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"Never events" and the quest to reduce preventable harm. | PSNet

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June 01, 2016 - Commentary "Never events" and the quest to reduce preventable harm. Citation Text: Austin M, Pronovost P. "Never events" and the quest to reduce preventable harm. Jt Comm J Qual Patient Saf. 2015;41(6):279-288. Copy Citation Format: Google Scholar PubMed BibTeX EndNote X3 X…

Team relations and role perceptions during anesthesia crisis management in magnetic-resonance imaging settings: a mixed-methods exploration. | PSNet

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December 13, 2023 - Study Team relations and role perceptions during anesthesia crisis management in magnetic-resonance imaging settings: a mixed-methods exploration. Citation Text: Schroeck H, Whitty MA, Hatton B, et al. Team relations and role perceptions during anesthesia crisis management in magnetic-re…

Differences in hospitals' workplace violence incident reporting practices: a mixed methods study. | PSNet

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January 19, 2022 - Study Differences in hospitals' workplace violence incident reporting practices: a mixed methods study. Citation Text: Odes R, Chapman SM, Ackerman SL, et al. Differences in hospitals' workplace violence incident reporting practices: a mixed methods study. Policy Polit Nurs Pract. 2022;2…

Characterisations of adverse events detected in a university hospital: a 4-year study using the Global Trigger Tool method. | PSNet

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December 09, 2020 - Study Characterisations of adverse events detected in a university hospital: a 4-year study using the Global Trigger Tool method. Citation Text: Rutberg H, Risberg MB, Sjödahl R, et al. Characterisations of adverse events detected in a university hospital: a 4-year study using the Global…

Clinical impact of medication review and deprescribing in older inpatients: a systematic review and meta-analysis. | PSNet

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April 21, 2021 - Review Clinical impact of medication review and deprescribing in older inpatients: a systematic review and meta-analysis. Citation Text: Carollo M, Crisafulli S, Vitturi G, et al. Clinical impact of medication review and deprescribing in older inpatients: a systematic review and meta‐ana…

Using the Global Trigger Tool in surgical and neurosurgical patients: a feasibility study. | PSNet

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June 09, 2021 - Study Using the Global Trigger Tool in surgical and neurosurgical patients: a feasibility study. Citation Text: Brösterhaus M, Hammer A, Gruber R, et al. Using the Global Trigger Tool in surgical and neurosurgical patients: a feasibility study. PLoS ONE. 2022;17(8):e0272853. doi:10.1371/…

Understanding how rapid response systems may improve safety for the acutely ill patient: learning from the frontline. | PSNet

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July 08, 2015 - Study Understanding how rapid response systems may improve safety for the acutely ill patient: learning from the frontline. Citation Text: Mackintosh N, Rainey H, Sandall J. Understanding how rapid response systems may improve safety for the acutely ill patient: learning from the front…

The Irish National Adverse Events Study (INAES): the frequency and nature of adverse events in Irish hospitals—a retrospective record review study. | PSNet

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March 03, 2021 - Study The Irish National Adverse Events Study (INAES): the frequency and nature of adverse events in Irish hospitals—a retrospective record review study. Citation Text: Rafter N, Hickey A, Conroy RM, et al. The Irish National Adverse Events Study (INAES): the frequency and nature of adve…

High rate of implementation of proposed actions for improvement with the Healthcare Failure Mode Effect Analysis method: evaluation of 117 analyses. | PSNet

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December 09, 2020 - Study High rate of implementation of proposed actions for improvement with the Healthcare Failure Mode Effect Analysis method: evaluation of 117 analyses. Citation Text: Öhrn A, Ericsson C, Andersson C, et al. High Rate of Implementation of Proposed Actions for Improvement With the Healt…

Reporting of sentinel events in Swedish hospitals: a comparison of severe adverse events reported by patients and providers. | PSNet

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December 09, 2020 - Study Reporting of sentinel events in Swedish hospitals: a comparison of severe adverse events reported by patients and providers. Citation Text: Öhrn A, Elfström J, Liedgren C, et al. Reporting of sentinel events in Swedish hospitals: a comparison of severe adverse events reported by …

