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A case of transfusion error in a trauma patient with subsequent root cause analysis leading to institutional change. | PSNet

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March 30, 2022 - Commentary A case of transfusion error in a trauma patient with subsequent root cause analysis leading to institutional change. Citation Text: Clifford SP, Mick PB, Derhake BM. A case of transfusion error in a trauma patient with subsequent root cause analysis leading to institutional ch…

Prospective evaluation of consultant surgeon sleep deprivation and outcomes in more than 4000 consecutive cardiac surgical procedures. | PSNet

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October 19, 2022 - Study Prospective evaluation of consultant surgeon sleep deprivation and outcomes in more than 4000 consecutive cardiac surgical procedures. Citation Text: Chu MWA, Stitt LW, Fox SA, et al. Prospective evaluation of consultant surgeon sleep deprivation and outcomes in more than 4000 cons…

Confronting safety gaps across labor and delivery teams. | PSNet

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December 04, 2013 - Study Confronting safety gaps across labor and delivery teams. Citation Text: Maxfield DG, Lyndon A, Kennedy HP, et al. Confronting safety gaps across labor and delivery teams. Am J Obstet Gynecol. 2013;209(5). doi:10.1016/j.ajog.2013.07.013. Copy Citation Format: DOI Googl…

Extended work duration and the risk of self-reported percutaneous injuries in interns. | PSNet

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January 07, 2011 - Study Extended work duration and the risk of self-reported percutaneous injuries in interns. Citation Text: Ayas N, Barger LK, Cade BE, et al. Extended work duration and the risk of self-reported percutaneous injuries in interns. JAMA. 2006;296(9):1055-62. Copy Citation Format: …

Effects of a night-team system on resident sleep and work hours. | PSNet

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November 16, 2022 - Study Effects of a night-team system on resident sleep and work hours. Citation Text: Chua K-P, Gordon M, Sectish TC, et al. Effects of a night-team system on resident sleep and work hours. Pediatrics. 2011;128(6):1142-7. doi:10.1542/peds.2011-1049. Copy Citation Format: DO…

Adapting cognitive task analysis to investigate clinical decision making and medication safety incidents. | PSNet

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March 10, 2021 - Study Adapting cognitive task analysis to investigate clinical decision making and medication safety incidents. Citation Text: Russ AL, Militello LG, Glassman PA, et al. Adapting Cognitive Task Analysis to Investigate Clinical Decision Making and Medication Safety Incidents. J Patient Sa…

The proportion of errors in medical prescriptions and their executions among hospitalized children before and during accreditation. | PSNet

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June 15, 2012 - Study The proportion of errors in medical prescriptions and their executions among hospitalized children before and during accreditation. Citation Text: Mekory TM, Bahat H, Bar-Oz B, et al. The proportion of errors in medical prescriptions and their executions among hospitalized children…

Content analysis of nurses' reflections on medication errors in a regional hospital. | PSNet

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December 23, 2020 - Study Content analysis of nurses' reflections on medication errors in a regional hospital. Citation Text: Issacs AN, RAYMOND A, KENT B. Content analysis of nurses’ reflections on medication errors in a regional hospital. Contemp Nurse. 2023;59(3):202-213. doi:10.1080/10376178.2023.222043…

Impact of sample size on variation of adverse events and preventable adverse events: systematic review on epidemiology and contributing factors. | PSNet

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May 15, 2024 - Review Impact of sample size on variation of adverse events and preventable adverse events: systematic review on epidemiology and contributing factors. Citation Text: Lessing C, Schmitz A, Albers B, et al. Impact of sample size on variation of adverse events and preventable adverse eve…

Automation of the I-PASS tool to improve transitions of care. | PSNet

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August 04, 2021 - Study Automation of the I-PASS tool to improve transitions of care. Citation Text: Skaret MM, Weaver TD, Humes RJ, et al. Automation of the I-PASS Tool to Improve Transitions of Care. J Healthc Qual. 2019;41(5):274-280. doi:10.1097/JHQ.0000000000000174. Copy Citation Format: …

Patient harm events and associated cost outcomes reported to a patient safety organization. | PSNet

