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psnet.ahrq.gov/issue/business-case-quality-case-studies-and-analysis
February 23, 2019 - Study
Classic
The business case for quality: case studies … The business case for quality: case studies and an analysis. … The authors examine four case studies to explore the financial and clinical implications of quality improvements … The authors share the differing perspectives of the stakeholders to demonstrate how intimately tied a … The business case for quality: case studies and an analysis.
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psnet.ahrq.gov/issue/committed-safety-ten-case-studies-reducing-harm-patients
July 31, 2012 - Book/Report
Committed to Safety: Ten Case Studies on Reducing Harm to Patients. … Citation Text:
Committed to Safety: Ten Case Studies on Reducing Harm to Patients. … This report presents ten case studies to illustrate interventions that address prominent and targeted … Safety: Ten Case Studies on Reducing Harm to Patients. … February 23, 2011
How RNs rescue patients: a qualitative study of RNs' perceived involvement
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psnet.ahrq.gov/web-mm/how-do-providers-recover-errors
May 22, 2024 - SPOTLIGHT CASE
How Do Providers Recover From Errors?
Citation Text:
West CP. … How Do Providers Recover From Errors?. PSNet [internet]. … How Do Providers Recover From Errors?. PSNet [internet]. … How house officers cope with their mistakes. West J Med. 1993;159:565-569. [go to PubMed] 21. … How Do Providers Recover From Errors?. PSNet [internet].
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psnet.ahrq.gov/issue/triangulating-case-finding-tools-patient-safety-surveillance-cross-sectional-case-study
February 08, 2012 - case study of puncture/laceration. … Triangulating case-finding tools for patient safety surveillance: a cross-sectional case study of puncture … Similar to a past study , the authors advocate for a strategy combining detection methods rather than … Triangulating case-finding tools for patient safety surveillance: a cross-sectional case study of puncture … May 20, 2009
How will we know patients are safer?
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psnet.ahrq.gov/curated-library/diagnostic-errors-case-studies
August 10, 2025 - The PSNet Collection
Curated Libraries
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Diagnostic Errors Case … Studies
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Copy URL … Through the PRIDE Learning Network, diagnostic error case studies were reviewed to identify common pitfalls … These de-identified case studies are free to view and available through this Curated Library. … self-catheterize (without any instructions on how to do so).
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psnet.ahrq.gov/issue/receptionist-input-quality-and-safety-repeat-prescribing-uk-general-practice-ethnographic
March 23, 2022 - practice: ethnographic case study. … Receptionist input to quality and safety in repeat prescribing in UK general practice: ethnographic case … study. … Receptionist input to quality and safety in repeat prescribing in UK general practice: ethnographic case … study.
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psnet.ahrq.gov/issue/enhancing-safety-culture-through-improved-incident-reporting-case-study-translational
March 10, 2021 - Commentary
Enhancing safety culture through improved incident reporting: a case study … Enhancing Safety Culture Through Improved Incident Reporting: A Case Study In Translational Research. … London over a 2-year period to improve incident reporting and optimize its use as a learning tool. … Enhancing Safety Culture Through Improved Incident Reporting: A Case Study In Translational Research. … July 8, 2020
How do hospital inpatients conceptualise patient safety?
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psnet.ahrq.gov/issue/what-we-can-do-about-maternal-mortality-and-how-do-it-quickly
September 01, 2016 - mortality—and how to do it quickly. … What We Can Do about Maternal Mortality - And How to Do It Quickly. … What We Can Do about Maternal Mortality - And How to Do It Quickly. … September 23, 2020
System issues leading to "found-on-floor" incidents: a multi-incident … threats to patient safety: case study involving a labor and delivery ward.
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psnet.ahrq.gov/issue/using-situ-simulation-identify-and-resolve-latent-environmental-threats-patient-safety-case
April 17, 2011 - threats to patient safety: case study involving a labor and delivery ward. … Using in situ simulation to identify and resolve latent environmental threats to patient safety: case … study involving a labor and delivery ward. … study involving a labor and delivery ward. … May 22, 2019
What we can do about maternal mortality—and how to do it quickly.
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psnet.ahrq.gov/issue/using-plan-do-study-act-transform-simulation-center
March 13, 2024 - Commentary
Using Plan Do Study Act to transform a simulation center. … Using Plan Do Study Act to Transform a Simulation Center. … Using Plan Do Study Act to Transform a Simulation Center. … May 12, 2021
How different countries respond to adverse events whilst patients' rights … to patient safety: case study involving a labor and delivery ward.
