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Laboratory test ordering and results management systems: a qualitative study of safety risks identified by administrators in general practice. | PSNet

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March 16, 2016 - Study Laboratory test ordering and results management systems: a qualitative study of safety risks identified by administrators in general practice. Citation Text: Bowie P, Halley L, McKay J. Laboratory test ordering and results management systems: a qualitative study of safety risks id…

What are the implications for patient safety and experience of a major healthcare IT breakdown? A qualitative study. | PSNet

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December 14, 2022 - Study What are the implications for patient safety and experience of a major healthcare IT breakdown? A qualitative study. Citation Text: Scantlebury A, Sheard L, Fedell C, et al. What are the implications for patient safety and experience of a major healthcare IT breakdown? A qualitativ…

Information flow during pediatric trauma care transitions: things falling through the cracks. | PSNet

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February 16, 2022 - Study Information flow during pediatric trauma care transitions: things falling through the cracks. Citation Text: Hoonakker PLT, Wooldridge AR, Hose B-Z, et al. Information flow during pediatric trauma care transitions: things falling through the cracks. Intern Emerg Med. 2019;14(5):797…

Disaster ergonomics: human factors in COVID-19 pandemic emergency management. | PSNet

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September 30, 2020 - Commentary Disaster ergonomics: human factors in COVID-19 pandemic emergency management. Citation Text: Sasangohar F, Moats J, Mehta R, et al. Disaster ergonomics: human factors in COVID-19 pandemic emergency management. Hum Factors. 2020;62(7):1061-1068. doi:10.1177/0018720820939428. …

Prevalence and nature of adverse medical device events in hospitalized children. | PSNet

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October 05, 2011 - Study Prevalence and nature of adverse medical device events in hospitalized children. Citation Text: Brady PW, Varadarajan K, Peterson LE, et al. Prevalence and nature of adverse medical device events in hospitalized children. J Hosp Med. 2013;8(7):390-3. doi:10.1002/jhm.2058. Copy …

Medical line entanglement: the unspoken patient safety hazard of medical devices. | PSNet

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May 08, 2019 - Study Medical line entanglement: the unspoken patient safety hazard of medical devices. Citation Text: Larimer C, Sumner V, Wander D. Medical line entanglement: the unspoken patient safety hazard of medical devices. Nutr Clin Pract. 2023;38(6):1296-1308. doi:10.1002/ncp.11000. Copy Cit…

Low perfusion and missed diagnosis of hypoxemia by pulse oximetry in darkly pigmented skin: a prospective study. | PSNet

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March 14, 2022 - Study Low perfusion and missed diagnosis of hypoxemia by pulse oximetry in darkly pigmented skin: a prospective study. Citation Text: Gudelunas MK, Lipnick M, Hendrickson C, et al. Low perfusion and missed diagnosis of hypoxemia by pulse oximetry in darkly pigmented skin: a prospective s…

Improving end-of-rotation transitions of care among ICU patients | PSNet

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September 23, 2020 - Journal Article Improving end-of-rotation transitions of care among ICU patients Citation Text: Denson JL, Knoeckel J, Kjerengtroen S, et al. Improving end-of-rotation transitions of care among ICU patients. BMJ Qual Saf. 2019;29(3):250-259. doi:10.1136/bmjqs-2019-009867. Copy Citation…

Reducing ambulatory central line-associated bloodstream infections: a family-centered approach. | PSNet

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February 15, 2023 - Study Reducing ambulatory central line-associated bloodstream infections: a family-centered approach. Citation Text: Wong CI, Ilowite M, Yan A, et al. Reducing ambulatory central line‐associated bloodstream infections: a family‐centered approach. Pediatr Blood Cancer. 2024;71(8):e31064. …

Use of in-situ simulation to investigate latent safety threats prior to opening a new emergency department. | PSNet

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January 20, 2021 - Study Use of in-situ simulation to investigate latent safety threats prior to opening a new emergency department. Citation Text: Medwid K, Smith SW, Gang M. Use of in-situ simulation to investigate latent safety threats prior to opening a new emergency department. Safety Sci. 2015;77:19-…

