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4041. Effects of skilled nursing facility structure and process factors on medication errors during nursing home admission. | PSNet
      psnet.ahrq.gov/issue/effects-skilled-nursing-facility-structure-and-process-factors-medication-errors-during
      April 24, 2018 - Study Effects of skilled nursing facility structure and process factors on medication errors during nursing home admission. Citation Text: Lane SJ, Troyer JL, Dienemann JA, et al. Effects of skilled nursing facility structure and process factors on medication errors during nursing home a…

4042. A descriptive study of nurse-reported missed care in neonatal intensive care units. | PSNet
      psnet.ahrq.gov/issue/descriptive-study-nurse-reported-missed-care-neonatal-intensive-care-units
      January 27, 2019 - Study A descriptive study of nurse-reported missed care in neonatal intensive care units. Citation Text: Tubbs-Cooley HL, Pickler RH, Younger JB, et al. A descriptive study of nurse-reported missed care in neonatal intensive care units. J Adv Nurs. 2015;71(4):813-24. doi:10.1111/jan.1257…

4043. Self-Reported Learning (SRL), a voluntary incident reporting system experience within a large health care organization. | PSNet
      psnet.ahrq.gov/issue/self-reported-learning-srl-voluntary-incident-reporting-system-experience-within-large-health
      October 26, 2022 - Study Self-Reported Learning (SRL), a voluntary incident reporting system experience within a large health care organization. Citation Text: Lurvey LD, Fassett MJ, Kanter MH. Self-Reported Learning (SRL), a voluntary incident reporting system experience within a large health care organiz…

4044. What does safety commitment mean to leaders? A multi-method investigation. | PSNet
      psnet.ahrq.gov/issue/what-does-safety-commitment-mean-leaders-multi-method-investigation
      September 11, 2024 - Study What does safety commitment mean to leaders? A multi-method investigation. Citation Text: Fruhen LS, Griffin MA, Andrei DM. What does safety commitment mean to leaders? A multi-method investigation. J Safety Res. 2019;68:203-214. doi:10.1016/j.jsr.2018.12.011. Copy Citation F…

4045. Quality measures for patients at risk of adverse outcomes in the Veterans Health Administration: expert panel recommendations. | PSNet
      psnet.ahrq.gov/issue/quality-measures-patients-risk-adverse-outcomes-veterans-health-administration-expert-panel
      June 22, 2022 - Commentary Quality measures for patients at risk of adverse outcomes in the Veterans Health Administration: expert panel recommendations. Citation Text: Chang ET, Newberry S, Rubenstein LV, et al. Quality Measures for Patients at Risk of Adverse Outcomes in the Veterans Health Administra…

4046. Effectiveness and cost of a transitional care program for heart failure: a prospective study with concurrent controls. | PSNet
      psnet.ahrq.gov/issue/effectiveness-and-cost-transitional-care-program-heart-failure-prospective-study-concurrent
      April 24, 2019 - Study Effectiveness and cost of a transitional care program for heart failure: a prospective study with concurrent controls. Citation Text: Stauffer BD, Fullerton C, Fleming N, et al. Effectiveness and cost of a transitional care program for heart failure: a prospective study with conc…

4047. Extent of diagnostic agreement among medical referrals. | PSNet
      psnet.ahrq.gov/issue/extent-diagnostic-agreement-among-medical-referrals
      October 31, 2011 - Study Extent of diagnostic agreement among medical referrals. Citation Text: Van Such M, Lohr R, Beckman T, et al. Extent of diagnostic agreement among medical referrals. J Eval Clin Pract. 2017;23(4):870-874. doi:10.1111/jep.12747. Copy Citation Format: DOI Google Scholar …

4048. A prospective observational study of physician handoff for intensive-care-unit-to-ward patient transfers. | PSNet
      psnet.ahrq.gov/issue/prospective-observational-study-physician-handoff-intensive-care-unit-ward-patient-transfers
      October 08, 2013 - Study A prospective observational study of physician handoff for intensive-care-unit-to-ward patient transfers. Citation Text: Li P, Stelfox HT, Ghali WA. A Prospective Observational Study of Physician Handoff for Intensive-Care-Unit-to-Ward Patient Transfers. Am J Med. 2011;124(9). do…

4049. Medication reconciliation improvement utilizing process redesign and clinical decision support. | PSNet
      psnet.ahrq.gov/issue/medication-reconciliation-improvement-utilizing-process-redesign-and-clinical-decision
      November 16, 2022 - Study Medication reconciliation improvement utilizing process redesign and clinical decision support. Citation Text: Rungvivatjarus T, Kuelbs CL, Miller L, et al. Medication Reconciliation Improvement Utilizing Process Redesign and Clinical Decision Support. Jt Comm J Qual Patient Saf. …

4050. The use of patient digital facial images to confirm patient identity in a children's hospital's anesthesia information management system. | PSNet
      psnet.ahrq.gov/issue/use-patient-digital-facial-images-confirm-patient-identity-childrens-hospitals-anesthesia
      May 06, 2009 - Study The use of patient digital facial images to confirm patient identity in a children's hospital's anesthesia information management system. Citation Text: Thomas JJ, Yaster M, Guffey P. The Use of Patient Digital Facial Images to Confirm Patient Identity in a Children's Hospital's An…

