, Terreros A, Sherman A, et al. A system-wide hospital child maltreatment patient safety program. Pediatrics. 2021;148(3):e2021050555. doi:10.1542/peds.2021-050555.
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psnet.ahrq.gov/issue/development-and-validation-deep-learning-model-detection-allergic-reactions-using-safety
June 15, 2022 - Study
Development and validation of a deep learning model for detection of allergic reactions using safety event reports across hospitals.
Citation Text:
Yang J, Wang L, Phadke NA, et al. Development and validation of a deep learning model for detection of allergic reactions using safety…
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psnet.ahrq.gov/issue/scoping-review-methodological-approaches-used-retrospective-chart-reviews-validate-adverse
April 29, 2020 - Review
A scoping review of the methodological approaches used in retrospective chart reviews to validate adverse event rates in administrative data.
Citation Text:
Connolly A, Kirwan M, Matthews A. A scoping review of the methodological approaches used in retrospective chart reviews to v…
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psnet.ahrq.gov/issue/validity-patient-safety-indicators-veterans-health-administration
October 16, 2008 - Special or Theme Issue
Validity of Patient Safety Indicators in the Veterans Health Administration.
Citation Text:
Validity of Patient Safety Indicators in the Veterans Health Administration. J Am Coll Surg. 2011;212:921-990.
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psnet.ahrq.gov/issue/patient-safety-indicators-overview
December 24, 2008 - Measurement Tool/Indicator
Classic
Patient Safety Indicators Overview.
Citation Text:
Patient Safety Indicators Overview. Agency for Healthcare Research and Quality
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psnet.ahrq.gov/perspective/remote-patient-monitoring
March 15, 2023 - There is also the benefit that you get potentially more accurate data. … please their health care provider, and with the pen and paper method they may not have as consistent or accurate … For the most part, the medical devices are accurate, and the values are going to be similar. … You would see patients take serial readings in a short frequency to try to see if that was really an accurate
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psnet.ahrq.gov/perspective/conversation-dr-neal-sikka-and-dr-colton-hood-about-remote-patient-monitoring
March 15, 2023 - There is also the benefit that you get potentially more accurate data. … please their health care provider, and with the pen and paper method they may not have as consistent or accurate … For the most part, the medical devices are accurate, and the values are going to be similar. … You would see patients take serial readings in a short frequency to try to see if that was really an accurate
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psnet.ahrq.gov/issue/inability-providers-predict-unplanned-readmissions
December 05, 2007 - Study
Inability of providers to predict unplanned readmissions.
Citation Text:
Allaudeen N, Schnipper JL, Orav J, et al. Inability of providers to predict unplanned readmissions. J Gen Intern Med. 2011;26(7):771-6. doi:10.1007/s11606-011-1663-3.
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psnet.ahrq.gov/issue/why-dont-nurses-consistently-take-patient-respiratory-rates
October 10, 2012 - Study
Why don't nurses consistently take patient respiratory rates?
Citation Text:
Ansell H, Meyer A, Thompson S. Why don't nurses consistently take patient respiratory rates? Br J Nurs. 2014;23(8):414-8.
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psnet.ahrq.gov/issue/debriefing-emergency-department-after-clinical-events-practical-guide
November 16, 2022 - Commentary
Debriefing in the emergency department after clinical events: a practical guide.
Citation Text:
Kessler DO, Cheng A, Mullan PC. Debriefing in the Emergency Department After Clinical Events: A Practical Guide. Ann Emerg Med. 2015;65(6):690-698. doi:10.1016/j.annemergmed.2014.10…
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psnet.ahrq.gov/issue/high-reliability-organization-mindset
April 01, 2020 - Commentary
A high-reliability organization mindset.
Citation Text:
Merchant NB, O’Neal J, Dealino-Perez C, et al. A high-reliability organization mindset. Am J Med Qual. 2022;37(6):504-510. doi:10.1097/jmq.0000000000000086.
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psnet.ahrq.gov/web-mm/other-hand
December 12, 2012 - The need for accurate and timely communication is imperative to patient safety and has been integrated … January 12, 2011
Emergency department medication lists are not accurate.
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psnet.ahrq.gov/web-mm/harm-alarm-fatigue
February 14, 2018 - One reason computer algorithms from telemetry monitoring systems are less diagnostic and less accurate … What types and numbers of alarms occur with hospital monitor devices and how accurate are they?
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psnet.ahrq.gov/issue/occurrence-no-harm-incidents-and-adverse-events-hospitalized-patients-ischemic-stroke-or-tia
August 05, 2020 - Study
Occurrence of no-harm incidents and adverse events in hospitalized patients with ischemic stroke or TIA: a cohort study using trigger tool methodology.
Citation Text:
Nowak B, Schwendimann R, Lyrer P, et al. Occurrence of no-harm incidents and adverse events in hospitalized patient…
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psnet.ahrq.gov/node/33574/psn-pdf
March 15, 2025 - fragmentation of ambulatory care in outpatient settings increases the challenge of making a timely and
accurate
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psnet.ahrq.gov/node/33570/psn-pdf
June 15, 2024 - care system reforms, including establishing a work system and safety culture that
foster timely and accurate
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psnet.ahrq.gov/issue/respectful-management-serious-clinical-adverse-events-second-edition
January 27, 2016 - Book/Report
Classic
Respectful Management of Serious Clinical Adverse Events. Second Edition.
Citation Text:
Respectful Management of Serious Clinical Adverse Events. Second Edition. Conway J, Federico F, Stewart K, Campbell MJ. Cambridge, MA: Institute for Heal…
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psnet.ahrq.gov/issue/standardizing-patient-safety-event-reporting-between-care-delivered-or-purchased-veterans
June 26, 2024 - Study
Standardizing patient safety event reporting between care delivered or purchased by the Veterans Health Administration (VHA).
Citation Text:
Rosen AK, Beilstein-Wedel E, Chan J, et al. Standardizing patient safety event reporting between care delivered or purchased by the Veterans …
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psnet.ahrq.gov/issue/positive-predictive-value-ahrq-accidental-puncture-or-laceration-patient-safety-indicator
April 03, 2017 - Slideset
Positive predictive value of the AHRQ accidental puncture or laceration patient safety indicator.
Citation Text:
Utter GH, Zrelak PA, Baron R, et al. Positive predictive value of the AHRQ accidental puncture or laceration patient safety indicator. Ann Surg. 2009;250(6):1041-5.…
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psnet.ahrq.gov/issue/failure-mode-and-effects-analysis-comparison-two-common-risk-prioritisation-methods
September 09, 2015 - Study
Failure mode and effects analysis: a comparison of two common risk prioritisation methods.
Citation Text:
McElroy LM, Khorzad R, Nannicelli AP, et al. Failure mode and effects analysis: a comparison of two common risk prioritisation methods. BMJ Qual Saf. 2016;25(5):329-336. doi:10…