Work system barriers and facilitators in inpatient care transitions of pediatric trauma patients. | PSNet

psnet.ahrq.gov/issue/work-system-barriers-and-facilitators-inpatient-care-transitions-pediatric-trauma-patients

September 11, 2019 - Study Work system barriers and facilitators in inpatient care transitions of pediatric trauma patients. Citation Text: Wooldridge AR, Carayon P, Hoonakker P, et al. Work system barriers and facilitators in inpatient care transitions of pediatric trauma patients. App Ergon. 2020;85:103059…

Pharmacy dispensing of electronically discontinued medications. | PSNet

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October 03, 2012 - Study Pharmacy dispensing of electronically discontinued medications. Citation Text: Allen AS, Sequist TD. Pharmacy dispensing of electronically discontinued medications. Ann Intern Med. 2012;157(10):700-705. doi:10.7326/0003-4819-157-10-201211200-00006. Copy Citation Format: …

Opportunities to improve diagnosis in emergency transfers to the pediatric intensive care unit. | PSNet

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June 28, 2023 - Study Opportunities to improve diagnosis in emergency transfers to the pediatric intensive care unit. Citation Text: Mehta SD, Congdon M, Phillips CA, et al. Opportunities to improve diagnosis in emergency transfers to the pediatric intensive care unit. J Hosp Med. 2023;18(6):509-518. do…

High 5s initiative: implementation of medication reconciliation in France a 5 years experimentation. | PSNet

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August 04, 2021 - Commentary High 5s initiative: implementation of medication reconciliation in France a 5 years experimentation. Citation Text: Dufay É, Doerper S, Michel B, et al. High 5s initiative: implementation of medication reconciliation in France a 5 years experimentation. Safety in Health. 2017;…

Integrating adverse event reporting into a free-text mobile application used in daily workflow increases adverse event reporting by physicians. | PSNet

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March 17, 2021 - Study Integrating adverse event reporting into a free-text mobile application used in daily workflow increases adverse event reporting by physicians. Citation Text: Delio J, Catalanotti JS, Marko K, et al. Integrating Adverse Event Reporting Into a Free-Text Mobile Application Used in Da…

Improving medication safety during hospital-based transitions of care. | PSNet

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May 08, 2017 - Commentary Improving medication safety during hospital-based transitions of care. Citation Text: Sponsler KC, Neal EB, Kripalani S. Improving medication safety during hospital-based transitions of care. Cleve Clin J Med. 2015;82(6):351-360. doi:10.3949/ccjm.82a.14025. Copy Citation …

Incident reporting systems: what will it take to make them less frustrating and achieve anything useful? | PSNet

psnet.ahrq.gov/issue/incident-reporting-systems-what-will-it-take-make-them-less-frustrating-and-achieve-anything

November 03, 2021 - Commentary Incident reporting systems: what will it take to make them less frustrating and achieve anything useful? Citation Text: Shojania KG. Incident reporting systems: what will it take to make them less frustrating and achieve anything useful? Jt Comm J Qual Patient Saf. 2021;47(12)…

Assessing reasons for decreased primary care access for individuals on prescribed opioids: an audit study. | PSNet

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November 17, 2021 - Study Assessing reasons for decreased primary care access for individuals on prescribed opioids: an audit study. Citation Text: Lagisetty P, Macleod C, Thomas J, et al. Assessing reasons for decreased primary care access for individuals on prescribed opioids. Pain. 2021;162(5):1379-1386.…

A human factors and survey methodology-based design of a web-based adverse event reporting system for families. | PSNet

psnet.ahrq.gov/issue/human-factors-and-survey-methodology-based-design-web-based-adverse-event-reporting-system

January 12, 2012 - Study A human factors and survey methodology-based design of a web-based adverse event reporting system for families. Citation Text: Daniels JP, King AD, Cochrane D, et al. A human factors and survey methodology-based design of a web-based adverse event reporting system for families. Int…

The additional cost of perioperative medication errors | PSNet

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July 24, 2024 - Study The additional cost of perioperative medication errors Citation Text: Langlieb ME, Sharma P, Hocevar M, et al. The additional cost of perioperative medication errors. J Patient Saf. 2023;19(6):375-378. doi:10.1097/pts.0000000000001136. Copy Citation Format: DOI Google…

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