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Learning from different lenses: reports of medical errors in primary care by clinicians, staff, and patients: a project of the American Academy of Family Physicians National Research Network. | PSNet

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June 11, 2008 - Study Learning from different lenses: reports of medical errors in primary care by clinicians, staff, and patients: a project of the American Academy of Family Physicians National Research Network. Citation Text: Phillips RL, Dovey SM, Graham D, et al. Learning From Different Lenses: R…

Nurse-physician communication during labor and birth: implications for patient safety. | PSNet

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January 03, 2017 - Study Nurse-physician communication during labor and birth: implications for patient safety. Citation Text: Simpson KR, James DC, Knox E. Nurse-physician communication during labor and birth: implications for patient safety. J Obstet Gynecol Neonatal Nurs. 2006;35(4):547-56. Copy Cit…

Impact of CRM-based team training on obstetric outcomes and clinicians' patient safety attitudes. | PSNet

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January 12, 2011 - Study Classic Impact of CRM-based team training on obstetric outcomes and clinicians' patient safety attitudes. Citation Text: Pratt SD, Mann S, Salisbury M, et al. John M. Eisenberg Patient Safety and Quality Awards. Impact of CRM-based training on obstetric ou…

Improving health care quality and patient safety through peer-to-peer assessment: demonstration project in two academic medical centers. | PSNet

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March 14, 2018 - Study Improving health care quality and patient safety through peer-to-peer assessment: demonstration project in two academic medical centers. Citation Text: Mort E, Bruckel J, Donelan K, et al. Improving Health Care Quality and Patient Safety Through Peer-to-Peer Assessment: Demonstrati…

Systems analysis of adverse drug events. | PSNet

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February 10, 2011 - Study Classic Systems analysis of adverse drug events. Citation Text: Leape L, Bates DW, Cullen DJ, et al. Systems analysis of adverse drug events. ADE Prevention Study Group. JAMA. 1995;274(1):35-43. Copy Citation Format: Google Scholar PubMed B…

Using a potentially aggressive/violent patient huddle to improve health care safety. | PSNet

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November 16, 2022 - Commentary Using a potentially aggressive/violent patient huddle to improve health care safety. Citation Text: Larson LA, Finley JL, Gross TL, et al. Using a Potentially Aggressive/Violent Patient Huddle to Improve Health Care Safety. Jt Comm J Qual Patient Saf. 2019;45(2):74-80. doi:10.…

Putting out fires: a qualitative study exploring the use of patient complaints to drive improvement at three academic hospitals. | PSNet

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October 27, 2021 - Study Putting out fires: a qualitative study exploring the use of patient complaints to drive improvement at three academic hospitals. Citation Text: Liu JJ, Rotteau L, Bell CM, et al. Putting out fires: a qualitative study exploring the use of patient complaints to drive improvement at …

Medicare letters to curb overprescribing of controlled substances had no detectable effect on providers. | PSNet

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May 25, 2016 - Study Medicare letters to curb overprescribing of controlled substances had no detectable effect on providers. Citation Text: Sacarny A, Yokum D, Finkelstein A, et al. Medicare Letters To Curb Overprescribing Of Controlled Substances Had No Detectable Effect On Providers. Health Aff (Mil…

Simulation based teamwork training for emergency department staff: does it improve clinical team performance when added to an existing didactic teamwork curriculum? | PSNet

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December 22, 2009 - Study Classic Simulation based teamwork training for emergency department staff: does it improve clinical team performance when added to an existing didactic teamwork curriculum? Citation Text: Shapiro MJ, Morey JC, Small SD, et al. Simulation based teamwork t…

Effect of an electronic medication reconciliation application and process redesign on potential adverse drug events: a cluster-randomized trial. | PSNet

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June 09, 2011 - Study Classic Effect of an electronic medication reconciliation application and process redesign on potential adverse drug events: a cluster-randomized trial. Citation Text: Schnipper JL, Hamann C, Ndumele CD, et al. Effect of an electronic medication reconcil…

Learning from complaints in healthcare: a realist review of academic literature, policy evidence and front-line insights. | PSNet

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January 12, 2022 - Review Emerging Classic Learning from complaints in healthcare: a realist review of academic literature, policy evidence and front-line insights. Citation Text: van Dael J, Reader TW, Gillespie A, et al. Learning from complaints in healthcare: a realist review o…