4051. Mobile in situ obstetric emergency simulation and teamwork training to improve maternal–fetal safety in hospitals. | PSNet
      psnet.ahrq.gov/issue/mobile-situ-obstetric-emergency-simulation-and-teamwork-training-improve-maternal-fetal
      July 09, 2008 - Study Mobile in situ obstetric emergency simulation and teamwork training to improve maternal–fetal safety in hospitals. Citation Text: Guise J-M, Lowe NK, Deering S, et al. Mobile in situ obstetric emergency simulation and teamwork training to improve maternal-fetal safety in hospitals.…

4052. Preventability of voluntarily reported or trigger tool–identified medication errors in a pediatric institution by information technology: a retrospective cohort study. | PSNet
      psnet.ahrq.gov/issue/preventability-voluntarily-reported-or-trigger-tool-identified-medication-errors-pediatric
      September 01, 2016 - Study Preventability of voluntarily reported or trigger tool–identified medication errors in a pediatric institution by information technology: a retrospective cohort study. Citation Text: Stultz JS, Nahata MC. Preventability of Voluntarily Reported or Trigger Tool-Identified Medication …

4053. Inappropriate medication in a national sample of US elderly patients receiving home health care. | PSNet
      psnet.ahrq.gov/issue/inappropriate-medication-national-sample-us-elderly-patients-receiving-home-health-care
      September 09, 2020 - Study Inappropriate medication in a national sample of US elderly patients receiving home health care. Citation Text: Bao Y, Shao H, Bishop TF, et al. Inappropriate medication in a national sample of US elderly patients receiving home health care. J Gen Intern Med. 2012;27(3):304-310. do…

4054. A scoping review of legibility of hand-written prescriptions and drug-orders: the writing on the wall. | PSNet
      psnet.ahrq.gov/issue/scoping-review-legibility-hand-written-prescriptions-and-drug-orders-writing-wall
      January 12, 2022 - Review A scoping review of legibility of hand-written prescriptions and drug-orders: the writing on the wall. Citation Text: Ariaga A, Balzan D, Falzon S, et al. A scoping review of legibility of hand-written prescriptions and drug-orders: the writing on the wall. Expert Rev Clin Pharmac…

4055. The perfect storm: exam of a medical error and factors contributing to its possible escalation. | PSNet
      psnet.ahrq.gov/issue/perfect-storm-exam-medical-error-and-factors-contributing-its-possible-escalation
      October 20, 2021 - Commentary The perfect storm: exam of a medical error and factors contributing to its possible escalation. Citation Text: Walters GK. The perfect storm: exam of a medical error and factors contributing to its possible escalation. J Patient Saf. 2021;17(4):e264-e267. doi:10.1097/pts.00000…

4056. Changing experience of adverse medical events in the National Health Service: comparison of two population surveys in 2001 and 2013. | PSNet
      psnet.ahrq.gov/issue/changing-experience-adverse-medical-events-national-health-service-comparison-two-population
      February 16, 2011 - Study Changing experience of adverse medical events in the National Health Service: comparison of two population surveys in 2001 and 2013. Citation Text: Gray AM, Fenn P, Rickman N, et al. Changing experience of adverse medical events in the National Health Service: Comparison of two pop…

4057. The American College of Surgeons' closed claims study: new insights for improving care. | PSNet
      psnet.ahrq.gov/issue/american-college-surgeons-closed-claims-study-new-insights-improving-care
      March 02, 2011 - Study The American College of Surgeons' closed claims study: new insights for improving care. Citation Text: Griffen FD, Stephens LS, Alexander JB, et al. The American College of Surgeons’ Closed Claims Study: New Insights for Improving Care. J Am Coll Surg. 2007;204(4). doi:10.1016/j.…

4058. Do house officers learn from their mistakes? | PSNet
      psnet.ahrq.gov/issue/do-house-officers-learn-their-mistakes
      April 19, 2011 - Study Classic Do house officers learn from their mistakes? Citation Text: Wu AW, Folkman S, McPhee SJ, et al. Do house officers learn from their mistakes? JAMA. 1991;265(16):2089-94. Copy Citation Format: Google Scholar PubMed BibTeX EndNote X3 XML…

4059. Disclosing medical errors to patients: attitudes and practices of physicians and trainees. | PSNet
      psnet.ahrq.gov/issue/disclosing-medical-errors-patients-attitudes-and-practices-physicians-and-trainees
      February 15, 2011 - Study Disclosing medical errors to patients: attitudes and practices of physicians and trainees. Citation Text: Kaldjian LC, Jones EW, Wu BJ, et al. Disclosing medical errors to patients: attitudes and practices of physicians and trainees. J Gen Intern Med. 2007;22(7):988-96. Copy Ci…

4060. Diagnostic accuracy of pediatric teledermatology using parent-submitted photographs: a randomized clinical trial. | PSNet
      psnet.ahrq.gov/issue/diagnostic-accuracy-pediatric-teledermatology-using-parent-submitted-photographs-randomized
      November 16, 2022 - Study Diagnostic accuracy of pediatric teledermatology using parent-submitted photographs: a randomized clinical trial. Citation Text: O'Connor DM, Jew OS, Perman MJ, et al. Diagnostic Accuracy of Pediatric Teledermatology Using Parent-Submitted Photographs: A Randomized Clinical Trial. …