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  1. Medical error, incident investigation and the second victim: doing better but feeling worse? | PSNet

    psnet.ahrq.gov/issue/medical-error-incident-investigation-and-second-victim-doing-better-feeling-worse
    July 29, 2020 - Commentary Medical error, incident investigation and the second victim: doing better but feeling worse? Citation Text: Wu AW, Steckelberg RC. Medical error, incident investigation and the second victim: doing better but feeling worse? BMJ Qual Saf. 2012;21(4):267-70. doi:10.1136/bmjqs-20…

  2. Medication errors in family practice, in hospitals and after discharge from the hospital: an ethical analysis. | PSNet

    psnet.ahrq.gov/issue/medication-errors-family-practice-hospitals-and-after-discharge-hospital-ethical-analysis
    September 23, 2020 - Commentary Medication errors in family practice, in hospitals and after discharge from the hospital: an ethical analysis. Citation Text: Clark PA. Medication errors in family practice, in hospitals and after discharge from the hospital: an ethical analysis. J Law Med Ethics. 2004;32(2)…

  3. The hospital ran out of her child's cancer drug. Now she's fighting to end shortages. | PSNet

    psnet.ahrq.gov/issue/hospital-ran-out-her-childs-cancer-drug-now-shes-fighting-end-shortages
    February 06, 2019 - Newspaper/Magazine Article The hospital ran out of her child's cancer drug. Now she's fighting to end shortages. Citation Text: The hospital ran out of her child's cancer drug. Now she's fighting to end shortages. Noguchi Y. Health Shots and All Things Considered. National Public Ra…

  4. Pediatric vaccination errors: application of the "5 rights" framework to a national error reporting database. | PSNet

    psnet.ahrq.gov/issue/pediatric-vaccination-errors-application-5-rights-framework-national-error-reporting-database
    September 21, 2008 - Study Pediatric vaccination errors: application of the "5 rights" framework to a national error reporting database. Citation Text: Bundy DG, Shore AD, Morlock L, et al. Pediatric vaccination errors: application of the "5 rights" framework to a national error reporting database. Vaccine.…

  5. Safety analysis over time: seven major changes to adverse event investigation. | PSNet

    psnet.ahrq.gov/issue/safety-analysis-over-time-seven-major-changes-adverse-event-investigation
    September 24, 2018 - Commentary Safety analysis over time: seven major changes to adverse event investigation. Citation Text: Vincent CA, Carthey J, Macrae C, et al. Safety analysis over time: seven major changes to adverse event investigation. Implementation Science. 2017;12(1). doi:10.1186/s13012-017-0695-…

  6. The cost of pneumonia after acute stroke. | PSNet

    psnet.ahrq.gov/issue/cost-pneumonia-after-acute-stroke
    August 04, 2021 - Study The cost of pneumonia after acute stroke. Citation Text: Katzan IL, Dawson NV, Thomas CL, et al. The cost of pneumonia after acute stroke. Neurology. 2007;68(22). doi:10.1212/01.wnl.0000263187.08969.45. Copy Citation Format: DOI Google Scholar BibTeX EndNote X3 XML …

  7. Blinding or information control in diagnosis: could it reduce errors in clinical decision-making? | PSNet

    psnet.ahrq.gov/issue/blinding-or-information-control-diagnosis-could-it-reduce-errors-clinical-decision-making
    October 13, 2018 - Review Blinding or information control in diagnosis: could it reduce errors in clinical decision-making? Citation Text: Lockhart JJ, Satya-Murti S. Blinding or information control in diagnosis: could it reduce errors in clinical decision-making? Diagnosis (Berl). 2018;5(4):179-189. doi:1…

  8. Overdiagnosis in primary care: framing the problem and finding solutions. | PSNet

    psnet.ahrq.gov/issue/overdiagnosis-primary-care-framing-problem-and-finding-solutions
    November 01, 2017 - Review Emerging Classic Overdiagnosis in primary care: framing the problem and finding solutions. Citation Text: Kale MS, Korenstein D. Overdiagnosis in primary care: framing the problem and finding solutions. BMJ. 2018;362:k2820. doi:10.1136/bmj.k2820. Copy C…

  9. The relationship between patients' perceptions of team effectiveness and their care experience in the emergency department. | PSNet

    psnet.ahrq.gov/issue/relationship-between-patients-perceptions-team-effectiveness-and-their-care-experience
    June 08, 2011 - Study The relationship between patients' perceptions of team effectiveness and their care experience in the emergency department. Citation Text: Kipnis A, Rhodes K, Burchill CN, et al. The relationship between patients' perceptions of team effectiveness and their care experience in the…

  10. Optimizing smart pump technology by increasing critical safety alerts and reducing clinically insignificant alerts. | PSNet

    psnet.ahrq.gov/issue/optimizing-smart-pump-technology-increasing-critical-safety-alerts-and-reducing-clinically
    February 12, 2014 - Study Optimizing smart pump technology by increasing critical safety alerts and reducing clinically insignificant alerts. Citation Text: Mansfield J, Jarrett S. Optimizing smart pump technology by increasing critical safety alerts and reducing clinically insignificant alerts. Hosp Pharm.…

