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  1. An evidence-based tool (PE for PS) for healthcare managers to assess patient engagement for patient safety in healthcare organizations. | PSNet

    psnet.ahrq.gov/issue/evidence-based-tool-pe-ps-healthcare-managers-assess-patient-engagement-patient-safety
    June 08, 2010 - Study An evidence-based tool (PE for PS) for healthcare managers to assess patient engagement for patient safety in healthcare organizations. Citation Text: Aho-Glele U, Pomey M-P, Gomes de Sousa MR, et al. An evidence-based tool (PE for PS) for healthcare managers to assess patient enga…

  2. Two fatal cases of accidental intrathecal vincristine administration: learning from death events. | PSNet

    psnet.ahrq.gov/issue/two-fatal-cases-accidental-intrathecal-vincristine-administration-learning-death-events
    March 24, 2021 - Commentary Two fatal cases of accidental intrathecal vincristine administration: learning from death events. Citation Text: Chotsampancharoen T, Sripornsawan P, Wongchanchailert M. Two fatal cases of accidental intrathecal vincristine administration: learning from death event. Chemothera…

  3. A multi-site assessment of inpatient safety event rates during the coronavirus disease 2019 pandemic. | PSNet

    psnet.ahrq.gov/issue/multi-site-assessment-inpatient-safety-event-rates-during-coronavirus-disease-2019-pandemic
    May 25, 2022 - Commentary A multi-site assessment of inpatient safety event rates during the coronavirus disease 2019 pandemic. Citation Text: Pollock BD, Dykhoff HJ, Breeher LE, et al. A multi-site assessment of inpatient safety event rates during the coronavirus disease 2019 pandemic. Mayo Clin Proc …

  4. EMS non-conveyance: a safe practice to decrease ED crowding or a threat to patient safety? | PSNet

    psnet.ahrq.gov/issue/ems-non-conveyance-safe-practice-decrease-ed-crowding-or-threat-patient-safety
    January 12, 2022 - Study EMS non-conveyance: a safe practice to decrease ED crowding or a threat to patient safety? Citation Text: Paulin J, Kurola J, Koivisto M, et al. EMS non-conveyance: A safe practice to decrease ED crowding or a threat to patient safety? BMC Emerg Med. 2021;21(1):115. doi:10.1186/s12…

  5. Accuracy of emergency department clinical findings for diagnosis of coronavirus disease 2019. | PSNet

    psnet.ahrq.gov/issue/accuracy-emergency-department-clinical-findings-diagnosis-coronavirus-disease-2019
    September 09, 2020 - Study Accuracy of emergency department clinical findings for diagnosis of coronavirus disease 2019. Citation Text: Peyrony O, Marbeuf-Gueye C, Truong V, et al. Accuracy of emergency department clinical findings for diagnosis of coronavirus disease 2019. Ann Emerg Med. 2020;76(4):405-412.…

  6. Developing and evaluating an automated all-cause harm trigger system. | PSNet

    psnet.ahrq.gov/issue/developing-and-evaluating-automated-all-cause-harm-trigger-system
    July 31, 2013 - Study Developing and evaluating an automated all-cause harm trigger system. Citation Text: Sammer C, Miller S, Jones C, et al. Developing and Evaluating an Automated All-Cause Harm Trigger System. Jt Comm J Qual Patient Saf. 2017;43(4):155-165. doi:10.1016/j.jcjq.2017.01.004. Copy Cita…

  7. Team relations and role perceptions during anesthesia crisis management in magnetic-resonance imaging settings: a mixed-methods exploration. | PSNet

    psnet.ahrq.gov/issue/team-relations-and-role-perceptions-during-anesthesia-crisis-management-magnetic-resonance
    December 13, 2023 - Study Team relations and role perceptions during anesthesia crisis management in magnetic-resonance imaging settings: a mixed-methods exploration. Citation Text: Schroeck H, Whitty MA, Hatton B, et al. Team relations and role perceptions during anesthesia crisis management in magnetic-re…

  8. Surgical safety and hospital volume across a wide range of interventions. | PSNet

    psnet.ahrq.gov/issue/surgical-safety-and-hospital-volume-across-wide-range-interventions
    April 04, 2011 - Study Surgical safety and hospital volume across a wide range of interventions. Citation Text: Eggli Y, Halfon P, Meylan D, et al. Surgical safety and hospital volume across a wide range of interventions. Med Care. 2010;48(11):962-71. doi:10.1097/MLR.0b013e3181eaf9f6. Copy Citation …

  9. A report of information technology and health deficiencies in U.S. nursing homes. | PSNet

    psnet.ahrq.gov/issue/report-information-technology-and-health-deficiencies-us-nursing-homes
    October 28, 2020 - Study A report of information technology and health deficiencies in U.S. nursing homes. Citation Text: Alexander GL, Madsen RW. A report of information technology and health deficiencies in U.S. nursing homes. J Patient Saf. 2021;17(6):e483-e489. doi:10.1097/pts.0000000000000390. Copy …

  10. Morning handover of on-call issues: opportunities for improvement. | PSNet

    psnet.ahrq.gov/issue/morning-handover-call-issues-opportunities-improvement
    September 26, 2012 - Study Morning handover of on-call issues: opportunities for improvement. Citation Text: Devlin MK, Kozij NK, Kiss A, et al. Morning handover of on-call issues: opportunities for improvement. JAMA Intern Med. 2014;174(9):1479-85. doi:10.1001/jamainternmed.2014.3033. Copy Citation Fo…

