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  1. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/35244/psn-pdf
    December 17, 2008 - Representative case series from public hospital admissions 1998 II: surgical adverse events. … Representative case series from public hospital admissions 1998 II: surgical adverse events. … https://psnet.ahrq.gov/issue/representative-case-series-public-hospital-admissions-1998-ii-surgical- adverse-events … The authors analyzed surgical adverse events to assess the occurrence, cause, patient impact, and … https://psnet.ahrq.gov/issue/representative-case-series-public-hospital-admissions-1998-ii-surgical-adverse-events
  2. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/36717/psn-pdf
    July 26, 2011 - Design of a retrospective patient record study on the occurrence of adverse events among patients in … Design of a retrospective patient record study on the occurrence of adverse events among patients in … https://psnet.ahrq.gov/issue/design-retrospective-patient-record-study-occurrence-adverse-events-among … - patients-dutch The researchers applied the Harvard study methodology to study the occurrence of adverse … https://psnet.ahrq.gov/issue/incidence-adverse-events-and-negligence-hospitalized-patients-results-harvard-medical
  3. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/37408/psn-pdf
    March 23, 2011 - Surgical adverse outcomes and patients’ evaluation of quality of care: inherent risk or reduced quality … Surgical adverse outcomes and patients' evaluation of quality of care: inherent risk or reduced quality … https://psnet.ahrq.gov/issue/surgical-adverse-outcomes-and-patients-evaluation-quality-care-inherent-risk … - or-reduced This study found that patients who experienced adverse events after discharge rated their … However, adverse events during hospitalization were not associated with negative impressions of the
  4. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/42893/psn-pdf
    March 13, 2014 - Effect of patient safety strategies on the incidence of adverse events. … Effect of patient safety strategies on the incidence of adverse events. … https://psnet.ahrq.gov/issue/effect-patient-safety-strategies-incidence-adverse-events This study found … that adverse event rates in a Spanish hospital increased following the introduction of various patient … /issue/comparison-hospital-adverse-events-identified-three-widely-used-detection-methods
  5. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/46224/psn-pdf
    July 12, 2017 - Systematic approaches to adverse events in obstetrics, Part 1 & Part 2. … Systematic approaches to adverse events in obstetrics, Part I: Event identification and classification … https://psnet.ahrq.gov/issue/systematic-approaches-adverse-events-obstetrics-part-1-part-2 Adverse events … The second article discusses how to respond to adverse events, such as root cause analysis, error disclosure … https://psnet.ahrq.gov/issue/systematic-approaches-adverse-events-obstetrics-part-1-part-2 https://psnet.ahrq.gov
  6. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/43813/psn-pdf
    January 20, 2015 - Adverse events in patients with return emergency department visits. … Adverse events in patients with return emergency department visits. … https://psnet.ahrq.gov/issue/adverse-events-patients-return-emergency-department-visits This observational … An adverse event was present in 12% of return visits that occurred within 72 hours of the initial visit … The authors suggest that this utilization pattern may be a promising trigger tool to identify adverse
  7. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/46790/psn-pdf
    March 14, 2018 - When clinicians drop out and start over after adverse events. … When Clinicians Drop Out and Start Over after Adverse Events. … https://psnet.ahrq.gov/issue/when-clinicians-drop-out-and-start-over-after-adverse-events Clinicians … who experience emotional distress after adverse events or medical errors are referred to as second … Researchers surveyed health care providers whose career choices were impacted by involvement in an adverse
  8. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/45820/psn-pdf
    March 15, 2017 - Development of a pediatric adverse events terminology. … Development of a Pediatric Adverse Events Terminology. … This commentary describes the development of a terminology specific to adverse events in children for … https://psnet.ahrq.gov/issue/development-pediatric-adverse-events-terminology https://psnet.ahrq.gov/ … jcaho-patient-safety-event-taxonomy-standardized-terminology-and-classification-schema-near https://psnet.ahrq.gov/issue/adverse-events-among-children-canadian-hospitals-canadian-paediatric-adverse-events-study
  9. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/40296/psn-pdf
    October 01, 2014 - Applying trigger tools to detect adverse events associated with outpatient surgery. … Applying trigger tools to detect adverse events associated with outpatient surgery. … https://psnet.ahrq.gov/issue/applying-trigger-tools-detect-adverse-events-associated-outpatient-surgery … This study demonstrated the utility of trigger tools to detect adverse events related to outpatient … https://psnet.ahrq.gov/issue/applying-trigger-tools-detect-adverse-events-associated-outpatient-surgery
  10. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/38853/psn-pdf
    January 04, 2010 - Introduction of discharge plan to reduce adverse events within 72 hours of discharge from the ICU. … Introduction of discharge plan to reduce adverse events within 72 hours of discharge from the ICU. … https://psnet.ahrq.gov/issue/introduction-discharge-plan-reduce-adverse-events-within-72-hours-discharge … - icu A structured discharge plan was associated with a reduction in preventable adverse events (but … an increase in overall adverse events) in patients who had been recently discharged from the intensive
