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Human factor in cardiac surgery: errors and near misses in a high technology medical domain. | PSNet

psnet.ahrq.gov/issue/human-factor-cardiac-surgery-errors-and-near-misses-high-technology-medical-domain

June 09, 2010 - Review Classic Human factor in cardiac surgery: errors and near misses in a high technology medical domain. Citation Text: Carthey J, de Leval MR, Reason JT. The human factor in cardiac surgery: errors and near misses in a high technology medical domain. Ann Tho…

Benchmarking surgical incident reports using a database and a triage system to reduce adverse outcomes. | PSNet

psnet.ahrq.gov/issue/benchmarking-surgical-incident-reports-using-database-and-triage-system-reduce-adverse

June 18, 2008 - Study Benchmarking surgical incident reports using a database and a triage system to reduce adverse outcomes. Citation Text: Antonacci AC, Lam S, Lavarias V, et al. Benchmarking surgical incident reports using a database and a triage system to reduce adverse outcomes. Arch Sur…

Clinical diagnoses and autopsy findings: discrepancies in critically ill patients. | PSNet

psnet.ahrq.gov/issue/clinical-diagnoses-and-autopsy-findings-discrepancies-critically-ill-patients

March 09, 2022 - Study Clinical diagnoses and autopsy findings: discrepancies in critically ill patients. Citation Text: Tejerina E, Esteban A, Fernández-Segoviano P, et al. Clinical diagnoses and autopsy findings: discrepancies in critically ill patients*. Crit Care Med. 2012;40(3):842-6. doi:10.1097/…

ED overcrowding is associated with an increased frequency of medication errors. | PSNet

psnet.ahrq.gov/issue/ed-overcrowding-associated-increased-frequency-medication-errors

August 20, 2018 - Study ED overcrowding is associated with an increased frequency of medication errors. Citation Text: Kulstad EB, Sikka R, Sweis RT, et al. ED overcrowding is associated with an increased frequency of medication errors. Am J Emerg Med. 2010;28(3):304-309. doi:10.1016/j.ajem.2008.12.014. …

'Providing good and comfortable care by building a bond of trust': nurses views regarding their role in patients' perception of safety in the intensive care unit. | PSNet

psnet.ahrq.gov/issue/providing-good-and-comfortable-care-building-bond-trust-nurses-views-regarding-their-role

February 14, 2024 - Study 'Providing good and comfortable care by building a bond of trust': nurses views regarding their role in patients' perception of safety in the intensive care unit. Citation Text: Wassenaar A, van den Boogaard M, van der Hooft T, et al. 'Providing good and comfortable care by buildin…

Patient factors associated with new prescribing of potentially inappropriate medications in multimorbid US older adults using multiple medications. | PSNet

psnet.ahrq.gov/issue/patient-factors-associated-new-prescribing-potentially-inappropriate-medications-multimorbid

August 18, 2021 - Study Patient factors associated with new prescribing of potentially inappropriate medications in multimorbid US older adults using multiple medications. Citation Text: Jungo KT, Streit S, Lauffenburger JC. Patient factors associated with new prescribing of potentially inappropriate medi…

Variations in surgical outcomes associated with hospital compliance with safety practices. | PSNet

psnet.ahrq.gov/issue/variations-surgical-outcomes-associated-hospital-compliance-safety-practices

June 14, 2017 - Study Variations in surgical outcomes associated with hospital compliance with safety practices. Citation Text: Brooke BS, Dominici F, Pronovost P, et al. Variations in surgical outcomes associated with hospital compliance with safety practices. Surgery. 2012;151(5):651-9. doi:10.1016/…

Learning from incident reporting? Analysis of incidents resulting in patient injuries in a web-based system in Swedish health care. | PSNet

psnet.ahrq.gov/issue/learning-incident-reporting-analysis-incidents-resulting-patient-injuries-web-based-system

August 04, 2021 - Study Learning from incident reporting? Analysis of incidents resulting in patient injuries in a web-based system in Swedish health care. Citation Text: Ahlberg E-L, Elfström J, Borgstedt MR, et al. Learning from incident reporting? Analysis of incidents resulting in patient injuries in …

Processes for identifying and reviewing adverse events and near misses at an academic medical center. | PSNet

psnet.ahrq.gov/issue/processes-identifying-and-reviewing-adverse-events-and-near-misses-academic-medical-center

September 25, 2024 - Study Processes for identifying and reviewing adverse events and near misses at an academic medical center. Citation Text: Martinez W, Lehmann LS, Hu Y-Y, et al. Processes for Identifying and Reviewing Adverse Events and Near Misses at an Academic Medical Center. Jt Comm J Qual Patient S…

Medicines reconciliation in the emergency department: important prescribing discrepancies between the shared medication record and patients' actual use of medication. | PSNet

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April 21, 2021 - Study Medicines reconciliation in the emergency department: important prescribing discrepancies between the shared medication record and patients' actual use of medication. Citation Text: Andersen TS, Gemmer MN, Sejberg HRC, et al. Medicines reconciliation in the emergency department: im…