  11. Reducing the burden of surgical harm: a systematic review of the interventions used to reduce adverse events in surgery. | PSNet

    psnet.ahrq.gov/issue/reducing-burden-surgical-harm-systematic-review-interventions-used-reduce-adverse-events
    June 21, 2016 - Review Reducing the burden of surgical harm: a systematic review of the interventions used to reduce adverse events in surgery. Citation Text: Howell A-M, Panesar S, Burns EM, et al. Reducing the burden of surgical harm: a systematic review of the interventions used to reduce adverse eve…

  12. Global oncology pharmacy response to COVID-19 pandemic: medication access and safety. | PSNet

    psnet.ahrq.gov/issue/global-oncology-pharmacy-response-covid-19-pandemic-medication-access-and-safety
    January 23, 2017 - Commentary Global oncology pharmacy response to COVID-19 pandemic: medication access and safety. Citation Text: Alexander M, Jupp J, Chazan G, et al. Global oncology pharmacy response to COVID-19 pandemic: medication access and safety. J Oncol Pharm Pract. 2020;26(5):1225-1229. doi:10.11…

  13. The impact of traditional and smart pump infusion technology on nurse medication administration performance in a simulated inpatient unit. | PSNet

    psnet.ahrq.gov/issue/impact-traditional-and-smart-pump-infusion-technology-nurse-medication-administration
    May 18, 2022 - Study The impact of traditional and smart pump infusion technology on nurse medication administration performance in a simulated inpatient unit. Citation Text: Trbovich PL, Pinkney S, Cafazzo JA, et al. The impact of traditional and smart pump infusion technology on nurse medication ad…

  14. Incidence of "never events" among weekend admissions versus weekday admissions to US hospitals: national analysis. | PSNet

    psnet.ahrq.gov/issue/incidence-never-events-among-weekend-admissions-versus-weekday-admissions-us-hospitals
    November 03, 2015 - Study Classic Incidence of "never events" among weekend admissions versus weekday admissions to US hospitals: national analysis. Citation Text: Attenello FJ, Wen T, Cen SY, et al. Incidence of "never events" among weekend admissions versus weekday admissions to …

  15. Impact of errors in paper-based and computerized diabetes management with decision support for hospitalized patients with type 2 diabetes. A post-hoc analysis of a before and after study. | PSNet

    psnet.ahrq.gov/issue/impact-errors-paper-based-and-computerized-diabetes-management-decision-support-hospitalized
    April 03, 2024 - Study Impact of errors in paper-based and computerized diabetes management with decision support for hospitalized patients with type 2 diabetes. A post-hoc analysis of a before and after study. Citation Text: Donsa K, Beck P, Höll B, et al. Impact of errors in paper-based and computerize…

  16. Patient comprehension of emergency department care and instructions: are patients aware of when they do not understand? | PSNet

    psnet.ahrq.gov/issue/patient-comprehension-emergency-department-care-and-instructions-are-patients-aware-when-they
    September 23, 2020 - Study Classic Patient comprehension of emergency department care and instructions: are patients aware of when they do not understand? Citation Text: Engel KG, Heisler M, Smith DM, et al. Patient comprehension of emergency department care and instructions: are …

  17. Older patients' perceptions of "unnecessary" tests and referrals: a national survey of Medicare beneficiaries. | PSNet

    psnet.ahrq.gov/issue/older-patients-perceptions-unnecessary-tests-and-referrals-national-survey-medicare
    May 25, 2011 - Study Older patients' perceptions of "unnecessary" tests and referrals: a national survey of Medicare beneficiaries. Citation Text: Herndon B, Schwartz LM, Woloshin S, et al. Older patients perceptions of "unnecessary" tests and referrals: a national survey of Medicare beneficiaries. J…

  18. Analysis of adverse events associated with adult moderate procedural sedation outside the operating room. | PSNet

    psnet.ahrq.gov/issue/analysis-adverse-events-associated-adult-moderate-procedural-sedation-outside-operating-room
    August 13, 2014 - Study Analysis of adverse events associated with adult moderate procedural sedation outside the operating room. Citation Text: Karamnov S, Sarkisian N, Grammer R, et al. Analysis of Adverse Events Associated With Adult Moderate Procedural Sedation Outside the Operating Room. J Patient Sa…

  19. Registration errors among patients receiving blood transfusions: a national analysis from 2008 to 2017. | PSNet

    psnet.ahrq.gov/issue/registration-errors-among-patients-receiving-blood-transfusions-national-analysis-2008-2017
    March 18, 2020 - Study Registration errors among patients receiving blood transfusions: a national analysis from 2008 to 2017. Citation Text: Vijenthira S, Armali C, Downie H, et al. Registration errors among patients receiving blood transfusions: a national analysis from 2008 to 2017. Vox Sang. 2021;116…

  20. National costs of the medical liability system. | PSNet

    psnet.ahrq.gov/issue/national-costs-medical-liability-system
    May 20, 2015 - Study Classic National costs of the medical liability system. Citation Text: Mello MM, Chandra A, Gawande AA, et al. National costs of the medical liability system. Health Aff (Millwood). 2010;29(9):1569-1577. doi:10.1377/hlthaff.2009.0807. Copy Citation F…
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