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Scaling safety: the South Carolina Surgical Safety Checklist experience. | PSNet

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February 07, 2018 - Study Scaling safety: the South Carolina Surgical Safety Checklist experience. Citation Text: Berry WR, Edmondson L, Gibbons LR, et al. Scaling Safety: The South Carolina Surgical Safety Checklist Experience. Health Aff (Millwood). 2018;37(11):1779-1786. doi:10.1377/hlthaff.2018.0717. …

Rates and types of events reported to established incident reporting systems in two US hospitals. | PSNet

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January 02, 2017 - Study Rates and types of events reported to established incident reporting systems in two US hospitals. Citation Text: Nuckols TK, Bell D, Liu H, et al. Rates and types of events reported to established incident reporting systems in two US hospitals. Qual Saf Health Care. 2007;16(3):16…

Delayed recognition of deterioration of patients in general wards is mostly caused by human related monitoring failures: a root cause analysis of unplanned ICU admissions. | PSNet

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December 21, 2017 - Study Delayed recognition of deterioration of patients in general wards is mostly caused by human related monitoring failures: a root cause analysis of unplanned ICU admissions. Citation Text: van Galen LS, Struik PW, Driesen BEJM, et al. Delayed Recognition of Deterioration of Patients …

Understanding how the design and implementation of online consultations affect primary care quality: systematic review of evidence with recommendations for designers, providers, and researchers. | PSNet

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October 05, 2022 - Review Understanding how the design and implementation of online consultations affect primary care quality: systematic review of evidence with recommendations for designers, providers, and researchers. Citation Text: Darley S, Coulson T, Peek N, et al. Understanding how the design and im…

Changes in hospital safety following penalties in the US Hospital Acquired Condition Reduction Program: retrospective cohort study. | PSNet

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September 29, 2021 - Study Changes in hospital safety following penalties in the US Hospital Acquired Condition Reduction Program: retrospective cohort study. Citation Text: Sankaran R, Sukul D, Nuliyalu U, et al. Changes in hospital safety following penalties in the US Hospital Acquired Condition Reduction …

Bridging the feedback gap: a sociotechnical approach to informing clinicians of patients' subsequent clinical course and outcomes. | PSNet

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January 21, 2019 - Commentary Bridging the feedback gap: a sociotechnical approach to informing clinicians of patients' subsequent clinical course and outcomes. Citation Text: Cifra CL, Sittig DF, Singh H. Bridging the feedback gap: a sociotechnical approach to informing clinicians of patients’ subsequent …

Patient harm during COVID-19 pandemic: using a human factors lens to promote patient and workforce safety. | PSNet

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September 14, 2022 - Commentary Patient harm during COVID-19 pandemic: using a human factors lens to promote patient and workforce safety. Citation Text: Alagha MA, Jaulin F, Yeung W, et al. Patient harm during COVID-19 pandemic: using a human factors lens to promote patient and workforce safety. J Patient S…

Work patterns and fatigue-related risk among junior doctors. | PSNet

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July 29, 2020 - Study Work patterns and fatigue-related risk among junior doctors. Citation Text: Gander P, Purnell H, Garden A, et al. Work patterns and fatigue-related risk among junior doctors. Occup Environ Med. 2007;64(11):733-8. Copy Citation Format: Google Scholar PubMed BibTeX En…

Diagnostic discordance, health information exchange, and inter-hospital transfer outcomes: a population study. | PSNet

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May 19, 2021 - Study Diagnostic discordance, health information exchange, and inter-hospital transfer outcomes: a population study. Citation Text: Usher M, Sahni N, Herrigel D, et al. Diagnostic discordance, health information exchange, and inter-hospital transfer outcomes: a population study. J Gen In…

Relationship between medication event rates and the Leapfrog computerized physician order entry evaluation tool. | PSNet

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November 26, 2014 - Study Relationship between medication event rates and the Leapfrog computerized physician order entry evaluation tool. Citation Text: Leung AA, Keohane C, Lipsitz S, et al. Relationship between medication event rates and the Leapfrog computerized physician order entry evaluation tool. J …

