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psnet.ahrq.gov/issue/addressing-postdischarge-adverse-events-neglected-area
November 13, 2024 - Author(s)
Adverse events in patients transitioning from the emergency department to the inpatient … November 13, 2024
Post-discharge adverse events among African American and Caucasian … Evaluating the Patient Safety Indicators: how well do they perform on Veterans Health Administration data … of selected AHRQ Patient Safety Indicators based on VA National Surgical Quality Improvement program data … June 16, 2021
Information transfer at hospital discharge: a systematic review.
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psnet.ahrq.gov/issue/incidence-and-trends-sepsis-us-hospitals-using-clinical-vs-claims-data-2009-2014
February 27, 2019 - Incidence and Trends of Sepsis in US Hospitals Using Clinical vs Claims Data, 2009-2014. … Although inpatient mortality due to sepsis declined somewhat, there was no change in the combined outcome … of death or discharge to hospice. … over time as well as a marked decrease in sepsis mortality and death or discharge to hospice. … Incidence and Trends of Sepsis in US Hospitals Using Clinical vs Claims Data, 2009-2014.
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psnet.ahrq.gov/node/40726/psn-pdf
July 03, 2014 - cannot detect errors until well after the event has occurred, as
they rely on screening administrative data … or review of the entire chart after discharge. … automated-identification-postoperative-complications-within-electronic-medical-record-using
https://psnet.ahrq.gov/issue/integrating-incident-data-five-reporting-systems-assess-patient-safety-making-sense-elephant … psnet.ahrq.gov/primer/diagnostic-errors
https://psnet.ahrq.gov/issue/variation-hospital-mortality-associated-inpatient-surgery … https://psnet.ahrq.gov/issue/variation-hospital-mortality-associated-inpatient-surgery
https://psnet.ahrq.gov
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psnet.ahrq.gov/issue/medication-related-hospital-readmissions-within-30-days-discharge-prevalence-preventability
April 27, 2022 - Study
Medication-related hospital readmissions within 30 days of discharge: prevalence … Medication-related hospital readmissions within 30 days of discharge: prevalence, preventability, type … Medication-related hospital readmissions within 30 days of discharge: prevalence, preventability, type … July 20, 2022
Effect of patient- and medication-related factors on inpatient medication … elderly fallers: identifying associated risk factors for 30-day unplanned readmissions using a clinical data
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psnet.ahrq.gov/node/47291/psn-pdf
October 31, 2018 - psnet.ahrq.gov/issue/incidence-and-method-suicide-hospitals-united-states
The Joint Commission identifies inpatient … Researchers examined two national databases to develop the first data-driven appraisal of hospital suicide … editorial raises concerns about the much
larger epidemic of suicide immediately after psychiatric hospital discharge … psnet.ahrq.gov/issue/incidence-and-method-suicide-hospitals-united-states
https://psnet.ahrq.gov/issue/inpatient-suicide-preventing-common-sentinel-event
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psnet.ahrq.gov/node/867985/psn-pdf
January 01, 2025 - In the inpatient environment, the discharge and referral process is essential to maintaining patient … safety,
as suicide rates spike in the days after discharge.17 Effective discharge planning involves … Scheduling rapid follow-up visit
appointments before discharge helps bridge the gap between inpatient … at]
https://psnet.ahrq.gov//#20
https://www.cdc.gov/suicide/facts/index.html
https://www.samhsa.gov/data … Suicide Attempts and Suicide Deaths Subsequent to Discharge From an Emergency
Department or an Inpatient
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psnet.ahrq.gov/issue/why-universal-precautions-are-needed-medication-lists
August 31, 2016 - ensure accuracy of electronic medication lists and reduce unnecessary or duplicate prescriptions in discharge … August 31, 2016
Potential benefit of electronic pharmacy claims data to prevent medication … history errors and resultant inpatient order errors. … June 19, 2019
Prospective daily review of discharge medications by pharmacists: effects … February 17, 2011
Making inpatient medication reconciliation patient centered, clinically
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psnet.ahrq.gov/issue/improving-perceptions-patient-safety-through-standardizing-handoffs-emergency-department
December 21, 2022 - Improving perceptions of patient safety through standardizing handoffs from the emergency department to the inpatient … Improving perceptions of patient safety through standardizing handoffs from the emergency department to the inpatient … This systematic review of handoffs from the emergency department to inpatient settings found that … Researchers found that little data exists on the impact of standardizing handoffs from the emergency … Effect of a pharmacist intervention on clinically important medication errors after hospital discharge
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psnet.ahrq.gov/issue/academic-half-day-improves-resident-perception-education-without-compromising-patient-safety
April 10, 2024 - Survey data indicate positive changes in resident attitudes and experiences after AHD implementation. … April 24, 2018
SAFER Care: improving caregiver comprehension of discharge instructions … June 20, 2018
The association between transfer of emergency department boarders to inpatient … January 11, 2023
Separating residents' inpatient and outpatient responsibilities: improving … May 8, 2017
The effect of workload reduction on the quality of residents' discharge summaries
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psnet.ahrq.gov/issue/medication-reconciliation-during-hospitalization-and-hospital-home-interface-observational
June 16, 2021 - This retrospective study examined regional prescription registry (RPR) data at a single Italian hospital … at 4 comparison points, pre-admission, admission, hospitalization, and post-discharge. … June 16, 2021
Medication errors at hospital admission and discharge: risk factors and … Influence of organizational climate and clinician morale on seclusion and physical restraint use in inpatient … and post-discharge.