  11. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/34065/psn-pdf
    February 09, 2011 - Incidence and preventability of adverse drug events among older persons in the ambulatory setting. … Incidence and Preventability of Adverse Drug Events Among Older Persons in the Ambulatory Setting. … This study analyzed more than 1500 adverse drug events and discovered that nearly 28% were preventable … The overall rate of adverse drug events approached 50 per 1000 person-years with the most serious events … https://psnet.ahrq.gov/issue/adverse-drug-events-ambulatory-care
  12. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/41284/psn-pdf
    May 04, 2012 - Determinants of adverse events in vascular surgery. … Determinants of adverse events in vascular surgery. … https://psnet.ahrq.gov/issue/determinants-adverse-events-vascular-surgery Vascular surgery is considered … The PSIs are best used to screen administrative data for potential adverse events, as in this study. … https://psnet.ahrq.gov/issue/determinants-adverse-events-vascular-surgery https://psnet.ahrq.gov/issue
  13. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/34792/psn-pdf
    January 01, 2011 - Physician knowledge, attitudes, and behavior related to reporting adverse drug events. … Physician Knowledge, Attitudes, and Behavior Related to Reporting Adverse Drug Events. … https://psnet.ahrq.gov/issue/physician-knowledge-attitudes-and-behavior-related-reporting-adverse-drug … of 3000 randomly chosen physicians aimed to assess their knowledge and understanding of reporting adverse … The authors conclude that better methods of reporting adverse drug events must include a combination
  14. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/36291/psn-pdf
    October 25, 2010 - Medicare payment for selected adverse events: building the business case for investing in patient safety … Medicare payment for selected adverse events: building the business case for investing in patient safety … https://psnet.ahrq.gov/issue/medicare-payment-selected-adverse-events-building-business-case-investing … This economic analysis used administrative data to identify adverse events during hospitalizations, … The analysis revealed that adverse events account for a small but significant proportion of overall
  15. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/36346/psn-pdf
    April 11, 2011 - Incidence and nature of adverse events during pediatric sedation/anesthesia for procedures outside the … Incidence and nature of adverse events during pediatric sedation/anesthesia for procedures outside the … https://psnet.ahrq.gov/issue/incidence-and-nature-adverse-events-during-pediatric-sedationanesthesia- … voluntarily submitted data on more than 30,000 encounters and found that the overall risk of serious adverse … However, adverse events with the potential for harm (near misses), such as unanticipated need for bag-mask
  16. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/44000/psn-pdf
    July 18, 2016 - Elucidating reasons for resident underutilization of electronic adverse event reporting. … Elucidating Reasons for Resident Underutilization of Electronic Adverse Event Reporting. … https://psnet.ahrq.gov/issue/elucidating-reasons-resident-underutilization-electronic-adverse-event- … https://psnet.ahrq.gov/issue/elucidating-reasons-resident-underutilization-electronic-adverse-event-reporting … https://psnet.ahrq.gov/issue/elucidating-reasons-resident-underutilization-electronic-adverse-event-reporting
  17. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/43302/psn-pdf
    August 21, 2014 - A medication-based trigger tool to identify adverse events in pediatric anesthesiology. … A medication-based trigger tool to identify adverse events in pediatric anesthesiology. … https://psnet.ahrq.gov/issue/medication-based-trigger-tool-identify-adverse-events-pediatric-anesthesiology … This commentary describes the development of a trigger tool initiative to detect and record adverse … https://psnet.ahrq.gov/issue/medication-based-trigger-tool-identify-adverse-events-pediatric-anesthesiology
  18. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/40769/psn-pdf
    March 21, 2012 - Identification of adverse events in ground transport emergency medical services. … Identification of adverse events in ground transport emergency medical services. … https://psnet.ahrq.gov/issue/identification-adverse-events-ground-transport-emergency-medical-services … This study established a consensus definition and rating system for adverse events in emergency medical … https://psnet.ahrq.gov/issue/identification-adverse-events-ground-transport-emergency-medical-services
  19. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/38371/psn-pdf
    January 28, 2009 - Continuous monitoring of adverse events: influence on the quality of care and the incidence of errors … Continuous monitoring of adverse events: influence on the quality of care and the incidence of errors … https://psnet.ahrq.gov/issue/continuous-monitoring-adverse-events-influence-quality-care-and-incidence … study used the methodology of the Harvard Medical Practice Study to establish a baseline incidence of adverse … https://psnet.ahrq.gov/issue/incidence-adverse-events-and-negligence-hospitalized-patients-results-harvard-medical
  20. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/37409/psn-pdf
    March 28, 2012 - Extent, nature and consequences of adverse events: results of a retrospective casenote review in a large … Extent, nature and consequences of adverse events: results of a retrospective casenote review in a large … https://psnet.ahrq.gov/issue/extent-nature-and-consequences-adverse-events-results-retrospective- casenote-review-large-nhs … This retrospective study screened hospital admissions for specific triggers to identify adverse events … Approximately 1 in 11 admissions had an adverse event, and 15% of these led to significant disability

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