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Patient safety incidents in endoscopy: a human factors analysis of non-procedural significant harm incidents from the National Reporting and Learning System (NRLS). | PSNet

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January 29, 2020 - Study Patient safety incidents in endoscopy: a human factors analysis of non-procedural … significant harm incidents from the National Reporting and Learning System (NRLS). … Patient safety incidents in endoscopy: a human factors analysis of nonprocedural significant harm incidents … and Classification System coding, decision-based errors were the most common factor contributing to incidents … Patient safety incidents in endoscopy: a human factors analysis of nonprocedural significant harm incidents

A retrospective review of serious surgical incidents in 5 large UK teaching hospitals: a system-based approach. | PSNet

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May 26, 2021 - Study A retrospective review of serious surgical incidents in 5 large UK teaching … A retrospective review of serious surgical incidents in 5 large UK teaching hospitals: a system-based … This study reviewed serious surgical incidents occurring at large teaching hospitals in one National … A retrospective review of serious surgical incidents in 5 large UK teaching hospitals: a system-based … Analysis of incidents resulting in patient injuries in a web-based system in Swedish health care.

A review of incidents related to health information technology in Swedish healthcare to characterise system issues as a basis for improvement in clinical practice. | PSNet

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December 20, 2023 - Study A review of incidents related to health information technology in Swedish healthcare … A review of incidents related to health information technology in Swedish healthcare to characterise … About three-quarters of the 95 incidents studied were due to technical factors. … Human factors accounted for 26% of incidents. Of all incidents, 20% led to patient harm. … A review of incidents related to health information technology in Swedish healthcare to characterise

Patient safety trends in 2022: an analysis of 256,679 serious events and incidents from the nation’s largest event reporting database. | PSNet

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July 24, 2024 - Study Patient safety trends in 2022: an analysis of 256,679 serious events and incidents … Patient Safety Trends in 2022: an analysis of 256,679 serious events and incidents from the nation’s … Pennsylvania requires all acute care facilities to report incidents and serious events to the Pennsylvania … Patient Safety Trends in 2022: an analysis of 256,679 serious events and incidents from the nation’s … 2022 2020 Pennsylvania Patient Safety Reporting: an analysis of serious events and incidents

Patient-safety incidents during COVID-19 health crisis in France: An exploratory sequential multi-method study in primary care. | PSNet

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February 05, 2020 - Study Patient-safety incidents during COVID-19 health crisis in France: An exploratory … Citation Text: Patient-safety incidents during COVID-19 health crisis in France: An exploratory sequential … This study examined patient safety incidents in primary care settings in France during the early months … Of the 132 reported incidents, 44% related to delayed diagnosis, assessments and referrals. … Reported incidents less commonly related to cancellation of care, home confinement-related incidents

Deaths following prehospital safety incidents: an analysis of a national database. | PSNet

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October 03, 2018 - Study Deaths following prehospital safety incidents: an analysis of a national database … Deaths following prehospital safety incidents: an analysis of a national database. … This study examined patient deaths related to ambulance safety incidents and found that the majority … Deaths following prehospital safety incidents: an analysis of a national database. … October 3, 2018 Serious incidents after death: content analysis of incidents reported

The impact of critical incidents on nurses and midwives: a systematic review. | PSNet

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May 11, 2022 - Review The impact of critical incidents on nurses and midwives: a systematic review … The impact of critical incidents on nurses and midwives: A systematic review. … This systematic review explored the experiences of critical incidents on nurses and midwives and … The impact of critical incidents on nurses and midwives: A systematic review. … July 8, 2020 A scoping review of adverse incidents research in aged care homes: learnings

Analysis of paediatric long-term ventilation incidents in the community | PSNet

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November 06, 2024 - Study Analysis of paediatric long-term ventilation incidents in the community … Analysis of paediatric long-term ventilation incidents in the community. … The reports clearly stated harm to the child in 41% of incidents, such as emergency tracheostomy change … Analysis of paediatric long-term ventilation incidents in the community. … September 2, 2020 Reporting incidents involving the use of advanced medical technologies

Learning from patient safety incidents involving acutely sick adults in hospital assessment units in England and Wales: a mixed methods analysis for quality improvement. | PSNet

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November 11, 2020 - Study Learning from patient safety incidents involving acutely sick adults in hospital … Learning from patient safety incidents involving acutely sick adults in hospital assessment units in … 377 included reports, diagnostic errors, medication-related errors, and failure to monitor patient incidents … Learning from patient safety incidents involving acutely sick adults in hospital assessment units in … Related Resources From the Same Author(s) A mixed-methods analysis of patient safety incidents

Trend analysis of radiation therapy incidents over seven years. | PSNet

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December 20, 2023 - Study Trend analysis of radiation therapy incidents over seven years. … Trend analysis of radiation therapy incidents over seven years. … Analysis of voluntary error reports indicated a decrease in safety incidents at a high-volume radiation … Trend analysis of radiation therapy incidents over seven years.