Developing a standard handoff process for operating room–to-ICU transitions: multidisciplinary clinician perspectives from the Handoffs and Transitions in Critical Care (HATRICC) study. | PSNet

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February 06, 2019 - Study Developing a standard handoff process for operating room–to-ICU transitions: multidisciplinary clinician perspectives from the Handoffs and Transitions in Critical Care (HATRICC) study. Citation Text: Lane-Fall MB, Pascual JL, Massa S, et al. Developing a Standard Handoff Process f…

Medication errors at hospital admission and discharge: risk factors and impact of medication reconciliation process to improve healthcare. | PSNet

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November 10, 2021 - Study Medication errors at hospital admission and discharge: risk factors and impact of medication reconciliation process to improve healthcare. Citation Text: Breuker C, Macioce V, Mura T, et al. Medication errors at hospital admission and discharge: risk factors and impact of medicatio…

Effect of interventions to improve safety culture on healthcare workers in hospital settings: a systematic review of the international literature. | PSNet

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September 06, 2023 - Review Effect of interventions to improve safety culture on healthcare workers in hospital settings: a systematic review of the international literature. Citation Text: Finn M, Walsh A, Rafter N, et al. Effect of interventions to improve safety culture on healthcare workers in hospital s…

Perioperative safety determinants in ethnic patient groups. | PSNet

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February 09, 2022 - Study Perioperative safety determinants in ethnic patient groups. Citation Text: Bloo G, Calsbeek H, Westert GP, et al. Perioperative safety determinants in ethnic patient groups. J Patient Saf Risk Manag. 2023;28(1):31-46. doi:10.1177/25160435231151545. Copy Citation Format: …

Does learning from mistakes have to be painful? Analysis of 5 years' experience from the Leeds radiology educational cases meetings identifies common repetitive reporting errors and suggests acknowledging and celebrating excellence (ACE) as a more positive way of teaching the same lessons. | PSNet

psnet.ahrq.gov/issue/does-learning-mistakes-have-be-painful-analysis-5-years-experience-leeds-radiology

April 05, 2013 - Study Does learning from mistakes have to be painful? Analysis of 5 years' experience from the Leeds radiology educational cases meetings identifies common repetitive reporting errors and suggests acknowledging and celebrating excellence (ACE) as a more positive way of teaching the same lessons. …

Providers' perceptions of communication breakdowns in cancer care. | PSNet

psnet.ahrq.gov/issue/providers-perceptions-communication-breakdowns-cancer-care

March 11, 2013 - Study Providers' perceptions of communication breakdowns in cancer care. Citation Text: Prouty CD, Mazor KM, Greene SM, et al. Providers' perceptions of communication breakdowns in cancer care. J Gen Intern Med. 2014;29(8):1122-30. doi:10.1007/s11606-014-2769-1. Copy Citation Forma…

Multifactorial interventions to reduce duration and variability in delays to identification of serious injury after falls in hospital inpatients. | PSNet

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July 20, 2022 - Study Multifactorial interventions to reduce duration and variability in delays to identification of serious injury after falls in hospital inpatients. Citation Text: Saleem J, Sarma D, Wright H, et al. Multifactorial interventions to reduce duration and variability in delays to identifi…

A multi-facetted patient safety resource--a qualitative interview study on hospital managers' perception of the nurse-led Rapid Response Team. | PSNet

psnet.ahrq.gov/issue/multi-facetted-patient-safety-resource-qualitative-interview-study-hospital-managers

September 20, 2023 - Study A multi-facetted patient safety resource--a qualitative interview study on hospital managers' perception of the nurse-led Rapid Response Team. Citation Text: Axelsen MS, Baumgarten M, Egholm CL, et al. A multi‐facetted patient safety resource—a qualitative interview study on hospit…

Situation awareness and the mitigation of risk associated with patient deterioration: a meta-narrative review of theories and models and their relevance to nursing practice. | PSNet

psnet.ahrq.gov/issue/situation-awareness-and-mitigation-risk-associated-patient-deterioration-meta-narrative

December 08, 2021 - Review Situation awareness and the mitigation of risk associated with patient deterioration: a meta-narrative review of theories and models and their relevance to nursing practice. Citation Text: Walshe N, Ryng S, Drennan J, et al. Situation awareness and the mitigation of risk associate…

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