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psnet.ahrq.gov/issue/community-discharge-among-post-acute-nursing-home-residents-association-patient-safety
November 04, 2020 - Study
Community discharge among post-acute nursing home residents: an association with patient safety culture?
Citation Text:
Guo W, Li Y, Temkin-Greener H. Community discharge among post-acute nursing home residents: an association with patient safety culture? J Am Med Dir Assoc. 2021;2…
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psnet.ahrq.gov/issue/fake-and-expired-medications-simulation-based-education-underappreciated-risk-patient-safety
September 26, 2012 - Commentary
Fake and expired medications in simulation-based education: an underappreciated risk to patient safety.
Citation Text:
Torrie J, Cumin D, Sheridan J, et al. Fake and expired medications in simulation-based education: an underappreciated risk to patient safety. BMJ Qual Saf. 20…
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psnet.ahrq.gov/issue/providers-and-patients-perspectives-diagnostic-errors-acute-care-setting
October 20, 2021 - Study
Providers' and patients' perspectives on diagnostic errors in the acute care setting.
Citation Text:
Schnock KO, Garber A, Fraser H, et al. Providers' and patients' perspectives on diagnostic errors in the acute care setting. Jt Comm J Qual Patient Saf. 2023;49(2):89-97. doi:10.101…
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psnet.ahrq.gov/issue/intervention-decrease-patient-identification-band-errors-childrens-hospital
October 06, 2016 - Study
An intervention to decrease patient identification band errors in a children's hospital.
Citation Text:
Hain PD, Joers B, Rush M, et al. An intervention to decrease patient identification band errors in a children's hospital. Qual Saf Health Care. 2010;19(3):244-7. doi:10.1136/qs…
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psnet.ahrq.gov/issue/exploring-stakeholder-perceptions-around-implementation-operating-room-black-box-patient
November 04, 2020 - Study
Exploring stakeholder perceptions around implementation of the Operating Room Black Box for patient safety research: a qualitative study using the theoretical domains framework.
Citation Text:
Etherington N, Usama A, Patey AM, et al. Exploring stakeholder perceptions around impleme…
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psnet.ahrq.gov/issue/hospital-board-oversight-quality-and-patient-safety-narrative-review-and-synthesis-recent
November 13, 2019 - Review
Classic
Hospital board oversight of quality and patient safety: a narrative review and synthesis of recent empirical research.
Citation Text:
Millar R, Mannion R, Freeman T, et al. Hospital board oversight of quality and patient safety: a narrative review…
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psnet.ahrq.gov/issue/psychological-safety-during-test-new-work-processes-emergency-department
September 08, 2021 - Study
Psychological safety during the test of new work processes in an emergency department.
Citation Text:
Dieckmann P, Tulloch S, Dalgaard AE, et al. Psychological safety during the test of new work processes in an emergency department. BMC Health Serv Res. 2022;22(1):307. doi:10.1186/…
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psnet.ahrq.gov/issue/real-time-automated-paging-and-decision-support-critical-laboratory-abnormalities
April 30, 2014 - Study
Real-time automated paging and decision support for critical laboratory abnormalities.
Citation Text:
Etchells E, Adhikari NKJ, Wu RC, et al. Real-time automated paging and decision support for critical laboratory abnormalities. BMJ Qual Saf. 2011;20(11):924-30. doi:10.1136/bmjqs…
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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…
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psnet.ahrq.gov/issue/determining-current-insulin-pen-use-practices-and-errors-inpatient-setting
June 29, 2016 - Study
Determining current insulin pen use practices and errors in the inpatient setting.
Citation Text:
Brown KE, Hertig JB. Determining Current Insulin Pen Use Practices and Errors in the Inpatient Setting. Jt Comm J Qual Patient Saf. 2016;42(12):568-AP7. doi:10.1016/S1553-7250(16)30109…
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psnet.ahrq.gov/issue/do-written-disclosures-serious-events-increase-risk-malpractice-claims-one-health-care
October 12, 2011 - Study
Do written disclosures of serious events increase risk of malpractice claims? One health care system's experience.
