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41. Is one-pen, one-patient achievable in the hospital? A quality improvement project to reduce risks of inadvertent insulin pen sharing at a large academic medical center. | PSNet
    psnet.ahrq.gov/issue/one-pen-one-patient-achievable-hospital-quality-improvement-project-reduce-risks-inadvertent
    April 10, 2024 - improvement project to reduce risks of inadvertent insulin pen sharing at a large academic medical center … Improvement Project to Reduce Risks of Inadvertent Insulin Pen Sharing at a Large Academic Medical Center … recommendations (e.g., label redesign, patient-specific bar coding on pens) at a quaternary academic medical center … Improvement Project to Reduce Risks of Inadvertent Insulin Pen Sharing at a Large Academic Medical Center

42. The host hospital 24-hour underreferral rate: an automated measure of call-center safety. | PSNet
    psnet.ahrq.gov/issue/host-hospital-24-hour-underreferral-rate-automated-measure-call-center-safety
    September 23, 2020 - Study The host hospital 24-hour underreferral rate: an automated measure of call-center … The host hospital 24-hour underreferral rate: an automated measure of call-center safety. … Conducted at a tertiary care pediatric hospital, this cohort study matched calls to the call center with … The study authors advocate for using the under-referral rate as a measure of call center quality of care … The host hospital 24-hour underreferral rate: an automated measure of call-center safety.

43. Factors associated with workplace violence among healthcare workers in an academic medical center. | PSNet
    psnet.ahrq.gov/issue/factors-associated-workplace-violence-among-healthcare-workers-academic-medical-center
    May 11, 2022 - Factors associated with workplace violence among healthcare workers in an academic medical center … Factors associated with workplace violence among healthcare workers in an academic medical center. … This study found that over half of healthcare workers at one large academic medical center in the United … Factors associated with workplace violence among healthcare workers in an academic medical center. … May 11, 2022 Institution of just culture physician peer review in an academic medical center

44. 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 - Processes for identifying and reviewing adverse events and near misses at an academic medical center … Processes for Identifying and Reviewing Adverse Events and Near Misses at an Academic Medical Center. … This survey of operational leaders at a single academic medical center identified multiple conferences … Processes for Identifying and Reviewing Adverse Events and Near Misses at an Academic Medical Center.

45. Patient outcomes compared between admissions coordinated by the transfer center and emergency department at a U.S. tertiary care hospital. | PSNet
    psnet.ahrq.gov/issue/patient-outcomes-compared-between-admissions-coordinated-transfer-center-and-emergency
    April 29, 2015 - Study Patient outcomes compared between admissions coordinated by the transfer center … Patient outcomes compared between admissions coordinated by the transfer center and emergency department … outcomes of patients admitted to one hospital via the emergency department (ED) and via a transfer center … In both matched and unmatched cohorts, patients admitted via the referral center had longer length of … Patient outcomes compared between admissions coordinated by the transfer center and emergency department

46. Safety lessons from the NIH Clinical Center. | PSNet
    psnet.ahrq.gov/issue/safety-lessons-nih-clinical-center
    April 10, 2024 - Commentary Safety lessons from the NIH Clinical Center. … Safety Lessons from the NIH Clinical Center. N Engl J Med. 2016;375(18):1705-1707. … Safety Lessons from the NIH Clinical Center. N Engl J Med. 2016;375(18):1705-1707.

47. National Center for Patient Safety (NCPS). | PSNet
    psnet.ahrq.gov/issue/national-center-patient-safety-ncps
    March 27, 2005 - Multi-use Website National Center for Patient Safety (NCPS). … Citation Text: National Center for Patient Safety (NCPS). … Copy URL Cite Citation Citation Text: National Center … September 24, 2017 MHA and MHA Keystone Center Annual Reports.

48. Hand Hygiene Project: Best Practices from Hospitals Participating in the Joint Commission Center for Transforming Healthcare Project. | PSNet
    psnet.ahrq.gov/issue/hand-hygiene-project-best-practices-hospitals-participating-joint-commission-center
    May 06, 2015 - Hand Hygiene Project: Best Practices from Hospitals Participating in the Joint Commission Center … Citation Text: Hand Hygiene Project: Best Practices from Hospitals Participating in the Joint Commission Center … This report describes how teams participating in The Joint Commission’s Center for Transforming Healthcare … Reducing the Risks of Wrong-Site Surgery: Safety Practices from The Joint Commission Center … September 30, 2015 Tennessee Center for Patient Safety.

49. Incidence of nosocomial COVID-19 in patients hospitalized at a large US academic medical center. | PSNet
    psnet.ahrq.gov/issue/incidence-nosocomial-covid-19-patients-hospitalized-large-us-academic-medical-center
    October 14, 2020 - Incidence of nosocomial COVID-19 in patients hospitalized at a large US academic medical center … Incidence of nosocomial COVID-19 in patients hospitalized at a large US academic medical center. … This cohort study included patients admitted to one large US academic medical center to assess the incidence … Incidence of nosocomial COVID-19 in patients hospitalized at a large US academic medical center. … system to identify unprofessional behaviors and mistreatment directed at trainees at an academic medical center

50. Viewing prevention of catheter-associated urinary tract infection as a system: using systems engineering and human factors engineering in a quality improvement project in an academic medical center. | PSNet
    psnet.ahrq.gov/issue/viewing-prevention-catheter-associated-urinary-tract-infection-system-using-systems
    July 12, 2023 - systems engineering and human factors engineering in a quality improvement project in an academic medical center … Systems Engineering and Human Factors Engineering in a Quality Improvement Project in an Academic Medical Center … program, principles of human factors engineering were applied to reduce CAUTI at an academic medical center … Systems Engineering and Human Factors Engineering in a Quality Improvement Project in an Academic Medical Center … Applying human factors engineering to address the telemetry alarm problem in a large medical center

