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December 19, 2018 - Patient groups, clinicians and healthcare professionals
agree—all test results need to be seen, understood and
followed up.
December 19, 2018
Dahm MR, Georgiou A, Herkes R, et al. Patient groups, clinicians and healthcare professionals agree - all
test results need to be seen, understood and followed up. Diagnosis…
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December 04, 2016 - Analysis of clinical decision support system
malfunctions: a case series and survey.
December 4, 2016
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series and survey. J Am Med Inform Assoc. 2016;23(6):1068-1076. doi:10.1093/jamia/ocw005.
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January 23, 2019 - Closing the Loop: A Guide to Safer Ambulatory Referrals
in the EHR Era.
January 23, 2019
Institute for Healthcare Improvement, National Patient Safety Foundation. Cambridge, MA: Institute for
Healthcare Improvement; 2017.
https://psnet.ahrq.gov/issue/closing-loop-guide-safer-ambulatory-referrals-ehr-era
Missed an…
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psnet.ahrq.gov/issue/neuromuscular-blocking-agents-reducing-associated-wrong-drug-errors
April 26, 2023 - Newspaper/Magazine Article
Neuromuscular blocking agents: reducing associated wrong-drug errors.
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April 16, 2018
This article discu…
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psnet.ahrq.gov/node/73110/psn-pdf
April 07, 2021 - Does one size fit all? Assessing the need for
organizational second victim support programs.
April 7, 2021
Edrees HH, Wu AW. Does one size fit all? Assessing the need for organizational second victim support
programs. J Patient Saf. 2021;17(3):e247-e254. doi:10.1097/pts.0000000000000321.
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November 30, 2016 - Hospital Survey on Patient Safety Culture: 2011 User
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November 30, 2016
Sorra J, Famolaro T, Dyer N, et al. Rockville, MD: Agency for Healthcare Research and Quality; April 2011.
AHRQ Publication No. 11-0030.
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November 08, 2023 - Use of the Second Victim Experience and Support Tool
(SVEST) to assess the impact of a departmental peer
support program on anesthesia professionals' second
victim experiences (SVEs) and perceptions of support two
years after implementation.
November 8, 2023
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March 28, 2005 - Adverse drug events in hospitalized patients: excess
length of stay, extra costs, and attributable mortality.
March 28, 2005
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stay, extra costs, and attributable mortality. JAMA. 1997;277(4):301-6.
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May 04, 2014 - Improving handoff communications in critical care:
utilizing simulation-based training toward process
improvement in managing patient risk.
May 4, 2014
Berkenstadt H, Haviv Y, Tuval A, et al. Improving handoff communications in critical care: utilizing
simulation-based training toward process improvement in managi…
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December 12, 2014 - Infusional chemotherapy and medication errors in a
tertiary care pediatric cancer unit in a resource-limited
setting.
December 12, 2014
Dhamija M, Kapoor G, Juneja A. Infusional chemotherapy and medication errors in a tertiary care pediatric
cancer unit in a resource-limited setting. J Pediatr Hematol Oncol. 2014;…
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May 22, 2015 - Patient safety goals for the proposed Federal Health
Information Technology Safety Center.
May 22, 2015
Sittig DF, Classen D, Singh H. Patient safety goals for the proposed Federal Health Information
Technology Safety Center. J Am Med Inform Assoc. 2015;22(2):472-8. doi:10.1136/amiajnl-2014-002988.
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August 13, 2013 - Surgical technology and operating-room safety failures: a
systematic review of quantitative studies.
August 13, 2013
Weerakkody RA, Cheshire NJ, Riga C, et al. Surgical technology and operating-room safety failures: a
systematic review of quantitative studies. BMJ Qual Saf. 2013;22(9):710-8. doi:10.1136/bmjqs-2012-…
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April 22, 2020 - The impact of surgical count technology on retained
surgical items rates in the Veterans Health
Administration.
April 22, 2020
Gunnar W, Soncrant C, Lynn MM, et al. The impact of surgical count technology on retained surgical items
rates in the Veterans Health Administration. J Patient Saf. 2020;16(4):255-258.
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November 26, 2013 - initiation of penicillin prophylaxis
for children with SCD under age 5 years
significantly reduced the incidence … daily administration of oral penicillin reduced Prophylaxis with oral
the incidence of life-threatening … The study was ended early
because of an 84% reduction in incidence of
Engl J Med
1986;314(25):1593
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www.monahrq.ahrq.gov/sites/default/files/wysiwyg/policymakers/chipra/factsheets/fullreports/chipra-135-graphics-section-5.pdf
November 26, 2013 - initiation of penicillin prophylaxis
for children with SCD under age 5 years
significantly reduced the incidence … daily administration of oral penicillin reduced Prophylaxis with oral
the incidence of life-threatening … The study was ended early
because of an 84% reduction in incidence of
Engl J Med
1986;314(25):1593
-
www.talkingquality.ahrq.gov/sites/default/files/wysiwyg/policymakers/chipra/factsheets/fullreports/chipra-135-graphics-section-5.pdf
November 26, 2013 - initiation of penicillin prophylaxis
for children with SCD under age 5 years
significantly reduced the incidence … daily administration of oral penicillin reduced Prophylaxis with oral
the incidence of life-threatening … The study was ended early
because of an 84% reduction in incidence of
Engl J Med
1986;314(25):1593
-
www.innovations.ahrq.gov/sites/default/files/wysiwyg/policymakers/chipra/factsheets/fullreports/chipra-135-graphics-section-5.pdf
November 26, 2013 - initiation of penicillin prophylaxis
for children with SCD under age 5 years
significantly reduced the incidence … daily administration of oral penicillin reduced Prophylaxis with oral
the incidence of life-threatening … The study was ended early
because of an 84% reduction in incidence of
Engl J Med
1986;314(25):1593
-
www.healthcare411.ahrq.gov/sites/default/files/wysiwyg/policymakers/chipra/factsheets/fullreports/chipra-135-graphics-section-5.pdf
November 26, 2013 - initiation of penicillin prophylaxis
for children with SCD under age 5 years
significantly reduced the incidence … daily administration of oral penicillin reduced Prophylaxis with oral
the incidence of life-threatening … The study was ended early
because of an 84% reduction in incidence of
Engl J Med
1986;314(25):1593
-
www.qualitymeasures.ahrq.gov/sites/default/files/wysiwyg/policymakers/chipra/factsheets/fullreports/chipra-135-graphics-section-5.pdf
November 26, 2013 - initiation of penicillin prophylaxis
for children with SCD under age 5 years
significantly reduced the incidence … daily administration of oral penicillin reduced Prophylaxis with oral
the incidence of life-threatening … The study was ended early
because of an 84% reduction in incidence of
Engl J Med
1986;314(25):1593
-
ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/policymakers/chipra/factsheets/fullreports/chipra-135-graphics-section-5.pdf
November 26, 2013 - initiation of penicillin prophylaxis
for children with SCD under age 5 years
significantly reduced the incidence … daily administration of oral penicillin reduced Prophylaxis with oral
the incidence of life-threatening … The study was ended early
because of an 84% reduction in incidence of
Engl J Med
1986;314(25):1593