Is there a relationship between high-quality performance in major teaching hospitals and residents' knowledge of quality and patient safety? | PSNet

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July 21, 2010 - Study Is there a relationship between high-quality performance in major teaching hospitals and residents' knowledge of quality and patient safety? Citation Text: Pingleton SK, Horak BJ, Davis DA, et al. Is there a relationship between high-quality performance in major teaching hospital…

The intended and unintended consequences of communication systems on general internal medicine inpatient care delivery: a prospective observational case study of five teaching hospitals. | PSNet

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October 31, 2011 - Study The intended and unintended consequences of communication systems on general internal medicine inpatient care delivery: a prospective observational case study of five teaching hospitals. Citation Text: Wu RC, Lo V, Morra D, et al. The intended and unintended consequences of communi…

Office surgery incidents: what seven years of Florida data show us. | PSNet

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August 19, 2009 - Study Office surgery incidents: what seven years of Florida data show us. Citation Text: Coldiron BM, Healy C, Bene NI. Office surgery incidents: what seven years of Florida data show us. Dermatol Surg. 2008;34(3):285-91; discussion 291-2. doi:10.1111/j.1524-4725.2007.34060.x. Copy C…

Medical errors during training: how do residents cope?: a descriptive study. | PSNet

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October 13, 2021 - Study Medical errors during training: how do residents cope?: a descriptive study. Citation Text: Fatima S, Soria S, Esteban- Cruciani N. Medical errors during training: how do residents cope?: a descriptive study. BMC Med Educ. 2021;21(1):408. doi:10.1186/s12909-021-02850-1. Copy Cit…

Learning from patient safety incidents: The Green Cross method. | PSNet

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June 14, 2023 - Study Learning from patient safety incidents: The Green Cross method. Citation Text: Jacobsen HK, Ballangrud R, Birkeli GH. Learning from patient safety incidents: the Green Cross method. Nurs Crit Care. 2024;Epub Jun 26. doi:10.1111/nicc.13114. Copy Citation Format: DOI Go…

The process and perspective of serious incident investigations in adult community mental health services: integrative review and synthesis. | PSNet

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February 07, 2024 - Review The process and perspective of serious incident investigations in adult community mental health services: integrative review and synthesis. Citation Text: Haylor H, Sparkes T, Armitage G, et al. The process and perspective of serious incident investigations in adult community ment…

Common contributing factors of diagnostic error: a retrospective analysis of 109 serious adverse event reports from Dutch hospitals. | PSNet

psnet.ahrq.gov/issue/common-contributing-factors-diagnostic-error-retrospective-analysis-109-serious-adverse-event

September 14, 2022 - Study Common contributing factors of diagnostic error: a retrospective analysis of 109 serious adverse event reports from Dutch hospitals. Citation Text: Hooftman J, Dijkstra AC, Suurmeijer I, et al. Common contributing factors of diagnostic error: a retrospective analysis of 109 serious…

Testing process errors and their harms and consequences reported from family medicine practices: a study of the American Academy of Family Physicians National Research Network. | PSNet

psnet.ahrq.gov/issue/testing-process-errors-and-their-harms-and-consequences-reported-family-medicine-practices

June 11, 2008 - Study Testing process errors and their harms and consequences reported from family medicine practices: a study of the American Academy of Family Physicians National Research Network. Citation Text: Hickner J, Graham DG, Elder NC, et al. Testing process errors and their harms and conseq…

Quality improvements in decreasing medication administration errors made by nursing staff in an academic medical center hospital: a trend analysis during the journey to Joint Commission International accreditation and in the post-accreditation era. | PSNet

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March 24, 2019 - Study Quality improvements in decreasing medication administration errors made by nursing staff in an academic medical center hospital: a trend analysis during the journey to Joint Commission International accreditation and in the post-accreditation era. Citation Text: Wang H-F, Jin J-F,…

Using clinical simulation to study how to improve quality and safety in healthcare. | PSNet

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March 31, 2021 - Review Classic Using clinical simulation to study how to improve quality and safety in healthcare. Citation Text: Lamé G, Dixon-Woods M. Using clinical simulation to study how to improve quality and safety in healthcare. BMJ Simul Technol Enhanc Learn. 2018;6(2)…

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