-
psnet.ahrq.gov/node/35360/psn-pdf
September 28, 2005 - Hospitals cutting nurses' long shifts.
September 28, 2005
Kowalczyk L.
https://psnet.ahrq.gov/issue/hospitals-cutting-nurses-long-shifts
This article reports on changes that hospitals are making to curb long work hours for nurses and how such
efforts could reduce potential errors.
https://psnet.ahrq.gov/issue/hos…
-
psnet.ahrq.gov/node/38665/psn-pdf
May 27, 2009 - Hospitals find confession good for the bottom line.
May 27, 2009
Greene J.
https://psnet.ahrq.gov/issue/hospitals-find-confession-good-bottom-line
This news article discusses apology teams at Michigan hospitals and how their disclosure efforts have
reduced malpractice costs.
https://psnet.ahrq.gov/issue/hospitals…
-
psnet.ahrq.gov/node/39129/psn-pdf
November 25, 2009 - How to avoid falling victim to a hospital mistake.
November 25, 2009
Cohen E.
https://psnet.ahrq.gov/issue/how-avoid-falling-victim-hospital-mistake
This news story describes an incident of patient misidentification and offers tips to help patients confirm
their care during a hospitalization.
https://psnet.ahrq.g…
-
psnet.ahrq.gov/node/38756/psn-pdf
January 20, 2010 - At VA hospital, a rogue cancer unit.
January 20, 2010
Bogdanich W.
https://psnet.ahrq.gov/issue/va-hospital-rogue-cancer-unit
Flawed safety standards, including a lack of peer review and oversight, led to a series of errors in a cancer
unit at a Philadelphia Veterans Affairs hospital.
https://psnet.ahrq.gov/issue…
-
psnet.ahrq.gov/node/37914/psn-pdf
August 06, 2008 - Hospital tells of surgery on wrong side.
August 6, 2008
Smith S.
https://psnet.ahrq.gov/issue/hospital-tells-surgery-wrong-side
This article reports on a wrong-side surgery that was immediately disclosed to the patient along with an
apology. Hospital administrators also disclosed the error to staff.
https://psnet…
-
psnet.ahrq.gov/node/49584/psn-pdf
April 01, 2009 - EMR Entry Error: Not So Benign
April 1, 2009
Koppel R. EMR Entry Error: Not So Benign. PSNet [internet]. 2009.
https://psnet.ahrq.gov/web-mm/emr-entry-error-not-so-benign
The Case
A 47-year-old man with advanced AIDS was admitted to an academic medical center with a chief complaint
of shortness of breath. He was …
-
psnet.ahrq.gov/node/33643/psn-pdf
December 01, 2006 - In Conversation with...J. Bryan Sexton, PhD, MA
December 1, 2006
In Conversation with..J. Bryan Sexton, PhD, MA. PSNet [internet]. 2006.
https://psnet.ahrq.gov/perspective/conversation-withj-bryan-sexton-phd-ma
Editor's Note: J. Bryan Sexton, PhD, MA, is Assistant Professor, Department of Anesthesiology and
Critic…
-
psnet.ahrq.gov/node/37129/psn-pdf
August 22, 2007 - Hospitals boost patients' power as advisers.
August 22, 2007
Landro L. Wall Street Journal. Aug. 8, 2007.
https://psnet.ahrq.gov/issue/hospitals-boost-patients-power-advisers
This article discusses the development of programs to actively involve patients in administrative, policy,
and safety work in hospitals.
ht…
-
psnet.ahrq.gov/node/35370/psn-pdf
November 28, 2016 - Going to the hospital? Don't forget to pack a nurse.
November 28, 2016
Tugend A.
https://psnet.ahrq.gov/issue/going-hospital-dont-forget-pack-nurse
This article discusses concerns about nurse shortages and why a patient or family might consider retaining
a private-duty nurse for a hospital stay.
https://psnet.ahr…
-
psnet.ahrq.gov/node/36733/psn-pdf
July 26, 2011 - Hospital trustees shift their focus to medical safety.
July 26, 2011
Rowland C. Boston Globe. March 5, 2007.
https://psnet.ahrq.gov/issue/hospital-trustees-shift-their-focus-medical-safety
This article discusses board members' responsibility to understand patient safety issues at the hospitals
they serve.
https:/…
-
psnet.ahrq.gov/node/36302/psn-pdf
September 27, 2006 - Fatal drug mix-up exposes hospital flaws.