Use of an electronic decision support tool to reduce polypharmacy in elderly people with chronic diseases: cluster randomised controlled trial. | PSNet

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August 18, 2021 - Study Emerging Classic Use of an electronic decision support tool to reduce polypharmacy in elderly people with chronic diseases: cluster randomised controlled trial. Citation Text: Rieckert A, Reeves D, Altiner A, et al. Use of an electronic decision support to…

Suffering in silence: a qualitative study of second victims of adverse events. | PSNet

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February 03, 2021 - Study Suffering in silence: a qualitative study of second victims of adverse events. Citation Text: Ullström S, Sachs MA, Hansson J, et al. Suffering in silence: a qualitative study of second victims of adverse events. BMJ Qual Saf. 2014;23(4):325-331. doi:10.1136/bmjqs-2013-002035. Co…

The effect of a system-level tiered huddle system on reporting patient safety events: an interrupted time series analysis. | PSNet

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October 07, 2020 - Study The effect of a system-level tiered huddle system on reporting patient safety events: an interrupted time series analysis. Citation Text: Adapa K, Ivester T, Shea CM, et al. The effect of a system-level tiered huddle system on reporting patient safety events: an interrupted time se…

Medication errors at hospital admission and discharge: risk factors and impact of medication reconciliation process to improve healthcare. | PSNet

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November 10, 2021 - Study Medication errors at hospital admission and discharge: risk factors and impact of medication reconciliation process to improve healthcare. Citation Text: Breuker C, Macioce V, Mura T, et al. Medication errors at hospital admission and discharge: risk factors and impact of medicatio…

How safe are outpatient electronic health records? An evaluation of medication-related decision support using the Ambulatory Electronic Health Record Evaluation Tool. | PSNet

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March 17, 2021 - Study How safe are outpatient electronic health records? An evaluation of medication-related decision support using the Ambulatory Electronic Health Record Evaluation Tool. Citation Text: Co Z, Classen DC, Cole JM, et al. How safe are outpatient electronic health records? An evaluation o…

Potentially inappropriate medication administration is associated with adverse postoperative outcomes in older surgical patients: a retrospective cohort study. | PSNet

psnet.ahrq.gov/issue/potentially-inappropriate-medication-administration-associated-adverse-postoperative-outcomes

October 07, 2020 - Study Potentially inappropriate medication administration is associated with adverse postoperative outcomes in older surgical patients: a retrospective cohort study. Citation Text: Burfeind KG, Zarnegarnia Y, Tekkali P, et al. Potentially inappropriate medication administration is associ…

Clinical impact and frequency of anatomic pathology errors in cancer diagnoses. | PSNet

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March 28, 2012 - Study Classic Clinical impact and frequency of anatomic pathology errors in cancer diagnoses. Citation Text: Raab SS, Grzybicki DM, Janosky JE, et al. Clinical impact and frequency of anatomic pathology errors in cancer diagnoses. Cancer. 2005;104(10):2205-13.…

Post-operative mortality, missed care and nurse staffing in nine countries: a cross-sectional study. | PSNet

psnet.ahrq.gov/issue/post-operative-mortality-missed-care-and-nurse-staffing-nine-countries-cross-sectional-study

December 12, 2014 - June 22, 2022 Factors associated with missed nursing care and nurse-assessed quality

The Safety Attitudes Questionnaire: psychometric properties, benchmarking data, and emerging research. | PSNet

psnet.ahrq.gov/issue/safety-attitudes-questionnaire-psychometric-properties-benchmarking-data-and-emerging

June 16, 2011 - nursing homes: variance of six patient safety climate factor scores across nursing homes and wards—assessed

Why patient summaries in electronic health records do not provide the cognitive support necessary for nurses' handoffs on medical and surgical units: insights from interviews and observations. | PSNet

psnet.ahrq.gov/issue/why-patient-summaries-electronic-health-records-do-not-provide-cognitive-support-necessary

January 18, 2013 - January 18, 2013 The effect of hospital electronic health record adoption on nurse-assessed

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