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Detecting adverse events in surgery: comparing events detected by the Veterans Health Administration Surgical Quality Improvement Program and the Patient Safety Indicators. | PSNet

psnet.ahrq.gov/issue/detecting-adverse-events-surgery-comparing-events-detected-veterans-health-administration

June 20, 2011 - Study Detecting adverse events in surgery: comparing events detected by the Veterans Health Administration Surgical Quality Improvement Program and the Patient Safety Indicators. Citation Text: Mull HJ, Borzecki A, Loveland S, et al. Detecting adverse events in surgery: comparing events …

Informal learning from error in hospitals: what do we learn, how do we learn and how can informal learning be enhanced? A narrative review. | PSNet

psnet.ahrq.gov/issue/informal-learning-error-hospitals-what-do-we-learn-how-do-we-learn-and-how-can-informal

March 14, 2012 - Review Informal learning from error in hospitals: what do we learn, how do we learn and how can informal learning be enhanced? A narrative review. Citation Text: de Feijter JM, de Grave WS, Koopmans RP, et al. Informal learning from error in hospitals: what do we learn, how do we learn…

Hospital at Home: setting a regulatory course to ensure safe, high-quality care. | PSNet

psnet.ahrq.gov/issue/hospital-home-setting-regulatory-course-ensure-safe-high-quality-care

June 30, 2021 - Commentary Hospital at Home: setting a regulatory course to ensure safe, high-quality care. Citation Text: DeCherrie LV, Leff B, Levine DM, et al. Hospital at Home: setting a regulatory course to ensure safe, high-quality care. Jt Comm J Qual Patient Saf. 2022;48(3):180-184. doi:10.1016/…

Mortality and morbidity meetings: an untapped resource for improving the governance of patient safety? | PSNet

psnet.ahrq.gov/issue/mortality-and-morbidity-meetings-untapped-resource-improving-governance-patient-safety

June 25, 2014 - Study Mortality and morbidity meetings: an untapped resource for improving the governance of patient safety? Citation Text: Higginson J, Walters R, Fulop NJ. Mortality and morbidity meetings: an untapped resource for improving the governance of patient safety? BMJ Qual Saf. 2012;21(7):…

A randomised controlled trial assessing the efficacy of an electronic discharge communication tool for preventing death or hospital readmission. | PSNet

psnet.ahrq.gov/issue/randomised-controlled-trial-assessing-efficacy-electronic-discharge-communication-tool

August 24, 2016 - Study A randomised controlled trial assessing the efficacy of an electronic discharge communication tool for preventing death or hospital readmission. Citation Text: Santana MJ, Holroyd-Leduc J, Southern DA, et al. A randomised controlled trial assessing the efficacy of an electronic dis…

The Safe Patient Flow Initiative: a collaborative quality improvement journey at Yale-New Haven Hospital. | PSNet

psnet.ahrq.gov/issue/safe-patient-flow-initiative-collaborative-quality-improvement-journey-yale-new-haven

June 07, 2023 - Study The Safe Patient Flow Initiative: a collaborative quality improvement journey at Yale-New Haven Hospital. Citation Text: Jweinat J, Damore P, Morris V, et al. The safe patient flow initiative: a collaborative quality improvement journey at Yale-New Haven Hospital. Jt Comm J Q…

A mixed methods study exploring patient safety culture at 4 VHA Hospitals. | PSNet

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September 25, 2019 - Study A mixed methods study exploring patient safety culture at 4 VHA Hospitals. Citation Text: Sullivan JL, Shin MH, Ranusch A, et al. A mixed methods study exploring patient safety culture at 4 VHA Hospitals. Jt Comm J Qual Patient Saf. 2024;50(11):791-800. doi:10.1016/j.jcjq.2024.07.0…

Impact of a clinical pharmacy admission medication reconciliation program on medication errors in "high-risk" patients. | PSNet

psnet.ahrq.gov/issue/impact-clinical-pharmacy-admission-medication-reconciliation-program-medication-errors-high

August 30, 2017 - Study Impact of a clinical pharmacy admission medication reconciliation program on medication errors in "high-risk" patients. Citation Text: Buckley MS, Harinstein LM, Clark KB, et al. Impact of a clinical pharmacy admission medication reconciliation program on medication errors in "hig…

Effect of hospital follow-up appointment on clinical event outcomes and mortality. | PSNet

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April 24, 2018 - Study Effect of hospital follow-up appointment on clinical event outcomes and mortality. Citation Text: Grafft CA, McDonald FS, Ruud KL, et al. Effect of hospital follow-up appointment on clinical event outcomes and mortality. Arch Intern Med. 2010;170(11):955-60. doi:10.1001/archinternm…

Should operations be regionalized? The empirical relation between surgical volume and mortality. | PSNet

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August 04, 2021 - Study Classic Should operations be regionalized? The empirical relation between surgical volume and mortality. Citation Text: Luft HS, Bunker JP, Enthoven AC. Should operations be regionalized? The empirical relation between surgical volume and mortality. N En…