Citation Text:
Painter LM, Kidwell KM, Kidwell RP, et al. Do Written Disclosures of Serious Events Increase Risk of Malpractice Claims? One Health Care System's Experi…
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psnet.ahrq.gov/issue/intensive-care-unit-safety-incidents-medical-versus-surgical-patients-prospective-multicenter
June 29, 2009 - Study
Intensive care unit safety incidents for medical versus surgical patients: a prospective multicenter study.
Citation Text:
Sinopoli DJ, Needham DM, Thompson DA, et al. Intensive care unit safety incidents for medical versus surgical patients: a prospective multicenter study. J Cr…
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psnet.ahrq.gov/issue/educating-seniors-be-patient-safety-self-advocates-primary-care
December 15, 2011 - Study
Educating seniors to be patient safety self-advocates in primary care.
Citation Text:
Elder NC, Regan SL, Pallerla H, et al. Educating Seniors to Be Patient Safety Self-Advocates in Primary Care. J Patient Saf. 2008;4(2). doi:10.1097/pts.0b013e318175d806.
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psnet.ahrq.gov/issue/care-coordination-strategies-and-barriers-during-medication-safety-incidents-qualitative
March 17, 2021 - Study
Care coordination strategies and barriers during medication safety incidents: a qualitative, cognitive task analysis.
Citation Text:
Russ-Jara AL, Luckhurst CL, Dismore RA, et al. Care coordination strategies and barriers during medication safety incidents: a qualitative, cognitive…
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psnet.ahrq.gov/issue/safety-climate-associated-adverse-events-nursing-homes-national-va-study
September 08, 2021 - Study
Safety climate associated with adverse events in nursing homes: a national VA study.
Citation Text:
Quach ED, Kazis LE, Zhao S, et al. Safety climate associated with adverse events in nursing homes: a national VA study. J Am Med Dir Assoc. 2021;22(2):388-392. doi:10.1016/j.jamda.20…
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psnet.ahrq.gov/issue/mobile-physician-reporting-clinically-significant-events-novel-way-improve-handoff
September 14, 2011 - Study
Mobile physician reporting of clinically significant events—a novel way to improve handoff communication and supervision of resident on call activities.
Citation Text:
Nabors C, Peterson SJ, Aronow WS, et al. Mobile physician reporting of clinically significant events-a novel way t…
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psnet.ahrq.gov/issue/adverse-events-healthcare-learning-mistakes
February 08, 2017 - Commentary
Adverse events in healthcare: learning from mistakes.
Citation Text:
Rafter N, Hickey A, Condell S, et al. Adverse events in healthcare: learning from mistakes. QJM. 2015;108(4):273-7. doi:10.1093/qjmed/hcu145.
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psnet.ahrq.gov/issue/drug-and-opioid-involved-overdose-deaths-united-states-2013-2017
June 28, 2017 - Study
Drug and opioid-involved overdose deaths- United States, 2013-2017.
Citation Text:
Scholl L, Seth P, Kariisa M, et al. Drug and Opioid-Involved Overdose Deaths - United States, 2013-2017. MMWR Morb Mortal Wkly Rep. 2018;67(5152):1419-1427. doi:10.15585/mmwr.mm675152e1.
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psnet.ahrq.gov/issue/inadequacies-physical-examination-cause-medical-errors-and-adverse-events-collection
June 01, 1989 - Study
Classic
Inadequacies of physical examination as a cause of medical errors and adverse events: a collection of vignettes.
Citation Text:
Verghese A, Charlton B, Kassirer JP, et al. Inadequacies of Physical Examination as a Cause of Medical Errors and Advers…
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psnet.ahrq.gov/issue/effect-clinical-decision-support-systems-systematic-review
September 23, 2020 - Review
Effect of clinical decision-support systems: a systematic review.
Citation Text:
Bright TJ, Wong A, Dhurjati R, et al. Effect of clinical decision-support systems: a systematic review. Ann Intern Med. 2012;157(1):29-43. doi:10.7326/0003-4819-157-1-201207030-00450.
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