  11. Guidelines for prevention, diagnosis and treatment of ventilator-associated pneumonia (VAP) in the trauma patient. | PSNet

    psnet.ahrq.gov/issue/guidelines-prevention-diagnosis-and-treatment-ventilator-associated-pneumonia-vap-trauma
    October 19, 2022 - Organizational Policy/Guidelines Guidelines for prevention, diagnosis and treatment of ventilator-associated pneumonia (VAP) in the trauma patient. Citation Text: Minei JP, Nathens AB, West M, et al. Guidelines for prevention, diagnosis and treatment of ventilator-associated pneumonia (V…

  12. A systematic review of the performance characteristics of clinical event monitor signals used to detect adverse drug events in the hospital setting. | PSNet

    psnet.ahrq.gov/issue/systematic-review-performance-characteristics-clinical-event-monitor-signals-used-detect
    March 28, 2012 - Review A systematic review of the performance characteristics of clinical event monitor signals used to detect adverse drug events in the hospital setting. Citation Text: Handler S, Altman RL, Perera S, et al. A systematic review of the performance characteristics of clinical event mon…

  13. Residents' reflections on quality improvement: temporal stability and associations with preventability of adverse patient events. | PSNet

    psnet.ahrq.gov/issue/residents-reflections-quality-improvement-temporal-stability-and-associations-preventability
    September 20, 2011 - Study Residents' reflections on quality improvement: temporal stability and associations with preventability of adverse patient events. Citation Text: Wittich CM, Reed DA, Drefahl MM, et al. Residents' reflections on quality improvement: temporal stability and associations with preventab…

  14. Electronic results management in pediatric ambulatory care: qualitative assessment. | PSNet

    psnet.ahrq.gov/issue/electronic-results-management-pediatric-ambulatory-care-qualitative-assessment
    September 26, 2012 - Study Electronic results management in pediatric ambulatory care: qualitative assessment. Citation Text: Ferris T, Johnson SA, Co JPT, et al. Electronic results management in pediatric ambulatory care: qualitative assessment. Pediatrics. 2009;123 Suppl 2:S85-91. doi:10.1542/peds.2008-1…

  15. An adverse event screening tool based on routinely collected hospital-acquired diagnoses. | PSNet

    psnet.ahrq.gov/issue/adverse-event-screening-tool-based-routinely-collected-hospital-acquired-diagnoses
    July 23, 2008 - Study An adverse event screening tool based on routinely collected hospital-acquired diagnoses. Citation Text: Brand CA, Tropea J, Gorelik A, et al. An adverse event screening tool based on routinely collected hospital-acquired diagnoses. Int J Qual Health Care. 2012;24(3):266-78. doi:10…

  16. Parent preferences for medical error disclosure: a qualitative study. | PSNet

    psnet.ahrq.gov/issue/parent-preferences-medical-error-disclosure-qualitative-study
    January 25, 2017 - Study Parent preferences for medical error disclosure: a qualitative study. Citation Text: Coffey M, Espin S, Hahmann T, et al. Parent Preferences for Medical Error Disclosure: A Qualitative Study. Hosp Pediatr. 2017;7(1):24-30. doi:10.1542/hpeds.2016-0048. Copy Citation Format: …

  17. Patterns of errors contributing to trauma mortality: lessons learned from 2,594 deaths. | PSNet

    psnet.ahrq.gov/issue/patterns-errors-contributing-trauma-mortality-lessons-learned-2594-deaths
    March 24, 2021 - Study Patterns of errors contributing to trauma mortality: lessons learned from 2,594 deaths. Citation Text: Gruen RL, Jurkovich GJ, McIntyre LK, et al. Patterns of Errors Contributing to Trauma Mortality. Transactions of the .. Meeting of the American Surgical Association. 2006;124. d…

  18. When should a multicampus hospital be considered a single entity for public reporting on patient safety issues? | PSNet

    psnet.ahrq.gov/issue/when-should-multicampus-hospital-be-considered-single-entity-public-reporting-patient-safety
    June 28, 2011 - Commentary When should a multicampus hospital be considered a single entity for public reporting on patient safety issues? Citation Text: Naessens JM, Culbertson R, Lefante JJ, et al. When should a multicampus hospital be considered a single entity for public reporting on patient safet…

  19. "What's psychology got to do with it?" Applying psychological theory to understanding failures in modern healthcare settings. | PSNet

    psnet.ahrq.gov/issue/whats-psychology-got-do-it-applying-psychological-theory-understanding-failures-modern
    July 10, 2017 - Commentary "What's psychology got to do with it?" Applying psychological theory to understanding failures in modern healthcare settings. Citation Text: Rydon-Grange M. 'What's Psychology got to do with it?' Applying psychological theory to understanding failures in modern healthcare sett…

  20. Double checking medicines: defence against error or contributory factor? | PSNet

    psnet.ahrq.gov/issue/double-checking-medicines-defence-against-error-or-contributory-factor
    January 31, 2024 - Study Double checking medicines: defence against error or contributory factor? Citation Text: Armitage G. Double checking medicines: defence against error or contributory factor? J Eval Clin Pract. 2008;14(4):513-9. Copy Citation Format: Google Scholar PubMed BibTeX EndNo…
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