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Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicator for Postoperative Respiratory Failure (PSI 11) does not identify accurately patients who received unsafe care. | PSNet

psnet.ahrq.gov/issue/agency-healthcare-research-and-quality-ahrq-patient-safety-indicator-postoperative

January 10, 2018 - Study Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicator for Postoperative Respiratory Failure (PSI 11) does not identify accurately patients who received unsafe care. Citation Text: Nguyen MC, Moffatt-Bruce SD, Strosberg DS, et al. Agency for Healthcare Research …

Harnessing event report data to identify diagnostic error during the COVID-19 pandemic. | PSNet

psnet.ahrq.gov/issue/harnessing-event-report-data-identify-diagnostic-error-during-covid-19-pandemic

October 07, 2020 - Study Harnessing event report data to identify diagnostic error during the COVID-19 pandemic. Citation Text: Shen L, Levie A, Singh H, et al. Harnessing event report data to identify diagnostic error during the COVID-19 pandemic. Jt Comm J Qual Patient Saf. 2022;48(2):71-80. doi:10.1016/…

The relationship between job stress and patient safety culture among nurses: a systematic review. | PSNet

psnet.ahrq.gov/issue/relationship-between-job-stress-and-patient-safety-culture-among-nurses-systematic-review

March 29, 2023 - Review The relationship between job stress and patient safety culture among nurses: a systematic review. Citation Text: Zabin LM, Zaitoun RSA, Sweity EM, et al. The relationship between job stress and patient safety culture among nurses: a systematic review. BMC Nurs. 2023;22(1):39. doi:…

Adverse events experienced while transferring the critically ill patient from the emergency department to the intensive care unit. | PSNet

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November 13, 2024 - Study Adverse events experienced while transferring the critically ill patient from the emergency department to the intensive care unit. Citation Text: Gillman L, Leslie G, Williams T, et al. Adverse events experienced while transferring the critically ill patient from the emergency de…

Assessing quality of older persons' emergency transitions between long-term and acute care settings: a proof-of-concept study. | PSNet

psnet.ahrq.gov/issue/assessing-quality-older-persons-emergency-transitions-between-long-term-and-acute-care

March 17, 2021 - Study Assessing quality of older persons' emergency transitions between long-term and acute care settings: a proof-of-concept study. Citation Text: Tate K, McLane P, Reid C, et al. Assessing quality of older persons’ emergency transitions between long-term and acute care settings: a proo…

Habit and automaticity in medical alert override: cohort study. | PSNet

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October 05, 2022 - Study Habit and automaticity in medical alert override: cohort study. Citation Text: Wang L, Goh KH, Yeow A, et al. Habit and automaticity in medical alert override: cohort study. J Med Internet Res. 2022;24(2):e23355. doi:10.2196/23355. Copy Citation Format: DOI Google Sch…

Perceptions of providing safe care for frail older people at home: a qualitative study based on focus group interviews with home care staff. | PSNet

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July 29, 2020 - Study Perceptions of providing safe care for frail older people at home: a qualitative study based on focus group interviews with home care staff. Citation Text: Silverglow A, Johansson L, Lidén E, et al. Perceptions of providing safe care for frail older people at home: a qualitative st…

Prevalence of adverse events in pediatric intensive care units in the United States. | PSNet

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April 11, 2011 - Study Prevalence of adverse events in pediatric intensive care units in the United States. Citation Text: Agarwal S, Classen D, Larsen G, et al. Prevalence of adverse events in pediatric intensive care units in the United States. Pediatr Crit Care Med. 2010;11(5):568-578. doi:10.1097/P…

Early warning systems and rapid response systems for the prevention of patient deterioration on acute adult hospital wards. | PSNet

psnet.ahrq.gov/issue/early-warning-systems-and-rapid-response-systems-prevention-patient-deterioration-acute-adult

July 29, 2020 - Review Early warning systems and rapid response systems for the prevention of patient deterioration on acute adult hospital wards. Citation Text: McGaughey J, Fergusson DA, Van Bogaert P, et al. Early warning systems and rapid response systems for the prevention of patient deterioration …

Effect of crew resource management training in a multidisciplinary obstetrical setting. | PSNet

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March 06, 2005 - Study Effect of crew resource management training in a multidisciplinary obstetrical setting. Citation Text: Haller G, Garnerin P, Morales M-A, et al. Effect of crew resource management training in a multidisciplinary obstetrical setting. Int J Qual Health Care. 2008;20(4):254-63. doi:…

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

psnet.ahrq.gov/issue/critical-incidents-involving-medical-emergency-team-5-year-retrospective-assessment

