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FDA Safety Communication: update--robotically-assisted surgical devices in mastectomy. | PSNet

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September 01, 2021 - Press Release/Announcement FDA Safety Communication: update--robotically-assisted surgical devices in mastectomy. Citation Text: FDA Safety Communication: update--robotically-assisted surgical devices in mastectomy. MedWatch Safety Alert. Silver Spring, MD: US Food and Drug Administratio…

Transparency, public reporting, and a culture of change to quality and safety in cardiac surgery. | PSNet

psnet.ahrq.gov/issue/transparency-public-reporting-and-culture-change-quality-and-safety-cardiac-surgery

February 17, 2021 - Commentary Transparency, public reporting, and a culture of change to quality and safety in cardiac surgery. Citation Text: Ibrahim M, Szeto WY, Gutsche J, et al. Transparency, public reporting, and a culture of change to quality and safety in cardiac surgery. Ann Thorac Surg. 2022;114(3…

Patient-as-observer approach: an alternative method for hand hygiene auditing in an ambulatory care setting. | PSNet

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September 13, 2023 - Study Patient-as-observer approach: an alternative method for hand hygiene auditing in an ambulatory care setting. Citation Text: Le-Abuyen S, Ng J, Kim S, et al. Patient-as-observer approach: an alternative method for hand hygiene auditing in an ambulatory care setting. Am J Infect Cont…

The frequency and significance of discrepancies in the surgical count. | PSNet

psnet.ahrq.gov/issue/frequency-and-significance-discrepancies-surgical-count

March 02, 2011 - Study The frequency and significance of discrepancies in the surgical count. Citation Text: Greenberg CC, Regenbogen SE, Lipsitz SR, et al. The Frequency and Significance of Discrepancies in the Surgical Count. Ann Surg. 2009;248(2). doi:10.1097/sla.0b013e318181c9a3. Copy Citation …

Enhancing safety of a system-wide in situ simulation program using no-go considerations. | PSNet

psnet.ahrq.gov/issue/enhancing-safety-system-wide-situ-simulation-program-using-no-go-considerations

June 13, 2018 - Study Enhancing safety of a system-wide in situ simulation program using no-go considerations. Citation Text: Minors AM, Yusaf TC, Bentley SK, et al. Enhancing safety of a system-wide in situ simulation program using no-go considerations. Simul Healthc. 2023;18(4):226-231. doi:10.1097/si…

Observational study of conformity in yet another medical learning environment: conformity to preceptors during high-fidelity simulation. | PSNet

psnet.ahrq.gov/issue/observational-study-conformity-yet-another-medical-learning-environment-conformity-preceptors

June 19, 2019 - Study Observational study of conformity in yet another medical learning environment: conformity to preceptors during high-fidelity simulation. Citation Text: Beran T, Altabbaa G, Oddone Paolucci E. Observational study of conformity in yet another medical learning environment: conformity …

Is researching adverse events in hospital deaths a good way to describe patient safety in hospitals: a retrospective patient record review study. | PSNet

psnet.ahrq.gov/issue/researching-adverse-events-hospital-deaths-good-way-describe-patient-safety-hospitals

March 18, 2013 - Study Is researching adverse events in hospital deaths a good way to describe patient safety in hospitals: a retrospective patient record review study. Citation Text: Baines RJ, Langelaan M, de Bruijne M, et al. Is researching adverse events in hospital deaths a good way to describe pati…

Improving care safety by characterizing task interruptions during interactions between healthcare professionals: an observational study. | PSNet

psnet.ahrq.gov/issue/improving-care-safety-characterizing-task-interruptions-during-interactions-between

March 05, 2025 - Study Improving care safety by characterizing task interruptions during interactions between healthcare professionals: an observational study. Citation Text: Teigné D, Cazet L, Birgand G, et al. Improving care safety by characterizing task interruptions during interactions between health…

A prospective study of suicide screening tools and their association with near-term adverse events in the ED. | PSNet

psnet.ahrq.gov/issue/prospective-study-suicide-screening-tools-and-their-association-near-term-adverse-events-ed

October 07, 2020 - Study A prospective study of suicide screening tools and their association with near-term adverse events in the ED. Citation Text: Chang BP, Tan TM. Suicide screening tools and their association with near-term adverse events in the ED. Am J Emerg Med. 2015;33(11):1680-1683. doi:10.1016/j…

Electronic alerts to prevent venous thromboembolism among hospitalized patients. | PSNet

psnet.ahrq.gov/issue/electronic-alerts-prevent-venous-thromboembolism-among-hospitalized-patients

October 19, 2022 - Study Classic Electronic alerts to prevent venous thromboembolism among hospitalized patients. Citation Text: Kucher N, Koo S, Quiroz R, et al. Electronic alerts to prevent venous thromboembolism among hospitalized patients. N Engl J Med. 2005;352(10):969-77. …

Clinical reasoning in dire times- analysis of cognitive biases in clinical cases during the COVID-19 pandemic. | PSNet

psnet.ahrq.gov/issue/clinical-reasoning-dire-times-analysis-cognitive-biases-clinical-cases-during-covid-19