Effectiveness of a pharmacist–nurse intervention on resolving medication discrepancies for patients transitioning from hospital to home health care. | PSNet

psnet.ahrq.gov/issue/effectiveness-pharmacist-nurse-intervention-resolving-medication-discrepancies-patients

December 03, 2014 - Study Effectiveness of a pharmacist–nurse intervention on resolving medication discrepancies for patients transitioning from hospital to home health care. Citation Text: Setter SM, Corbett CF, Neumiller JJ, et al. Effectiveness of a pharmacist-nurse intervention on resolving medication…

Handoffs causing patient harm: a survey of medical and surgical house staff. | PSNet

psnet.ahrq.gov/issue/handoffs-causing-patient-harm-survey-medical-and-surgical-house-staff

July 10, 2008 - Study Handoffs causing patient harm: a survey of medical and surgical house staff. Citation Text: Kitch BT, Cooper JB, Zapol WM, et al. Handoffs causing patient harm: a survey of medical and surgical house staff. Jt Comm J Qual Patient Saf. 2008;34(10):563-70. Copy Citation Format:…

Hospital- and system-wide interventions for health care-associated infections: a systematic review. | PSNet

psnet.ahrq.gov/issue/hospital-and-system-wide-interventions-health-care-associated-infections-systematic-review

January 12, 2022 - Review Hospital- and system-wide interventions for health care-associated infections: a systematic review. Citation Text: Maurer NR, Hogan TH, Walker DM. Hospital- and system-wide interventions for health care-associated infections: a systematic review. Med Care Res Rev. 2021;78(6):643-6…

ASHP National Survey of Pharmacy Practice in Hospital Settings: clinical services and workforce-2021. | PSNet

psnet.ahrq.gov/issue/ashp-national-survey-pharmacy-practice-hospital-settings-clinical-services-and-workforce-2021

September 30, 2020 - Study ASHP National Survey of Pharmacy Practice in Hospital Settings: clinical services and workforce-2021. Citation Text: Schneider PJ, Pedersen CA, Ganio MC, et al. ASHP National Survey of Pharmacy Practice in Hospital Settings: clinical services and workforce—2021. Am J Health Syst Ph…

The effect of external inspections on safety in acute hospitals in the National Health Service in England: a controlled interrupted time-series analysis. | PSNet

psnet.ahrq.gov/issue/effect-external-inspections-safety-acute-hospitals-national-health-service-england-controlled

January 12, 2022 - Study The effect of external inspections on safety in acute hospitals in the National Health Service in England: a controlled interrupted time-series analysis. Citation Text: Castro-Avila A, Bloor K, Thompson C. The effect of external inspections on safety in acute hospitals in the Natio…

Predictors of adverse events and medical errors among adult inpatients of psychiatric units of acute care general hospitals. | PSNet

psnet.ahrq.gov/issue/predictors-adverse-events-and-medical-errors-among-adult-inpatients-psychiatric-units-acute

November 06, 2019 - Study Predictors of adverse events and medical errors among adult inpatients of psychiatric units of acute care general hospitals. Citation Text: Vermeulen JM, Doedens P, Cullen SW, et al. Predictors of Adverse Events and Medical Errors Among Adult Inpatients of Psychiatric Units of Acut…

Using the rapid response system to provide better oversight of patient care processes. | PSNet

psnet.ahrq.gov/issue/using-rapid-response-system-provide-better-oversight-patient-care-processes

January 07, 2015 - Commentary Using the rapid response system to provide better oversight of patient care processes. Citation Text: Moore MS, Howard SK, Lighthall GK. Using the rapid response system to provide better oversight of patient care processes. Jt Comm J Qual Patient Saf. 2007;33(11):695-8, 645. …

Improvement in the detection of adverse drug events by the use of electronic health and prescription records: an evaluation of two trigger tools. | PSNet

psnet.ahrq.gov/issue/improvement-detection-adverse-drug-events-use-electronic-health-and-prescription-records

September 23, 2020 - Study Improvement in the detection of adverse drug events by the use of electronic health and prescription records: an evaluation of two trigger tools. Citation Text: Nwulu U, Nirantharakumar K, Odesanya R, et al. Improvement in the detection of adverse drug events by the use of electr…

Medication errors resulting in harm: using chargemaster data to determine association with cost of hospitalization and length of stay. | PSNet

psnet.ahrq.gov/issue/medication-errors-resulting-harm-using-chargemaster-data-determine-association-cost

June 02, 2021 - Study Medication errors resulting in harm: using chargemaster data to determine association with cost of hospitalization and length of stay. Citation Text: McCarthy BC, Tuiskula KA, Driscoll TP, et al. Medication errors resulting in harm: Using chargemaster data to determine association …

Patient safety and image transfer between referring hospitals and neuroscience centres: could we do better? | PSNet

psnet.ahrq.gov/issue/patient-safety-and-image-transfer-between-referring-hospitals-and-neuroscience-centres-could

July 19, 2023 - Study Patient safety and image transfer between referring hospitals and neuroscience centres: could we do better? Citation Text: Crocker M, Cato-Addison WB, Pushpananthan S, et al. Patient safety and image transfer between referring hospitals and neuroscience centres: could we do bette…

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