September 27, 2006
Davies T.
https://psnet.ahrq.gov/issue/fatal-drug-mix-exposes-hospital-flaws
This article reports on the deaths of three infants from heparin overdoses and describes how the hospital
community has responded to the errors.
https://psnet.ahrq.gov/issue/fa…
-
psnet.ahrq.gov/node/39681/psn-pdf
July 14, 2010 - Do no harm: hospital care in Las Vegas.
July 14, 2010
Allen M; Richards A.
https://psnet.ahrq.gov/issue/do-no-harm-hospital-care-las-vegas
This news series reports on an investigation that included hospital record review and interviews with
stakeholders to explore the quality and safety of health care in Las Vegas…
-
psnet.ahrq.gov/node/38918/psn-pdf
September 02, 2009 - Hospitals own up to errors.
September 2, 2009
Landro L. Wall Street Journal. August 25, 2009:D1.
https://psnet.ahrq.gov/issue/hospitals-own-errors
This column shares the experience of hospitals and families whose involvement in open disclosure has
resulted in improved care, reduced litigation costs, and patient pa…
-
psnet.ahrq.gov/node/865455/psn-pdf
March 27, 2024 - Communication During Transitions of Care
March 27, 2024
Gurses AP, Sousane Z, Mossburg S. Communication During Transitions of Care. PSNet [internet]. 2024.
https://psnet.ahrq.gov/perspective/communication-during-transitions-care
Introduction
Inaccurate or untimely communication and ineffective teamwork in healthca…
-
psnet.ahrq.gov/issue/strategies-prevent-healthcare-associated-infections-through-hand-hygiene
July 03, 2014 - Commentary
Strategies to prevent healthcare-associated infections through hand hygiene.
Citation Text:
Ellingson K, Haas JP, Aiello AE, et al. Strategies to prevent healthcare-associated infections through hand hygiene. Infect Control Hosp Epidemiol. 2014;35(8):937-960. doi:10.1086/67714…
-
psnet.ahrq.gov/issue/expanding-role-antimicrobial-stewardship-programs-hospitals-united-states-lessons-learned
March 04, 2015 - Study
The expanding role of antimicrobial stewardship programs in hospitals in the United States: lessons learned from a multisite qualitative study.
Citation Text:
Kapadia SN, Abramson EL, Carter EJ, et al. The Expanding Role of Antimicrobial Stewardship Programs in Hospitals in the Uni…
-
psnet.ahrq.gov/issue/drug-related-problems-medical-wards-computerized-physician-order-entry-system
December 01, 2010 - Study
Drug-related problems in medical wards with a computerized physician order entry system.
Citation Text:
Bedouch P, Allenet B, Grass A, et al. Drug-related problems in medical wards with a computerized physician order entry system. J Clin Pharm Ther. 2009;34(2):187-95. doi:10.1111…
-
psnet.ahrq.gov/issue/national-and-local-medication-error-reporting-systems-survey-practices-16-countries
September 09, 2015 - Study
National and local medication error reporting systems—a survey of practices in 16 countries.
Citation Text:
Holmström A-R, Airaksinen M, Weiss M, et al. National and local medication error reporting systems: a survey of practices in 16 countries. J Patient Saf. 2012;8(4):165-76. …
-
psnet.ahrq.gov/issue/how-make-medication-error-reporting-systems-work-factors-associated-their-successful
December 05, 2012 - Study
How to make medication error reporting systems work—factors associated with their successful development and implementation.
Citation Text:
Holmström A-R, Laaksonen R, Airaksinen M. How to make medication error reporting systems work--Factors associated with their successful develo…
-
psnet.ahrq.gov/issue/exploratory-study-knowledge-brokering-hospital-settings-facilitating-knowledge-sharing-and
July 02, 2008 - Study
An exploratory study of knowledge brokering in hospital settings: facilitating knowledge sharing and learning for patient safety?
Citation Text:
Waring J, Currie G, Crompton A, et al. An exploratory study of knowledge brokering in hospital settings: facilitating knowledge sharing …