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Using a potentially aggressive/violent patient huddle to improve health care safety. | PSNet

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November 16, 2022 - Commentary Using a potentially aggressive/violent patient huddle to improve health care safety. Citation Text: Larson LA, Finley JL, Gross TL, et al. Using a Potentially Aggressive/Violent Patient Huddle to Improve Health Care Safety. Jt Comm J Qual Patient Saf. 2019;45(2):74-80. doi:10.…

The need to include assisted living in responding to the COVID-19 pandemic. | PSNet

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April 14, 2021 - Commentary The need to include assisted living in responding to the COVID-19 pandemic. Citation Text: Zimmerman S, Sloane PD, Katz PR, et al. The need to include assisted living in responding to the COVID-19 pandemic. J Am Med Dir Assoc. 2020;21(5). doi:10.1016/j.jamda.2020.03.024. Cop…

Differences in donor heart acceptance by race and gender of patients on the transplant waiting list. | PSNet

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January 12, 2022 - Study Differences in donor heart acceptance by race and gender of patients on the transplant waiting list. Citation Text: Breathett K, Knapp SM, Lewsey SC, et al. Differences in donor heart acceptance by race and gender of patients on the transplant waiting list. JAMA. 2024;331(16):1379-…

Missed acute coronary syndrome during telephone triage at out-of-hours primary care: lessons from a case-control study. | PSNet

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March 11, 2020 - Study Missed acute coronary syndrome during telephone triage at out-of-hours primary care: lessons from a case-control study. Citation Text: Erkelens DC, Rutten FH, Wouters LT, et al. Missed Acute Coronary Syndrome During Telephone Triage at Out-of-Hours Primary Care. J Patient Saf. 2022…

Improving timely recognition and treatment of sepsis in the pediatric ICU. | PSNet

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December 09, 2020 - Study Improving timely recognition and treatment of sepsis in the pediatric ICU. Citation Text: Vidrine R, Zackoff M, Paff Z, et al. Improving timely recognition and treatment of sepsis in the pediatric ICU. Jt Comm J Qual Patient Saf. 2020;46(5):299-307. doi:10.1016/j.jcjq.2020.02.005. …

Leveraging a redesigned morbidity and mortality conference that incorporates the clinical and educational missions of improving quality and patient safety. | PSNet

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April 24, 2018 - Commentary Leveraging a redesigned morbidity and mortality conference that incorporates the clinical and educational missions of improving quality and patient safety. Citation Text: Tad-Y DB, Pierce RG, Pell JM, et al. Leveraging a Redesigned Morbidity and Mortality Conference That Incor…

An estimate of missed pediatric sepsis in the emergency department. | PSNet

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December 08, 2021 - Study An estimate of missed pediatric sepsis in the emergency department. Citation Text: Cifra CL, Westlund E, Ten Eyck P, et al. An estimate of missed pediatric sepsis in the emergency department. Diagnosis (Berl). 2020;8(2):193-198. doi:10.1515/dx-2020-0023. Copy Citation Format:…

Analysis of the interprofessional clinical learning environment for quality improvement and patient safety from perspectives of interprofessional teams. | PSNet

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April 19, 2017 - Study Analysis of the interprofessional clinical learning environment for quality improvement and patient safety from perspectives of interprofessional teams. Citation Text: Cheng MKW, Collins S, Baron RB, et al. Analysis of the interprofessional clinical learning environment for quality…

Quality improvement priorities for safer out-of-hours palliative care: lessons from a mixed-methods analysis of a national incident-reporting database. | PSNet

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July 03, 2016 - Study Quality improvement priorities for safer out-of-hours palliative care: lessons from a mixed-methods analysis of a national incident-reporting database. Citation Text: Williams H, Donaldson SL, Noble S, et al. Quality improvement priorities for safer out-of-hours palliative care: Le…

Using the Generic Analysis Method to analyze sentinel event reports across hospitals: a retrospective cross-sectional study. | PSNet

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May 18, 2022 - Study Using the Generic Analysis Method to analyze sentinel event reports across hospitals: a retrospective cross-sectional study. Citation Text: Baartmans MC, van Schoten SM, Smit BJ, et al. Using the Generic Analysis Method to analyze sentinel event reports across hospitals: a retrospe…

Unplanned transfers to a medical intensive care unit: causes and relationship to preventable errors in care. | PSNet

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July 19, 2023 - Study Unplanned transfers to a medical intensive care unit: causes and relationship to preventable errors in care. Citation Text: Bapoje SR, Gaudiani JL, Narayanan V, et al. Unplanned transfers to a medical intensive care unit: causes and relationship to preventable errors in care. J …