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psnet.ahrq.gov/issue/application-engineering-problem-solving-methodology-address-persistent-problems-patient
March 18, 2020 - problems in patient safety: a case study on retained surgical sponges after surgery. … : a case study on retained surgical sponges after surgery. … This case study reports on a collaboration between engineers and safety professionals to address the … : a case study on retained surgical sponges after surgery. … September 5, 2018
How well do incident reporting systems work on inpatient psychiatric
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psnet.ahrq.gov/issue/contextual-factors-influencing-implementation-multifaceted-intervention-improve-teamwork-and
November 15, 2023 - to improve teamwork and quality for hospitalized patients: a multi-site qualitative comparative case … study. … and Quality for Hospitalized Patients: A Multisite Qualitative Comparative Case Study. … and Quality for Hospitalized Patients: A Multisite Qualitative Comparative Case Study. … November 16, 2022
Positive approaches to safety: learning from what we do well.
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psnet.ahrq.gov/issue/checklists-and-guidelines-imaging-techniques-visualizing-what-do
December 02, 2015 - Checklists and guidelines: imaging techniques for visualizing what to do. … Checklists and guidelines: imaging techniques for visualizing what to do. … December 2, 2015
The business case for quality: case studies and an analysis. … March 17, 2021
Case study: preventing surgical complications at Baystate Medical Center … July 21, 2010
The Checklist Manifesto: How to Get Things Right.
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psnet.ahrq.gov/issue/use-pharmaceuticals-dialysis-patients-how-well-do-we-know-our-patients-allergies
March 04, 2011 - How well do we know our patients' allergies? … HOW WELL DO WE KNOW OUR PATIENTS' ALLERGIES? … HOW WELL DO WE KNOW OUR PATIENTS' ALLERGIES? … April 24, 2018
Enabling a learning healthcare system with automated computer protocols … prescribing in UK general practice: ethnographic case study.
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psnet.ahrq.gov/issue/how-can-specialist-investigation-agencies-inform-system-wide-learning-patient-safety
January 29, 2014 - leaders of nursing homes negotiate their dual responsibilities- a case study. … February 28, 2024
Leading quality and safety on the frontline - a case study of department … May 15, 2024
Investigating hospital supervision: a case study of regulatory inspectors … and requirements for complying with quality and safety regulation in nursing homes - a case study. … May 3, 2023
20 years after To Err Is Human: a bibliometric analysis of ‘the IOM report
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psnet.ahrq.gov/issue/intensive-care-unit-alarms-how-many-do-we-need
March 01, 2011 - Study
Intensive care unit alarms—how many do we need? … Intensive care unit alarms--how many do we need? … Intensive care unit alarms--how many do we need? … April 22, 2015
How context affects electronic health record–based test result follow-up … July 10, 2008
Limited health literacy is a barrier to medication reconciliation in ambulatory
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psnet.ahrq.gov/issue/tasks-processes-case-changing-health-information-technology-improve-health-care
February 10, 2015 - This commentary describes how health information technology (IT) could be revamped to support patient-centered … care and how a new IT system would affect policy. … improvement: findings from six case studies. … June 8, 2022
Collaborative case review: a systems-based approach to patient safety event … least 1,500 avoidable deaths a year—and aim to do even better.
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psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.167_slideshow.ppt
January 01, 2008 - Spotlight Case [MONTH] 2003
Spotlight Case January 2008
How Do Providers Recover from Errors? … Case: How Do Providers Recover from Errors? … The primary team decided to perform a therapeutic thoracentesis. … Case: How Do Providers Recover from Errors?
Consent was obtained from the patient and his wife. … cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17473944
Case (cont.): How Do Providers Recover from
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psnet.ahrq.gov/submit-case-landing
March 25, 2025 - Breadcrumb
Home
Training and Education
WebM&M: Case Studies … Note that you can choose to submit cases either as a guest or while logged in to a PSNet account. … If your case is selected, you will receive detailed instructions via email on how to collect payment. … How interesting is the case from a medical error/patient safety standpoint?
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psnet.ahrq.gov/issue/why-do-people-sue-doctors-study-patients-and-relatives-taking-legal-action
August 04, 2021 - Study
Classic
Why do people sue doctors? … Citation Text:
Vincent C, Young M, Phillips A. Why do people sue doctors? … In addition, a case study presented the tension between malpractice claims and patient safety initiatives … Why do people sue doctors? A study of patients and relatives taking legal action. … November 4, 2015
How does routine disclosure of medical error affect patients' propensity