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  1. Bariatric surgery with operating room teams that stayed fixed during the day: a multicenter study analyzing the effects on patient outcomes, teamwork and safety climate, and procedure duration. | PSNet

    psnet.ahrq.gov/issue/bariatric-surgery-operating-room-teams-stayed-fixed-during-day-multicenter-study-analyzing
    December 21, 2014 - Study Bariatric surgery with operating room teams that stayed fixed during the day: a multicenter study analyzing the effects on patient outcomes, teamwork and safety climate, and procedure duration. Citation Text: Stepaniak PS, Heij C, Buise MP, et al. Bariatric surgery with operating r…

  2. Medical line entanglement: the unspoken patient safety hazard of medical devices. | PSNet

    psnet.ahrq.gov/issue/medical-line-entanglement-unspoken-patient-safety-hazard-medical-devices
    May 08, 2019 - Study Medical line entanglement: the unspoken patient safety hazard of medical devices. Citation Text: Larimer C, Sumner V, Wander D. Medical line entanglement: the unspoken patient safety hazard of medical devices. Nutr Clin Pract. 2023;38(6):1296-1308. doi:10.1002/ncp.11000. Copy Cit…

  3. Design and testing of the safety agenda mobile app for managing health care managers' patient safety responsibilities. | PSNet

    psnet.ahrq.gov/issue/design-and-testing-safety-agenda-mobile-app-managing-health-care-managers-patient-safety
    July 12, 2017 - Study Design and testing of the safety agenda mobile app for managing health care managers' patient safety responsibilities. Citation Text: Mira JJ, Carrillo I, Fernandez C, et al. Design and Testing of the Safety Agenda Mobile App for Managing Health Care Managers' Patient Safety Respon…

  4. Evaluation of accuracy of IHI Trigger Tool in identifying adverse drug events: a prospective observational study. | PSNet

    psnet.ahrq.gov/issue/evaluation-accuracy-ihi-trigger-tool-identifying-adverse-drug-events-prospective
    October 18, 2023 - Study Evaluation of accuracy of IHI Trigger Tool in identifying adverse drug events: a prospective observational study. Citation Text: Silva M das DG, Martins MAP, Viana L de G, et al. Evaluation of accuracy of IHI Trigger Tool in identifying adverse drug events: a prospective observatio…

  5. Adverse events and patient outcomes among hospitalized children cared for by general pediatricians vs hospitalists. | PSNet

    psnet.ahrq.gov/issue/adverse-events-and-patient-outcomes-among-hospitalized-children-cared-general-pediatricians
    March 23, 2016 - Study Adverse events and patient outcomes among hospitalized children cared for by general pediatricians vs hospitalists. Citation Text: Basco WT. Comparing the Care of Pediatric Hospitalists With That of General Pediatricians. JAMA Netw Open. 2018;1(8). doi:10.1001/jamanetworkopen.2018.…

  6. Errors and error-producing conditions during a simulated, prehospital, pediatric cardiopulmonary arrest. | PSNet

    psnet.ahrq.gov/issue/errors-and-error-producing-conditions-during-simulated-prehospital-pediatric-cardiopulmonary
    August 25, 2021 - Study Errors and error-producing conditions during a simulated, prehospital, pediatric cardiopulmonary arrest. Citation Text: Lammers RL, Willoughby-Byrwa M, Fales WD. Errors and error-producing conditions during a simulated, prehospital, pediatric cardiopulmonary arrest. Simul Healthc. …

  7. Exploring clinical lessons learned by experienced hospitalists from diagnostic errors and successes. | PSNet

    psnet.ahrq.gov/issue/exploring-clinical-lessons-learned-experienced-hospitalists-diagnostic-errors-and-successes
    January 15, 2025 - Study Exploring clinical lessons learned by experienced hospitalists from diagnostic errors and successes. Citation Text: Kotwal S, Howell M, Zwaan L, et al. Exploring clinical lessons learned by experienced hospitalists from diagnostic errors and successes. J Gen Intern Med. 2024;39(8):…

  8. How to make medication error reporting systems work—factors associated with their successful development and implementation. | PSNet

    psnet.ahrq.gov/issue/how-make-medication-error-reporting-systems-work-factors-associated-their-successful
    December 05, 2012 - Study How to make medication error reporting systems work—factors associated with their successful development and implementation. Citation Text: Holmström A-R, Laaksonen R, Airaksinen M. How to make medication error reporting systems work--Factors associated with their successful develo…

  9. National and local medication error reporting systems—a survey of practices in 16 countries. | PSNet

    psnet.ahrq.gov/issue/national-and-local-medication-error-reporting-systems-survey-practices-16-countries
    September 09, 2015 - Study National and local medication error reporting systems—a survey of practices in 16 countries. Citation Text: Holmström A-R, Airaksinen M, Weiss M, et al. National and local medication error reporting systems: a survey of practices in 16 countries. J Patient Saf. 2012;8(4):165-76. …

  10. Contextual factors influencing the implementation of a multifaceted intervention to improve teamwork and quality for hospitalized patients: a multi-site qualitative comparative case study. | PSNet

    psnet.ahrq.gov/issue/contextual-factors-influencing-implementation-multifaceted-intervention-improve-teamwork-and
    November 15, 2023 - Study Contextual factors influencing the implementation of a multifaceted intervention to improve teamwork and quality for hospitalized patients: a multi-site qualitative comparative case study. Citation Text: Terwilliger IA, Johnson JK, Manojlovich M, et al. Contextual Factors Influenci…