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psnet.ahrq.gov/node/837748/psn-pdf
August 05, 2022 - across transitions of care (TOC) is an important source of
potential harm to patients.1 Up to 67% of inpatients … In a prospective observational study of 180 general
medical inpatients from two academic medical centers … Interestingly, the MARQUIS data demonstrates that training staff to perform BPMHs was shown to be
detrimental … 2.85 to 0.98 discrepancies per patient; interrupted time series analysis of the sites with sufficient data … Classifying and predicting errors of inpatient medication
reconciliation.
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psnet.ahrq.gov/issue/learning-lawsuits-using-malpractice-claims-data-develop-care-transitions-planning-tools
January 21, 2019 - Study
Learning from lawsuits: using malpractice claims data to develop care transitions … Learning From Lawsuits: Using Malpractice Claims Data to Develop Care Transitions Planning Tools. … home visits for middle-aged and older adults receiving skilled home healthcare services after hospital discharge … December 30, 2014
Paid malpractice claims for adverse events in inpatient and outpatient … August 23, 2007
Risk of medication errors at hospital discharge and barriers to problem
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psnet.ahrq.gov/issue/combined-impact-medicares-hospital-pay-performance-programs-quality-and-safety-outcomes-mixed
December 08, 2021 - This study used 2007 to 2016 inpatient discharge data from 14 states to compare rates of inpatient quality … The confused and bewildered hospital: adverse event discovery, pay-for-performance, and big data
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psnet.ahrq.gov/perspective/what-have-we-learned-about-safe-inpatient-handovers
March 01, 2011 - What Have We Learned About Safe Inpatient Handovers? … What Have We Learned About Safe Inpatient Handovers?. PSNet [internet]. … this risk stratification there's different expectations of the time it will take and the amount of data … For some, like readmission or discharge, that makes intuitive sense, but for a specific inpatient handoff … Our data does show that some people do recognize the tradeoff.
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psnet.ahrq.gov/node/36486/psn-pdf
June 13, 2011 - medication errors frequently occur at times of transitions in care such
as hospital admission and discharge … At the time of hospital admission, the system integrates data from the
outpatient and inpatient EMR … unintended-medication-discrepancies-time-hospital-admission
https://psnet.ahrq.gov/issue/incidence-and-severity-adverse-events-affecting-patients-after-discharge-hospital
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psnet.ahrq.gov/Primers
April 01, 2021 - April 2021
An essential aspect of preventing medical errors and improving patient safety is using data … , run charts and control charts – hospitals and health systems can leverage to track patient safety data … Patient Safety Primers
Discharge Planning and Transitions of Care
March 2020
Discharge planning … The digitization of health care data has had some positive effects on patient safety, but it has also … Data indicates that more than 20% of patients in these settings experience an adverse event during their
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psnet.ahrq.gov/issue/safety-elderly-fallers-identifying-associated-risk-factors-30-day-unplanned-readmissions
May 04, 2022 - elderly fallers: identifying associated risk factors for 30-day unplanned readmissions using a clinical data … elderly fallers: identifying associated risk factors for 30-day unplanned readmissions using a clinical data … Discharge programs targeting these patients could reduce 30-day unplanned readmissions. … January 12, 2022
Developing and aligning a safety event taxonomy for inpatient psychiatry … November 30, 2022
Assessment of requests for medication-related follow-up after hospital discharge
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psnet.ahrq.gov/issue/preventing-medication-errors-transitions-care-patient-case-approach
October 17, 2012 - ensure that the correct medication information follows patients throughout their hospital stay and discharge … More
Related Resources
Patient Safety Primers
Inpatient … and post-discharge. … June 10, 2018
Promoting effective transitions of care at hospital discharge: a review … June 13, 2011
Hospitals put emphasis on collection of medication data.
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psnet.ahrq.gov/issue/association-hospitalist-years-experience-mortality-hospitalized-medicare-population
May 11, 2022 - This analysis of Medicare data found that patients cared for by hospitalist physicians in their first … March 17, 2021
Inpatient housestaff discontinuity of care and patient adverse events. … Association of changing hospital readmission rates with mortality rates after hospital discharge … May 3, 2017
Inpatient notes: reducing diagnostic error—a new horizon of opportunities … , 2010
Patient safety concerns arising from test results that return after hospital discharge
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psnet.ahrq.gov/web-mm/challenges-diabetes-management-and-medication-reconciliation
March 15, 2023 - across transitions of care (TOC) is an important source of potential harm to patients. 1 Up to 67% of inpatients … In a prospective observational study of 180 general medical inpatients from two academic medical centers … Interestingly, the MARQUIS data demonstrates that training staff to perform BPMHs was shown to be detrimental … 2.85 to 0.98 discrepancies per patient; interrupted time series analysis of the sites with sufficient data … Classifying and predicting errors of inpatient medication reconciliation.