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July 18, 2017 - Study Patient harm events and associated cost outcomes reported to a patient safety organization. Citation Text: Miller S, Stockwell DC. Patient harm events and associated cost outcomes reported to a patient safety organization. J Patient Saf. 2024;20(7):e92-e96. doi:10.1097/pts.00000000…

"Sign right here and you're good to go": a content analysis of audiotaped emergency department discharge instructions. | PSNet

psnet.ahrq.gov/issue/sign-right-here-and-youre-good-go-content-analysis-audiotaped-emergency-department-discharge

December 18, 2013 - Study "Sign right here and you're good to go": a content analysis of audiotaped emergency department discharge instructions. Citation Text: Vashi A, Rhodes K. "Sign right here and you're good to go": a content analysis of audiotaped emergency department discharge instructions. Ann Emer…

Error reduction and performance improvement in the emergency department through formal teamwork training: evaluation results of the MedTeams project. | PSNet

psnet.ahrq.gov/issue/error-reduction-and-performance-improvement-emergency-department-through-formal-teamwork

June 24, 2015 - Study Classic Error reduction and performance improvement in the emergency department through formal teamwork training: evaluation results of the MedTeams project. Citation Text: Morey JC, Simon R, Jay G, et al. Error reduction and performance improvement in t…

Pediatric medication safety considerations for pharmacists in an adult hospital setting. | PSNet

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January 29, 2020 - Commentary Pediatric medication safety considerations for pharmacists in an adult hospital setting. Citation Text: Kennedy AR, Massey LR. Pediatric medication safety considerations for pharmacists in an adult hospital setting. Am J Health Syst Pharm. 2019;76(19):1481-1491. doi:10.1093/aj…

Veterans Health Administration response to the COVID-19 crisis: surveillance to action. | PSNet

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November 17, 2021 - Commentary Veterans Health Administration response to the COVID-19 crisis: surveillance to action. Citation Text: Charles MA, Yackel EE, Mills PD, et al. Veterans Health Administration response to the COVID-19 crisis: surveillance to action. J Patient Saf. 2022;18(7):686-691. doi:10.1097…

Awareness of racial and ethnic bias and potential solutions to address bias with use of health care algorithms. | PSNet

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November 16, 2022 - Study Awareness of racial and ethnic bias and potential solutions to address bias with use of health care algorithms. Citation Text: Jain A, Brooks JR, Alford CC, et al. Awareness of racial and ethnic bias and potential solutions to address bias with use of health care algorithms. JAMA H…

Patients' concerns about medical errors during hospitalization. | PSNet

psnet.ahrq.gov/issue/patients-concerns-about-medical-errors-during-hospitalization

December 22, 2008 - Study Classic Patients' concerns about medical errors during hospitalization. Citation Text: Burroughs TE, Waterman AD, Gallagher TH, et al. Patients' concerns about medical errors during hospitalization. Jt Comm J Qual Patient Saf. 2007;33(1):5-14. Copy Citat…

Society for Maternal-Fetal Medicine Special Statement: telemedicine in obstetrics-quality and safety considerations. | PSNet

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August 10, 2022 - Organizational Policy/Guidelines Society for Maternal-Fetal Medicine Special Statement: telemedicine in obstetrics-quality and safety considerations. Citation Text: Healy A, Davidson C, Allbert J, et al. Society for Maternal-Fetal Medicine Special Statement: telemedicine in obstetrics-qu…

Putting knowledge into practice: does information on adverse drug interactions influence people's dosing behaviour? | PSNet

psnet.ahrq.gov/issue/putting-knowledge-practice-does-information-adverse-drug-interactions-influence-peoples

June 14, 2023 - Study Putting knowledge into practice: does information on adverse drug interactions influence people's dosing behaviour? Citation Text: Dohle S, Dawson IGJ. Putting knowledge into practice: Does information on adverse drug interactions influence people's dosing behaviour? Br J Health Ps…

Predictors and triggers of incivility within healthcare teams: a systematic review of the literature. | PSNet

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July 21, 2011 - Review Predictors and triggers of incivility within healthcare teams: a systematic review of the literature. Citation Text: Keller S, Yule S, Zagarese V, et al. Predictors and triggers of incivility within healthcare teams: a systematic review of the literature. BMJ Open. 2020;10(6):e035…

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