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Identifying risks and opportunities in outpatient surgical patient safety: a qualitative analysis of Veterans Health Administration staff perceptions. | PSNet

psnet.ahrq.gov/issue/identifying-risks-and-opportunities-outpatient-surgical-patient-safety-qualitative-analysis

November 10, 2010 - Study Identifying risks and opportunities in outpatient surgical patient safety: a qualitative analysis of Veterans Health Administration staff perceptions. Citation Text: Mull HJ, Rosen AK, Charns MP, et al. Identifying Risks and Opportunities in Outpatient Surgical Patient Safety: A Qu…

Older folks in hospitals: the contributing factors and recommendations for incident prevention. | PSNet

psnet.ahrq.gov/issue/older-folks-hospitals-contributing-factors-and-recommendations-incident-prevention

April 13, 2022 - Study Older folks in hospitals: the contributing factors and recommendations for incident prevention. Citation Text: Mansah M, Griffiths R, Fernandez R, et al. Older folks in hospitals: the contributing factors and recommendations for incident prevention. J Patient Saf. 2014;10(3):146-53…

No harm found when nurse anesthetists work without supervision by physicians. | PSNet

psnet.ahrq.gov/issue/no-harm-found-when-nurse-anesthetists-work-without-supervision-physicians

August 04, 2021 - Study No harm found when nurse anesthetists work without supervision by physicians. Citation Text: Dulisse B, Cromwell J. No harm found when nurse anesthetists work without supervision by physicians. Health Aff (Millwood). 2010;29(8):1469-1475. doi:10.1377/hlthaff.2008.0966. Copy Citat…

BONE break: a hot debrief tool to reduce second victim syndrome for nurses. | PSNet

psnet.ahrq.gov/issue/bone-break-hot-debrief-tool-reduce-second-victim-syndrome-nurses

August 02, 2015 - Study BONE break: a hot debrief tool to reduce second victim syndrome for nurses. Citation Text: Hess A, Flicek T, Watral AT, et al. BONE break: a hot debrief tool to reduce second victim syndrome for nurses. Jt Comm J Qual Patient Saf. 2024;50(9):673-677. doi:10.1016/j.jcjq.2024.05.005.…

'If no-one stops me, I'll make the mistake again': changing prescribing behaviours through feedback; a Perceptual Control Theory perspective. | PSNet

psnet.ahrq.gov/issue/if-no-one-stops-me-ill-make-mistake-again-changing-prescribing-behaviours-through-feedback

July 01, 2017 - Study 'If no-one stops me, I'll make the mistake again': changing prescribing behaviours through feedback; a Perceptual Control Theory perspective. Citation Text: Ferguson J, Keyworth C, Tully MP. 'If no-one stops me, I'll make the mistake again': Changing prescribing behaviours through …

Diagnostic discrepancies in the emergency department: a retrospective study. | PSNet

psnet.ahrq.gov/issue/diagnostic-discrepancies-emergency-department-retrospective-study

October 04, 2023 - Study Diagnostic discrepancies in the emergency department: a retrospective study. Citation Text: Schols LA, Maranus ME, Rood PPM, et al. Diagnostic discrepancies in the emergency department: a retrospective study. J Patient Saf. 2024;20(6):420-425. doi:10.1097/pts.0000000000001252. Co…

Day of discharge does not impact hospital readmission after major cardiac surgery. | PSNet

psnet.ahrq.gov/issue/day-discharge-does-not-impact-hospital-readmission-after-major-cardiac-surgery

October 16, 2019 - Study Day of discharge does not impact hospital readmission after major cardiac surgery. Citation Text: Sanaiha Y, Ou R, Ramos G, et al. Day of Discharge Does Not Impact Hospital Readmission After Major Cardiac Surgery. Ann Thorac Surg. 2018;106(6):1767-1773. doi:10.1016/j.athoracsur.201…

Cognitive bias during clinical decision-making and its influence on patient outcomes in the emergency department: a scoping review. | PSNet

psnet.ahrq.gov/issue/cognitive-bias-during-clinical-decision-making-and-its-influence-patient-outcomes-emergency

September 21, 2022 - Review Cognitive bias during clinical decision-making and its influence on patient outcomes in the emergency department: a scoping review. Citation Text: Jala S, Fry M, Elliott R. Cognitive bias during clinical decision‐making and its influence on patient outcomes in the emergency depart…

The accuracy of medical dispatch—a systematic review. | PSNet

psnet.ahrq.gov/issue/accuracy-medical-dispatch-systematic-review

March 12, 2025 - Review The accuracy of medical dispatch—a systematic review. Citation Text: Bohm K, Kurland L. The accuracy of medical dispatch - a systematic review. Scand J Trauma Resusc Emerg Med. 2018;26(1):94. doi:10.1186/s13049-018-0528-8. Copy Citation Format: DOI Google Scholar Pub…

Patient misidentifications caused by errors in standard barcode technology. | PSNet

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June 13, 2012 - Study Patient misidentifications caused by errors in standard barcode technology. Citation Text: Snyder ML, Carter A, Jenkins K, et al. Patient misidentifications caused by errors in standard bar code technology. Clin Chem. 2010;56(10):1554-60. doi:10.1373/clinchem.2010.150094. Copy …