51. Adverse drug reactions and therapeutic errors in older adults: a hazard factor analysis of poison center data. | PSNet
    psnet.ahrq.gov/issue/adverse-drug-reactions-and-therapeutic-errors-older-adults-hazard-factor-analysis-poison
    September 09, 2013 - Adverse drug reactions and therapeutic errors in older adults: a hazard factor analysis of poison center … Adverse drug reactions and therapeutic errors in older adults: a hazard factor analysis of poison center … The investigators analyzed medication-related data from a poison control call center and found that 1.6% … Adverse drug reactions and therapeutic errors in older adults: a hazard factor analysis of poison center … A toolkit to disseminate best practices in inpatient medication reconciliation: Multi-Center

52. Medication errors in a pharmacy-based bar-code-repackaging center. | PSNet
    psnet.ahrq.gov/issue/medication-errors-pharmacy-based-bar-code-repackaging-center
    June 28, 2010 - Study Medication errors in a pharmacy-based bar-code-repackaging center. … Medication errors in a pharmacy-based bar-code-repackaging center. … The authors describe a bar-code-repackaging center within their hospital pharmacy and confirm the types … Medication errors in a pharmacy-based bar-code-repackaging center.

53. Understanding ultrarare adverse events - lessons learned from a twelve-year review of intraoperative deaths at an academic medical center. | PSNet
    psnet.ahrq.gov/issue/understanding-ultrarare-adverse-events-lessons-learned-twelve-year-review-intraoperative
    March 29, 2023 - events - lessons learned from a twelve-year review of intraoperative deaths at an academic medical center … events - lessons learned from a twelve-year review of intraoperative deaths at an academic medical center … review of 154 intraoperative deaths occurring between March 2010 and August 2022 at one academic medical center … events - lessons learned from a twelve-year review of intraoperative deaths at an academic medical center

54. JCAHO to launch global patient safety center: the initial focus will be on reviewing and publicizing research findings. | PSNet
    psnet.ahrq.gov/issue/jcaho-launch-global-patient-safety-center-initial-focus-will-be-reviewing-and-publicizing
    December 22, 2010 - Newspaper/Magazine Article JCAHO to launch global patient safety center: the initial … Citation Text: JCAHO to launch global patient safety center: the initial focus will be on reviewing … reports on the launch of the Joint Commission on Accreditation of Healthcare Organizations' International Center … Cite Citation Citation Text: JCAHO to launch global patient safety center

55. Pharmacy prevalence of second victim syndrome in a comprehensive cancer center. | PSNet
    psnet.ahrq.gov/issue/pharmacy-prevalence-second-victim-syndrome-comprehensive-cancer-center
    June 03, 2020 - Study Pharmacy prevalence of second victim syndrome in a comprehensive cancer center … Pharmacy prevalence of second victim syndrome in a comprehensive cancer center. … At one comprehensive cancer center, 37% of pharmacists, pharmacy technicians, and pharmacy staff reported … Pharmacy prevalence of second victim syndrome in a comprehensive cancer center.

56. Implementation of an online reporting system to identify unprofessional behaviors and mistreatment directed at trainees at an academic medical center. | PSNet
    psnet.ahrq.gov/issue/implementation-online-reporting-system-identify-unprofessional-behaviors-and-mistreatment
    July 13, 2022 - system to identify unprofessional behaviors and mistreatment directed at trainees at an academic medical center … system to identify unprofessional behaviors and mistreatment directed at trainees at an academic medical center … describes the characteristics of incident reports submitted by trainees in a large academic medical center … system to identify unprofessional behaviors and mistreatment directed at trainees at an academic medical center

57. Institution of just culture physician peer review in an academic medical center. | PSNet
    psnet.ahrq.gov/issue/institution-just-culture-physician-peer-review-academic-medical-center
    October 20, 2021 - Study Institution of just culture physician peer review in an academic medical center … Institution of just culture physician peer review in an academic medical center. … A multidisciplinary panel at one academic medical center established a new approach for physician peer … Institution of just culture physician peer review in an academic medical center.

58. Preventable morbidity at a mature trauma center. | PSNet
    psnet.ahrq.gov/issue/preventable-morbidity-mature-trauma-center
    September 22, 2021 - Study Preventable morbidity at a mature trauma center. … Citation Text: Preventable morbidity at a mature trauma center. … Cite Citation Citation Text: Preventable morbidity at a mature trauma center … 2012 Patient safety in trauma: maximal impact management errors at a level I trauma center

59. Vanderbilt Center for Patient and Professional Advocacy. | PSNet
    psnet.ahrq.gov/issue/vanderbilt-center-patient-and-professional-advocacy
    March 02, 2022 - Multi-use Website Vanderbilt Center for Patient and Professional Advocacy. … Citation Text: Vanderbilt Center for Patient and Professional Advocacy. 2135 Blakemore Ave, Nashville … Copy URL Cite Citation Citation Text: Vanderbilt Center … March 2, 2022 National Center for Patient Safety (NCPS). … October 25, 2017 Center for Health Care Human Factors.

60. Patterns of disrespectful physician behavior at an academic medical center: implications for training, prevention, and remediation. | PSNet
    psnet.ahrq.gov/issue/patterns-disrespectful-physician-behavior-academic-medical-center-implications-training
    June 14, 2023 - Study Patterns of disrespectful physician behavior at an academic medical center: … Patterns of Disrespectful Physician Behavior at an Academic Medical Center: Implications for Training … retrospectively reviewed events involving disrespectful provider behavior at a single academic medical center … Patterns of Disrespectful Physician Behavior at an Academic Medical Center: Implications for Training