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psnet.ahrq.gov/node/73901/psn-pdf
September 29, 2021 - A second reviewer evaluated
a subset of the “Good Catch” cases and there was 80% agreement between the
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psnet.ahrq.gov/submit-innovations-landing
February 26, 2025 - organizations are encouraged to submit new or reimagined patient safety innovations that have been implemented, evaluated
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psnet.ahrq.gov/issue/pearls-pitfalls-and-errors-musculoskeletal-diagnosis
February 26, 2025 - December 6, 2017
Why Current Breast Pathology Practices Must Be Evaluated.
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psnet.ahrq.gov/sites/default/files/2023-03/challenging_case_of_multiple_suicide_attempts_in_a_complex_patient_with_psychiatric_comorbidities.pdf
January 01, 2023 - of lorazepam to relieve anxiety.
5
Case Details (2)
• A consulting psychiatrist at the hospital evaluated … • The patient was discharged to her mother’s care the same day that she
was evaluated by the consulting … after her mother promised to
monitor the patient and control her medications until she could be re-
evaluated … • A consulting psychiatrist evaluated the patient but recommended sending
her home on a benzodiazepine
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psnet.ahrq.gov/node/42099/psn-pdf
March 13, 2013 - found that potential harms (such as increased
use of sedating medications) had not been systematically evaluated
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psnet.ahrq.gov/node/41223/psn-pdf
March 21, 2012 - This study evaluated
the role of England's Care Quality Commission in their own regulatory investigation
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psnet.ahrq.gov/node/44026/psn-pdf
November 03, 2015 - This randomized
controlled trial evaluated the effect of a postdischarge virtual ward where patients
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psnet.ahrq.gov/node/45310/psn-pdf
January 03, 2017 - This retrospective study evaluated the
safety of the electronic referral process by reviewing the medical
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psnet.ahrq.gov/issue/hospital-responses-leapfrog-group-local-markets
March 04, 2011 - This study evaluated factors contributing to hospitals' progress toward meeting the patient safety goals
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psnet.ahrq.gov/issue/assessment-transparency-cost-estimates-economic-evaluations-patient-safety-programmes
January 15, 2009 - Through analyzing studies that evaluated cost, efficiency, and effectiveness of patient safety initiatives
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psnet.ahrq.gov/issue/measuring-nursing-error-psychometrics-misscare-and-practice-and-professional-issues-items
October 17, 2012 - This study evaluated the validity and reliability of a standardized survey instrument used to detect
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psnet.ahrq.gov/issue/quality-improvement-and-patient-safety-activities-academic-departments-medicine
July 02, 2014 - This national survey evaluated the scope and nature of quality improvement and patient safety activities
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psnet.ahrq.gov/issue/missing-link-dedicated-patient-safety-education-within-top-ranked-us-nursing-school-curricula
November 15, 2018 - This study evaluated for the presence of patient safety curricula among top nursing schools and discusses
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psnet.ahrq.gov/issue/impact-digitally-acquired-peer-diagnostic-input-diagnostic-confidence-outpatient-cases
June 15, 2022 - This intervention study evaluated the effect of peer input on diagnostic confidence on cases with diagnostic
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psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.206_slideshow.ppt
October 01, 2009 - Surgery was delayed while the consultant evaluated the patient. … The CMO’s Responsibility to Protect Patient Safety
The author, a former CMO, would have quickly evaluated
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psnet.ahrq.gov/issue/preventing-pregnancy-related-mental-health-deaths-insights-14-us-maternal-mortality-review
November 10, 2021 - Researchers evaluated data from 2008 to 2017 from 14 state Maternal Mortality Review Committees and found
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psnet.ahrq.gov/issue/patient-safety-when-receiving-telephone-advice-primary-care-swedish-qualitative-interview
October 13, 2021 - This Swedish study evaluated district nurses’ experiences and perceptions of patient safety at a national
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psnet.ahrq.gov/issue/impact-pharmacist-interventions-medication-errors-hospitalized-pediatric-patients-systematic
August 04, 2021 - In this systematic review, the authors evaluated the evidence on the effectiveness of clinical pharmacist
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psnet.ahrq.gov/issue/unscheduled-return-visits-emergency-department-icu-admission-trigger-tool-diagnostic-error
December 02, 2020 - This study evaluated the efficacy of reviewing ED return visits that result in an ICU admission to determine
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psnet.ahrq.gov/issue/ambulatory-virtual-care-during-pandemic-patient-safety-considerations
August 12, 2020 - Through patient satisfaction surveys and patient complaints, this US hospital evaluated the quality and