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Using in situ simulation to identify and resolve latent environmental threats to patient safety: case study involving a labor and delivery ward. | PSNet

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April 17, 2011 - Commentary Using in situ simulation to identify and resolve latent environmental threats to patient safety: case study involving a labor and delivery ward. Citation Text: Hamman WR, Beaudin-Seiler BM, Beaubien JM, et al. Using in situ simulation to identify and resolve latent environme…

Incidence and characteristics of errors detected by a short team briefing in pediatric anesthesia. | PSNet

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September 30, 2020 - Study Incidence and characteristics of errors detected by a short team briefing in pediatric anesthesia. Citation Text: Keil O, Brunsmann K, Boethig D, et al. Incidence and characteristics of errors detected by a short team briefing in pediatric anesthesia. Paediatr Anaesth. 2022;32(10):…

Technology-enhanced simulation for health professions education: a systematic review and meta-analysis. | PSNet

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October 19, 2022 - Review Classic Technology-enhanced simulation for health professions education: a systematic review and meta-analysis. Citation Text: Cook DA, Hatala R, Brydges R, et al. Technology-enhanced simulation for health professions education: a systematic review and me…

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…

A hybrid methodology for modeling risk of adverse events in complex health-care settings. | PSNet

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November 11, 2015 - Study A hybrid methodology for modeling risk of adverse events in complex health-care settings. Citation Text: Kazemi R, Mosleh A, Dierks M. A Hybrid Methodology for Modeling Risk of Adverse Events in Complex Health-Care Settings. Risk Anal. 2017;37(3):421-440. doi:10.1111/risa.12702. …

The standardisation of handoffs in a large academic paediatric emergency department using I-PASS. | PSNet

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October 21, 2020 - Study The standardisation of handoffs in a large academic paediatric emergency department using I-PASS. Citation Text: Chladek MS, Doughty C, Patel B, et al. The Standardisation of handoffs in a large academic paediatric emergency department using I-PASS. BMJ Open Qual. 2021;10(3):e00125…

Hospital-initiated transitional care interventions as a patient safety strategy: a systematic review. | PSNet

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August 12, 2014 - Review Hospital-initiated transitional care interventions as a patient safety strategy: a systematic review. Citation Text: Rennke S, Nguyen OK, Shoeb MH, et al. Hospital-initiated transitional care interventions as a patient safety strategy: a systematic review. Ann Intern Med. 2013;15…

Evaluating the medication process in the context of CPOE use: the significance of working around the system. | PSNet

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February 23, 2009 - Study Evaluating the medication process in the context of CPOE use: the significance of working around the system. Citation Text: Niazkhani Z, Pirnejad H, van der Sijs H, et al. Evaluating the medication process in the context of CPOE use: the significance of working around the system.…

The nature of the response to airway management incident reports in high income countries: a scoping review. | PSNet

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December 15, 2014 - Review The nature of the response to airway management incident reports in high income countries: a scoping review. Citation Text: Endlich Y, Davies EL, Kelly J. The nature of the response to airway management incident reports in high income countries: a scoping review. Anaesth Intensive…

Apologies following an adverse medical event: the importance of focusing on the consumer's needs. | PSNet

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June 27, 2011 - Study Apologies following an adverse medical event: the importance of focusing on the consumer's needs. Citation Text: Allan A, McKillop D, Dooley J, et al. Apologies following an adverse medical event: The importance of focusing on the consumer's needs. Patient Educ Couns. 2015;98(9):10…

Completeness of serious adverse drug event reports received by the US Food and Drug Administration in 2014. | PSNet

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September 25, 2008 - Study Completeness of serious adverse drug event reports received by the US Food and Drug Administration in 2014. Citation Text: Moore TJ, Furberg CD, Mattison DR, et al. Completeness of serious adverse drug event reports received by the US Food and Drug Administration in 2014. Pharmacoe…

Medication errors reported by US family physicians and their office staff. | PSNet

psnet.ahrq.gov/issue/medication-errors-reported-us-family-physicians-and-their-office-staff

June 11, 2008 - Study Medication errors reported by US family physicians and their office staff. Citation Text: Kuo GM, Phillips RL, Graham D, et al. Medication errors reported by US family physicians and their office staff. Quality and Safety in Health Care. 2008;17(4). doi:10.1136/qshc.2007.024869. …

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

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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:…

Chronic pain diagnoses and opioid dispensings among insured individuals with serious mental illness. | PSNet

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November 29, 2023 - Study Chronic pain diagnoses and opioid dispensings among insured individuals with serious mental illness. Citation Text: Owen-Smith A, Stewart C, Sesay MM, et al. Chronic pain diagnoses and opioid dispensings among insured individuals with serious mental illness. BMC Psych. 2020;20(1):4…

From the flight deck to the operating room: an initial pilot study of the feasibility and potential impact of true interdisciplinary team training using high-fidelity simulation. | PSNet

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February 25, 2009 - Study From the flight deck to the operating room: an initial pilot study of the feasibility and potential impact of true interdisciplinary team training using high-fidelity simulation. Citation Text: Paige JT, Kozmenko V, Morgan B, et al. From the Flight Deck to the Operating Room: A…

Identifying unintended consequences of quality indicators: a qualitative study. | PSNet

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March 04, 2020 - Study Identifying unintended consequences of quality indicators: a qualitative study. Citation Text: Lester HE, Hannon KL, Campbell S. Identifying unintended consequences of quality indicators: a qualitative study. BMJ Qual Saf. 2011;20(12):1057-61. doi:10.1136/bmjqs.2010.048371. Cop…

Supporting doctors as healthcare quality and safety advocates: recommendations from the Association of Surgeons in Training (ASiT). | PSNet

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April 13, 2016 - Study Supporting doctors as healthcare quality and safety advocates: recommendations from the Association of Surgeons in Training (ASiT). Citation Text: Fleming CA, Humm G, Wild JR, et al. Supporting doctors as healthcare quality and safety advocates: Recommendations from the Association…

Development and evaluation of the Institute for Healthcare Improvement global trigger tool. | PSNet

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February 10, 2015 - Commentary Development and evaluation of the Institute for Healthcare Improvement global trigger tool. Citation Text: Classen DC, Lloyd RC, Provost LP, et al. Development and Evaluation of the Institute for Healthcare Improvement Global Trigger Tool. J Patient Saf. 2008;4(3). doi:10.10…

The AMÉLIE project: failure mode, effects and criticality analysis: a model to evaluate the nurse medication administration process on the floor. | PSNet

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September 24, 2016 - Study The AMÉLIE project: failure mode, effects and criticality analysis: a model to evaluate the nurse medication administration process on the floor. Citation Text: Nguyen C, Côté J, Lebel D, et al. The AMÉLIE project: failure mode, effects and criticality analysis: a model to evalua…

Exploring physician perspectives of residency holdover handoffs: a qualitative study to understand an increasingly important type of handoff. | PSNet

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April 27, 2015 - Study Exploring physician perspectives of residency holdover handoffs: a qualitative study to understand an increasingly important type of handoff. Citation Text: Duong JA, Jensen TP, Morduchowicz S, et al. Exploring Physician Perspectives of Residency Holdover Handoffs: A Qualitative St…

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