Effects of a multicentre teamwork and communication programme on patient outcomes: results from the Triad for Optimal Patient Safety (TOPS) project. | PSNet

psnet.ahrq.gov/issue/effects-multicentre-teamwork-and-communication-programme-patient-outcomes-results-triad

January 16, 2013 - Study Effects of a multicentre teamwork and communication programme on patient outcomes: results from the Triad for Optimal Patient Safety (TOPS) project. Citation Text: Auerbach AD, Sehgal NL, Blegen MA, et al. Effects of a multicentre teamwork and communication programme on patient o…

How incident reporting systems can stimulate social and participative learning: a mixed-methods study. | PSNet

psnet.ahrq.gov/issue/how-incident-reporting-systems-can-stimulate-social-and-participative-learning-mixed-methods

November 04, 2020 - Study How incident reporting systems can stimulate social and participative learning: a mixed-methods study. Citation Text: de Kam D, Kok J, Grit K, et al. How incident reporting systems can stimulate social and participative learning: a mixed-methods study. Health Policy (New York). 202…

Do not PIMP my nursing home ride! The impact of Potentially Inappropriate Medications Prescribing on residents' emergency care use. | PSNet

psnet.ahrq.gov/issue/do-not-pimp-my-nursing-home-ride-impact-potentially-inappropriate-medications-prescribing

March 17, 2021 - Study Do not PIMP my nursing home ride! The impact of Potentially Inappropriate Medications Prescribing on residents' emergency care use. Citation Text: Rapp T, Sicsic J, Tavassoli N, et al. Do not PIMP my nursing home ride! The impact of Potentially Inappropriate Medications Prescribing…

Analysis of 23,364 patient-generated, physician-reviewed malpractice claims from a non-tort, blame-free, national patient insurance system: lessons learned from Sweden. | PSNet

psnet.ahrq.gov/issue/analysis-23364-patient-generated-physician-reviewed-malpractice-claims-non-tort-blame-free

December 18, 2017 - Study Analysis of 23,364 patient-generated, physician-reviewed malpractice claims from a non-tort, blame-free, national patient insurance system: lessons learned from Sweden. Citation Text: Pukk-Härenstam K, Ask J, Brommels M, et al. Analysis of 23 364 patient-generated, physician-revi…

Current teaching and evaluation methods in critical care medicine: has the Accreditation Council for Graduate Medical Education affected how we practice and teach in the intensive care unit? | PSNet

psnet.ahrq.gov/issue/current-teaching-and-evaluation-methods-critical-care-medicine-has-accreditation-council

February 23, 2022 - Study Current teaching and evaluation methods in critical care medicine: has the Accreditation Council for Graduate Medical Education affected how we practice and teach in the intensive care unit? Citation Text: Chudgar SM, Cox CE, Que LG, et al. Current teaching and evaluation methods…

Does computerized provider order entry reduce prescribing errors for hospital inpatients? A systematic review. | PSNet

psnet.ahrq.gov/issue/does-computerized-provider-order-entry-reduce-prescribing-errors-hospital-inpatients

February 15, 2012 - Review Does computerized provider order entry reduce prescribing errors for hospital inpatients? A systematic review. Citation Text: Reckmann MH, Westbrook JI, Koh Y, et al. Does computerized provider order entry reduce prescribing errors for hospital inpatients? A systematic review. J…

Safely practicing in a new environment: a qualitative study to inform physician onboarding practices. | PSNet

psnet.ahrq.gov/issue/safely-practicing-new-environment-qualitative-study-inform-physician-onboarding-practices

July 02, 2019 - Study Safely practicing in a new environment: a qualitative study to inform physician onboarding practices. Citation Text: Lagoo J, Berry WR, Henrich N, et al. Safely practicing in a new environment: a qualitative study to inform physician onboarding practices. Jt Comm J Qual Patient Saf…

Just what the doctor ordered. Review of the evidence of the impact of computerized physician order entry system on medication errors. | PSNet

psnet.ahrq.gov/issue/just-what-doctor-ordered-review-evidence-impact-computerized-physician-order-entry-system

June 15, 2016 - Review Just what the doctor ordered. Review of the evidence of the impact of computerized physician order entry system on medication errors. Citation Text: Shamliyan TA, Duval S, Du J, et al. Just what the doctor ordered. Review of the evidence of the impact of computerized physician o…

A comparison of hospital adverse events identified by three widely used detection methods. | PSNet

psnet.ahrq.gov/issue/comparison-hospital-adverse-events-identified-three-widely-used-detection-methods

January 04, 2012 - Study A comparison of hospital adverse events identified by three widely used detection methods. Citation Text: Naessens JM, Campbell CR, Huddleston JM, et al. A comparison of hospital adverse events identified by three widely used detection methods. Int J Qual Health Care. 2009;21(4):…

The relationship between organizational leadership for safety and learning from patient safety events. | PSNet

psnet.ahrq.gov/issue/relationship-between-organizational-leadership-safety-and-learning-patient-safety-events

November 27, 2009 - Study The relationship between organizational leadership for safety and learning from patient safety events. Citation Text: Ginsburg LR, Chuang Y-T, Berta WB, et al. The relationship between organizational leadership for safety and learning from patient safety events. Health Serv Res. …

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