Hospital-wide cardiac arrest in situ simulation to identify and mitigate latent safety threats. | PSNet

psnet.ahrq.gov/issue/hospital-wide-cardiac-arrest-situ-simulation-identify-and-mitigate-latent-safety-threats

April 14, 2021 - Study Hospital-wide cardiac arrest in situ simulation to identify and mitigate latent safety threats. Citation Text: Bentley SK, Meshel A, Boehm L, et al. Hospital-wide cardiac arrest in situ simulation to identify and mitigate latent safety threats. Adv Simul (Lond). 2022;7(1):15. doi:1…

Individualized medication review in older people with multimorbidity: a comparative analysis between patients living at home and in a nursing home. | PSNet

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May 04, 2022 - Study Individualized medication review in older people with multimorbidity: a comparative analysis between patients living at home and in a nursing home. Citation Text: Molist-Brunet N, Sevilla-Sánchez D, Puigoriol-Juvanteny E, et al. Individualized medication review in older people wit…

Organisational crisis resource management: leading an academic department of emergency medicine through the COVID-19 pandemic. | PSNet

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September 29, 2021 - Commentary Organisational crisis resource management: leading an academic department of emergency medicine through the COVID-19 pandemic. Citation Text: Gavin N, Romney M-LS, Lema PC, et al. Organisational crisis resource management: leading an academic department of emergency medicine t…

Sources of unsafe primary care for older adults: a mixed-methods analysis of patient safety incident reports. | PSNet

psnet.ahrq.gov/issue/sources-unsafe-primary-care-older-adults-mixed-methods-analysis-patient-safety-incident

October 12, 2016 - Study Sources of unsafe primary care for older adults: a mixed-methods analysis of patient safety incident reports. Citation Text: Cooper A, Edwards A, Williams H, et al. Sources of unsafe primary care for older adults: a mixed-methods analysis of patient safety incident reports. Age Age…

Using a claims data-based sentinel system to improve compliance with clinical guidelines: results of a randomized prospective study. | PSNet

psnet.ahrq.gov/issue/using-claims-data-based-sentinel-system-improve-compliance-clinical-guidelines-results

October 19, 2022 - Study Using a claims data-based sentinel system to improve compliance with clinical guidelines: results of a randomized prospective study. Citation Text: Javitt JC, Steinberg G, Locke T, et al. Using a claims data-based sentinel system to improve compliance with clinical guidelines: re…

Improving medication reconciliation with comprehensive evaluation at a Veterans Affairs skilled-nursing facility. | PSNet

psnet.ahrq.gov/issue/improving-medication-reconciliation-comprehensive-evaluation-veterans-affairs-skilled-nursing

May 19, 2021 - Study Improving medication reconciliation with comprehensive evaluation at a Veterans Affairs skilled-nursing facility. Citation Text: Baughman AW, Triantafylidis LK, O'Neil N, et al. Improving medication reconciliation with comprehensive evaluation at a Veterans Affairs skilled-nursing …

Changes in outcomes for internal medicine inpatients after work-hour regulations. | PSNet

psnet.ahrq.gov/issue/changes-outcomes-internal-medicine-inpatients-after-work-hour-regulations

September 30, 2012 - Study Classic Changes in outcomes for internal medicine inpatients after work-hour regulations. Citation Text: Horwitz LI, Kosiborod M, Lin Z, et al. Changes in outcomes for internal medicine inpatients after work-hour regulations. Ann Intern Med. 2007;147(2):…

Resident duty hours in surgery for ensuring patient safety, providing optimum resident education and training, and promoting resident well-being: a response from the American College of Surgeons to the Report of the Institute of Medicine, "Resident Duty Hours: Enhancing Sleep, Supervision, and Safety." | PSNet

psnet.ahrq.gov/issue/resident-duty-hours-surgery-ensuring-patient-safety-providing-optimum-resident-education-and

August 26, 2011 - Commentary Resident duty hours in surgery for ensuring patient safety, providing optimum resident education and training, and promoting resident well-being: a response from the American College of Surgeons to the Report of the Institute of Medicine, "Resident Duty Hours: Enhancing Sleep, Supervision…

'Poking the skunk': ethical and medico-legal concerns in research about patients' experiences of medical injury. | PSNet

psnet.ahrq.gov/issue/poking-skunk-ethical-and-medico-legal-concerns-research-about-patients-experiences-medical

May 05, 2021 - Commentary 'Poking the skunk': ethical and medico-legal concerns in research about patients' experiences of medical injury. Citation Text: Moore JS, Mello MM, Bismark M. 'Poking the skunk': Ethical and medico-legal concerns in research about patients' experiences of medical injury. Bioet…

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