November 11, 2020 - Study Critical incidents involving the medical emergency team: a 5-year retrospective assessment for healthcare improvement. Citation Text: Danielis M, Destrebecq A, Terzoni S, et al. Critical incidents involving the medical emergency team: a 5-year retrospective assessment for healthcar…

The impact of a computerized physician order entry system on medical errors with antineoplastic drugs 5 years after its implementation. | PSNet

psnet.ahrq.gov/issue/impact-computerized-physician-order-entry-system-medical-errors-antineoplastic-drugs-5-years

November 17, 2021 - Study The impact of a computerized physician order entry system on medical errors with antineoplastic drugs 5 years after its implementation. Citation Text: Cuervo S, Sanchis R, Lopez P, et al. The impact of a computerized physician order entry system on medical errors with antineoplasti…

Evaluating inpatient mortality: a new electronic review process that gathers information from front-line providers. | PSNet

psnet.ahrq.gov/issue/evaluating-inpatient-mortality-new-electronic-review-process-gathers-information-front-line

February 18, 2011 - Study Evaluating inpatient mortality: a new electronic review process that gathers information from front-line providers. Citation Text: Provenzano A, Rohan S, Trevejo E, et al. Evaluating inpatient mortality: a new electronic review process that gathers information from front-line provi…

Adherence to Surgical Care Improvement Project measures and the association with postoperative infections. | PSNet

psnet.ahrq.gov/issue/adherence-surgical-care-improvement-project-measures-and-association-postoperative-infections

November 25, 2020 - Study Classic Adherence to Surgical Care Improvement Project measures and the association with postoperative infections. Citation Text: Stulberg JJ, Delaney CP, Neuhauser D, et al. Adherence to surgical care improvement project measures and the association wit…

Analysis of readmissions in a mobile integrated health transitional care program using root cause analysis and common cause analysis. | PSNet

psnet.ahrq.gov/issue/analysis-readmissions-mobile-integrated-health-transitional-care-program-using-root-cause

June 08, 2022 - Study Analysis of readmissions in a mobile integrated health transitional care program using root cause analysis and common cause analysis. Citation Text: Buitrago I, Seidl KL, Gingold DB, et al. Analysis of readmissions in a mobile integrated health transitional care program using root …

The vulnerabilities of computerized physician order entry systems: a qualitative study. | PSNet

psnet.ahrq.gov/issue/vulnerabilities-computerized-physician-order-entry-systems-qualitative-study

July 02, 2019 - Study The vulnerabilities of computerized physician order entry systems: a qualitative study. Citation Text: Slight SP, Eguale T, Amato MG, et al. The vulnerabilities of computerized physician order entry systems: a qualitative study: Table 1. J Am Med Inform Assoc. 2015;23(2):311-316. d…

Outpatient CPOE orders discontinued due to 'erroneous entry': prospective survey of prescribers' explanations for errors. | PSNet

psnet.ahrq.gov/issue/outpatient-cpoe-orders-discontinued-due-erroneous-entry-prospective-survey-prescribers

October 13, 2018 - Study Outpatient CPOE orders discontinued due to 'erroneous entry': prospective survey of prescribers' explanations for errors. Citation Text: Hickman T-TT, Quist AJL, Salazar A, et al. Outpatient CPOE orders discontinued due to 'erroneous entry': prospective survey of prescribers' expla…

Application of the aviation black box principle in pediatric cardiac surgery: tracking all failures in the pediatric cardiac operating room. | PSNet

psnet.ahrq.gov/issue/application-aviation-black-box-principle-pediatric-cardiac-surgery-tracking-all-failures

October 07, 2013 - Study Application of the aviation black box principle in pediatric cardiac surgery: tracking all failures in the pediatric cardiac operating room. Citation Text: Bowermaster R, Miller M, Ashcraft T, et al. Application of the aviation black box principle in pediatric cardiac surgery: trac…

PCA safety data review after clinical decision support and smart pump technology implementation. | PSNet

psnet.ahrq.gov/issue/pca-safety-data-review-after-clinical-decision-support-and-smart-pump-technology

October 08, 2016 - Study PCA safety data review after clinical decision support and smart pump technology implementation. Citation Text: Prewitt J, Schneider S, Horvath M, et al. PCA safety data review after clinical decision support and smart pump technology implementation. J Patient Saf. 2013;9(2):103-9…

Improving patient safety governance and systems through learning from successes and failures: qualitative surveys and interviews with international experts. | PSNet

psnet.ahrq.gov/issue/improving-patient-safety-governance-and-systems-through-learning-successes-and-failures

May 08, 2017 - Study Improving patient safety governance and systems through learning from successes and failures: qualitative surveys and interviews with international experts. Citation Text: Hibbert PD, Stewart S, Wiles LK, et al. Improving patient safety governance and systems through learning from …

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