Thematic reviews of patient safety incidents as a tool for systems thinking: a quality improvement report. | PSNet

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January 15, 2020 - Commentary Thematic reviews of patient safety incidents as a tool for systems thinking … Thematic reviews of patient safety incidents as a tool for systems thinking: a quality improvement report … Learning from patient safety incidents can help health care organizations improve processes and care … This article provides a template for organizations to review patient safety incidents and classify them … The process involves clearly characterizing the safety incidents, describing the involved safety systems

Care coordination strategies and barriers during medication safety incidents: a qualitative, cognitive task analysis. | PSNet

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March 17, 2021 - Study Care coordination strategies and barriers during medication safety incidents … Care coordination strategies and barriers during medication safety incidents: a qualitative, cognitive … This qualitative study examined medication safety incidents at one VA hospital and found that health … Care coordination strategies and barriers during medication safety incidents: a qualitative, cognitive … February 2, 2022 The nature, severity and causes of medication incidents from an Australian

Critical incidents involving the medical emergency team: a 5-year retrospective assessment for healthcare improvement. | PSNet

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November 11, 2020 - Study Critical incidents involving the medical emergency team: a 5-year retrospective … Critical incidents involving the medical emergency team: a 5-year retrospective assessment for healthcare … This retrospective study analyzed critical incidents that occurred during MET responses over a five-year … Critical incidents involving the medical emergency team: a 5-year retrospective assessment for healthcare … Analysis of incidents resulting in patient injuries in a web-based system in Swedish health care.

Prosocial voice in the hierarchy of healthcare professionals: the role of emotions after harmful patient safety incidents. | PSNet

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February 23, 2022 - voice in the hierarchy of healthcare professionals: the role of emotions after harmful patient safety incidents … voice in the hierarchy of healthcare professionals: the role of emotions after harmful patient safety incidents … Healthcare professionals who are involved in patient safety incidents can experience psychological … this study explored the emotional experience of healthcare professionals involved in patient safety incidents … March 8, 2023 Support for healthcare professionals after surgical patient safety incidents

Interventions to support nurses as second victims of patient safety incidents: a qualitative study of nurse managers' perceptions. | PSNet

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November 24, 2021 - Study Interventions to support nurses as second victims of patient safety incidents … Interventions to support nurses as second victims of patient safety incidents: a qualitative study of … Interventions to support nurses as second victims of patient safety incidents: a qualitative study of … the Same Author(s) Artificial intelligence for identifying the prevention of medication incidents … May 22, 2024 Flow of information contributing to medication incidents in home care- an

Strengthening open disclosure after incidents in maternity care: a realist synthesis of international research evidence. | PSNet

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September 18, 2024 - Review Strengthening open disclosure after incidents in maternity care: a realist … Strengthening open disclosure after incidents in maternity care: a realist synthesis of international … Patients and families expect full, timely disclosure after incidents. … Strengthening open disclosure after incidents in maternity care: a realist synthesis of international … March 15, 2023 Identifying no-harm incidents in home healthcare: a cohort study using

Learning from patient safety incidents: The Green Cross method. | PSNet

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June 14, 2023 - Study Learning from patient safety incidents: The Green Cross method. … Learning from patient safety incidents: the Green Cross method. … A diverse array of methods exists to report and learn from patient safety incidents. … experience with the Green Cross method, a proactive method to report and learn from patient safety incidents … Learning from patient safety incidents: the Green Cross method.

Analysis of the nature and contributory factors of medication safety incidents following hospital discharge using National Reporting and Learning System (NRLS) data from England and Wales: a multi-method study. | PSNet

psnet.ahrq.gov/issue/analysis-nature-and-contributory-factors-medication-safety-incidents-following-hospital

October 25, 2023 - Study Analysis of the nature and contributory factors of medication safety incidents … Analysis of the nature and contributory factors of medication safety incidents following hospital discharge … Patients over 65 were the most common age group and, of incidents with a stated level of harm, most did … Overall, most incidents occurred at the prescribing stage, but varied by patient age group. … Analysis of the nature and contributory factors of medication safety incidents following hospital discharge

2020 Pennsylvania Patient Safety Reporting: an analysis of serious events and incidents from the nation’s largest event reporting database. | PSNet

psnet.ahrq.gov/issue/2020-pennsylvania-patient-safety-reporting-analysis-serious-events-and-incidents-nations

July 06, 2022 - Study 2020 Pennsylvania Patient Safety Reporting: an analysis of serious events and incidents … Kepner S, Jones RM. 2020 Pennsylvania Patient Safety Reporting: an analysis of serious events and incidents … Of all submitted events in 2020, 97% were from hospitals, and 97% were incidents; 3 percent were serious … October 6, 2021 Reporting incidents involving the use of advanced medical technologies … February 12, 2020 Learning from patient safety incidents involving acutely sick adults

Blackbox error management: how do practices deal with critical incidents in everyday practice? A qualitative interview study. | PSNet

psnet.ahrq.gov/issue/blackbox-error-management-how-do-practices-deal-critical-incidents-everyday-practice

May 01, 2024 - Study Blackbox error management: how do practices deal with critical incidents in … Blackbox error management: how do practices deal with critical incidents in everyday practice? … i.e., primary care, dentists, dermatology, orthopedic surgery, psychiatry/psychology) define critical incidents … Respondents described critical incidents across a spectrum, from organizational processes to medical … Blackbox error management: how do practices deal with critical incidents in everyday practice?

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