Residents, responsibility, and error: how residents learn to navigate the intersection. | PSNet

psnet.ahrq.gov/issue/residents-responsibility-and-error-how-residents-learn-navigate-intersection

August 21, 2019 - Study Residents, responsibility, and error: how residents learn to navigate the intersection. Citation Text: Shepherd L, Chilton S, Cristancho SM. Residents, responsibility, and error: how residents learn to navigate the intersection. Acad Med. 2023;98(8):934-940. doi:10.1097/acm.0000000…

Empowering frontline nurses: a structured intervention enables nurses to improve medication administration accuracy. | PSNet

psnet.ahrq.gov/issue/empowering-frontline-nurses-structured-intervention-enables-nurses-improve-medication

March 13, 2012 - Study Empowering frontline nurses: a structured intervention enables nurses to improve medication administration accuracy. Citation Text: Kliger J, Blegen MA, Gootee D, et al. Empowering frontline nurses: a structured intervention enables nurses to improve medication administration accur…

Evaluation of the culture of safety and quality in pediatric primary care practices. | PSNet

psnet.ahrq.gov/issue/evaluation-culture-safety-and-quality-pediatric-primary-care-practices

January 26, 2022 - Study Evaluation of the culture of safety and quality in pediatric primary care practices. Citation Text: Oyegoke S, Gigli KH. Evaluation of the culture of safety and quality in pediatric primary care practices. J Patient Saf. 2022;18(4):e753-e759. doi:10.1097/pts.0000000000000942. Cop…

Identification of adverse events at an orthopedics department in Sweden. | PSNet

psnet.ahrq.gov/issue/identification-adverse-events-orthopedics-department-sweden

May 08, 2013 - Study Identification of adverse events at an orthopedics department in Sweden. Citation Text: Unbeck M, Muren O, Lillkrona U. Identification of adverse events at an orthopedics department in Sweden. Acta Orthop. 2008;79(3):396-403. doi:10.1080/17453670710015319. Copy Citation For…

Occupational stress and cognitive failure of nurses and associations with on self-reported adverse events: a national cross-sectional survey. | PSNet

psnet.ahrq.gov/issue/occupational-stress-and-cognitive-failure-nurses-and-associations-self-reported-adverse

June 09, 2021 - Study Emerging Classic Occupational stress and cognitive failure of nurses and associations with on self-reported adverse events: a national cross-sectional survey. Citation Text: Kakemam E, Kalhor R, Khakdel Z, et al. Occupational stress and cognitive failure o…

Expressing concern and writing it down: an experimental study investigating transfer of information at nursing handover. | PSNet

psnet.ahrq.gov/issue/expressing-concern-and-writing-it-down-experimental-study-investigating-transfer-information

November 17, 2014 - Study Expressing concern and writing it down: an experimental study investigating transfer of information at nursing handover. Citation Text: Lee H, Cumin D, Devcich DA, et al. Expressing concern and writing it down: an experimental study investigating transfer of information at nursing …

Effect of distractions on operative performance and ability to multitask—a case for deliberate practice. | PSNet

psnet.ahrq.gov/issue/effect-distractions-operative-performance-and-ability-multitask-case-deliberate-practice

September 15, 2010 - Study Effect of distractions on operative performance and ability to multitask—a case for deliberate practice. Citation Text: Ahmed A, Ahmad M, Stewart M, et al. Effect of distractions on operative performance and ability to multitask--a case for deliberate practice. Laryngoscope. 2015;1…

Shepherding change: how the market, healthcare providers, and public policy can deliver quality care for the 21st century. | PSNet

psnet.ahrq.gov/issue/shepherding-change-how-market-healthcare-providers-and-public-policy-can-deliver-quality-care

July 20, 2022 - Commentary Shepherding change: how the market, healthcare providers, and public policy can deliver quality care for the 21st century. Citation Text: Kennedy P, Pronovost P. Shepherding change: how the market, healthcare providers, and public policy can deliver quality care for the 21st…

The surgical ward round checklist: improving patient safety and clinical documentation. | PSNet

psnet.ahrq.gov/issue/surgical-ward-round-checklist-improving-patient-safety-and-clinical-documentation

March 17, 2021 - Study The surgical ward round checklist: improving patient safety and clinical documentation. Citation Text: Krishnamohan N, Maitra I, Shetty VD. The surgical ward round checklist: improving patient safety and clinical documentation. J Multidiscip Healthc. 2019;12:789-794. doi:10.2147/JM…

Risk of medication safety incidents with antibiotic use measured by defined daily doses. | PSNet

psnet.ahrq.gov/issue/risk-medication-safety-incidents-antibiotic-use-measured-defined-daily-doses

July 06, 2022 - Study Risk of medication safety incidents with antibiotic use measured by defined daily doses. Citation Text: Hamad A, Cavell G, Wade P, et al. Risk of medication safety incidents with antibiotic use measured by defined daily doses. Int J Clin Pharm. 2013;35(5):772-9. doi:10.1007/s11096…

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