February 09, 2022 - Study Clinical reasoning in dire times- analysis of cognitive biases in clinical cases during the COVID-19 pandemic. Citation Text: Coen M, Sader J, Junod-Perron N, et al. Clinical reasoning in dire times- analysis of cognitive biases in clinical cases during the COVID-19 pandemic. Inter…

Challenging hierarchy in healthcare teams--ways to flatten gradients to improve teamwork and patient care. | PSNet

psnet.ahrq.gov/issue/challenging-hierarchy-healthcare-teams-ways-flatten-gradients-improve-teamwork-and-patient

October 29, 2017 - Review Challenging hierarchy in healthcare teams--ways to flatten gradients to improve teamwork and patient care. Citation Text: Green B, Oeppen RS, Smith DW, et al. Challenging hierarchy in healthcare teams - ways to flatten gradients to improve teamwork and patient care. Br J Oral Maxi…

Systematic workup of transfusion reactions reveals passive co-reporting of handling errors. | PSNet

psnet.ahrq.gov/issue/systematic-workup-transfusion-reactions-reveals-passive-co-reporting-handling-errors

December 21, 2016 - Study Systematic workup of transfusion reactions reveals passive co-reporting of handling errors. Citation Text: Nitsche E, Dreßler J, Henschler R. Systematic workup of transfusion reactions reveals passive co-reporting of handling errors. J Blood Med. 2023;14:435-443. doi:10.2147/jbm.s4…

The COVID-19 pandemic: resilient organisational response to a low-chance, high-impact event. | PSNet

psnet.ahrq.gov/issue/covid-19-pandemic-resilient-organisational-response-low-chance-high-impact-event

October 07, 2020 - Commentary The COVID-19 pandemic: resilient organisational response to a low-chance, high-impact event. Citation Text: Lloyd-Smith MK. The COVID-19 pandemic: resilient organisational response to a low-chance, high-impact event. BMJ Leader. 2020;4:109-112. doi:10.1136/leader-2020-000245. …

Efficiency and safety of speech recognition for documentation in the electronic health record. | PSNet

psnet.ahrq.gov/issue/efficiency-and-safety-speech-recognition-documentation-electronic-health-record

February 14, 2024 - Study Efficiency and safety of speech recognition for documentation in the electronic health record. Citation Text: Hodgson T, Magrabi F, Coiera E. Efficiency and safety of speech recognition for documentation in the electronic health record. J Am Med Inform Assoc. 2017;24(6):1127-1133. …

Hearing impairment and the amelioration of avoidable medical error: a cross-sectional survey. | PSNet

psnet.ahrq.gov/issue/hearing-impairment-and-amelioration-avoidable-medical-error-cross-sectional-survey

June 09, 2021 - Study Hearing impairment and the amelioration of avoidable medical error: a cross-sectional survey. Citation Text: Henn P, O’Tuathaigh C, Keegan D, et al. Hearing impairment and the amelioration of avoidable medical error: a cross-sectional survey. J Patient Saf. 2021;17(3):e155-e160. do…

Leadership and the high reliability transformation: a qualitative study at Truman VA medical center. | PSNet

psnet.ahrq.gov/issue/leadership-and-high-reliability-transformation-qualitative-study-truman-va-medical-center

May 31, 2023 - Study Leadership and the high reliability transformation: a qualitative study at Truman VA medical center. Citation Text: Leonard C, Gilmartin HM, Starr LM, et al. Leadership and the high reliability transformation: a qualitative study at Truman VA medical center. J Healthc Risk Manag. 2…

Care quality and safety in long-term aged care settings: a systematic review and narrative analysis of missed care measurements. | PSNet

psnet.ahrq.gov/issue/care-quality-and-safety-long-term-aged-care-settings-systematic-review-and-narrative-analysis

August 17, 2022 - Review Care quality and safety in long-term aged care settings: a systematic review and narrative analysis of missed care measurements. Citation Text: Wang X, Rihari‐Thomas J, Bail K, et al. Care quality and safety in long‐term aged care settings: a systematic review and narrative analys…

Pediatric trainee perspectives on the decision to disclose medical errors. | PSNet

psnet.ahrq.gov/issue/pediatric-trainee-perspectives-decision-disclose-medical-errors

April 27, 2022 - Study Pediatric trainee perspectives on the decision to disclose medical errors. Citation Text: Lin M, Horwitz LI, Gross RS, et al. Pediatric trainee perspectives on the decision to disclose medical errors. J Patient Saf. 2022;18(2):e470-e476. doi:10.1097/pts.0000000000000848. Copy Cit…

30-day potentially avoidable readmissions due to adverse drug events. | PSNet

psnet.ahrq.gov/issue/30-day-potentially-avoidable-readmissions-due-adverse-drug-events

June 14, 2017 - Study 30-day potentially avoidable readmissions due to adverse drug events. Citation Text: Dalleur O, Beeler PE, Schnipper JL, et al. 30-Day Potentially Avoidable Readmissions Due to Adverse Drug Events. J Patient Saf. 2021;17(5):e379-e386. doi:10.1097/pts.0000000000000346. Copy Citati…

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