  11. Patient handover from surgery to intensive care: using Formula 1 pit-stop and aviation models to improve safety and quality. | PSNet

    psnet.ahrq.gov/issue/patient-handover-surgery-intensive-care-using-formula-1-pit-stop-and-aviation-models-improve
    October 03, 2011 - Study Patient handover from surgery to intensive care: using Formula 1 pit-stop and aviation models to improve safety and quality. Citation Text: Catchpole K, de Leval MR, McEwan A, et al. Patient handover from surgery to intensive care: using Formula 1 pit-stop and aviation models to …

  12. Reduction in opioid prescribing through evidence-based prescribing guidelines. | PSNet

    psnet.ahrq.gov/issue/reduction-opioid-prescribing-through-evidence-based-prescribing-guidelines
    January 27, 2019 - Study Reduction in opioid prescribing through evidence-based prescribing guidelines. Citation Text: Howard R, Waljee JF, Brummett CM, et al. Reduction in Opioid Prescribing Through Evidence-Based Prescribing Guidelines. JAMA Surg. 2018;153(3):285-287. doi:10.1001/jamasurg.2017.4436. Co…

  13. Impact of staff turnover during cardiac surgical procedures. | PSNet

    psnet.ahrq.gov/issue/impact-staff-turnover-during-cardiac-surgical-procedures
    November 06, 2019 - Study Impact of staff turnover during cardiac surgical procedures. Citation Text: Bloom JP, Moonsamy P, Gartland RM, et al. Impact of staff turnover during cardiac surgical procedures. J Thorac Cardiovasc Surg. 2019. doi:10.1016/j.jtcvs.2019.11.051. Copy Citation Format: DO…

  14. Association of hospital participation in a regional trauma quality improvement collaborative with patient outcomes. | PSNet

    psnet.ahrq.gov/issue/association-hospital-participation-regional-trauma-quality-improvement-collaborative-patient
    August 20, 2018 - Study Association of hospital participation in a regional trauma quality improvement collaborative with patient outcomes. Citation Text: Hemmila MR, Cain-Nielsen AH, Jakubus JL, et al. Association of Hospital Participation in a Regional Trauma Quality Improvement Collaborative With Patie…

  15. Errors detected in pediatric oral liquid medication doses prepared in an automated workflow management system. | PSNet

    psnet.ahrq.gov/issue/errors-detected-pediatric-oral-liquid-medication-doses-prepared-automated-workflow-management
    June 22, 2009 - Study Errors detected in pediatric oral liquid medication doses prepared in an automated workflow management system. Citation Text: Bledsoe S, Van Buskirk A, Falconer J, et al. Errors detected in pediatric oral liquid medication doses prepared in an automated workflow management system. …

  16. Improving end-of-rotation transitions of care among ICU patients | PSNet

    psnet.ahrq.gov/issue/improving-end-rotation-transitions-care-among-icu-patients
    September 23, 2020 - Journal Article Improving end-of-rotation transitions of care among ICU patients Citation Text: Denson JL, Knoeckel J, Kjerengtroen S, et al. Improving end-of-rotation transitions of care among ICU patients. BMJ Qual Saf. 2019;29(3):250-259. doi:10.1136/bmjqs-2019-009867. Copy Citation…

  17. Surgeon-specific mortality data disguise wider failings in delivery of safe surgical services. | PSNet

    psnet.ahrq.gov/issue/surgeon-specific-mortality-data-disguise-wider-failings-delivery-safe-surgical-services
    March 09, 2022 - Study Surgeon-specific mortality data disguise wider failings in delivery of safe surgical services. Citation Text: Westaby S, De Silva R, Petrou M, et al. Surgeon-specific mortality data disguise wider failings in delivery of safe surgical services. Eur J Cardiothorac Surg. 2015;47(2):3…

  18. The multidisciplinary approach to GI cancer results in change of diagnosis and management of patients. Multidisciplinary care impacts diagnosis and management of patients. | PSNet

    psnet.ahrq.gov/issue/multidisciplinary-approach-gi-cancer-results-change-diagnosis-and-management-patients
    December 21, 2014 - Study The multidisciplinary approach to GI cancer results in change of diagnosis and management of patients. Multidisciplinary care impacts diagnosis and management of patients. Citation Text: Meguid C, Schulick RD, Schefter TE, et al. The Multidisciplinary Approach to GI Cancer Results …

  19. Development of a core drug list towards improving prescribing education and reducing errors in the UK. | PSNet

    psnet.ahrq.gov/issue/development-core-drug-list-towards-improving-prescribing-education-and-reducing-errors-uk
    April 13, 2022 - Study Development of a core drug list towards improving prescribing education and reducing errors in the UK. Citation Text: Baker E, Pryce Roberts A, Wilde K, et al. Development of a core drug list towards improving prescribing education and reducing errors in the UK. Br J Clin Pharmac…

  20. Bayesian cohort and cross-sectional analyses of the PINCER trial: a pharmacist-led intervention to reduce medication errors in primary care. | PSNet

    psnet.ahrq.gov/issue/bayesian-cohort-and-cross-sectional-analyses-pincer-trial-pharmacist-led-intervention-reduce
    December 21, 2022 - Study Bayesian cohort and cross-sectional analyses of the PINCER trial: a pharmacist-led intervention to reduce medication errors in primary care. Citation Text: Hemming K, Chilton PJ, Lilford RJ, et al. Bayesian cohort and cross-sectional analyses of the PINCER trial: a pharmacist-led…
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