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Healthcare Inspection—Emergency Department Patient Deaths: Memphis VAMC, Memphis, Tennessee. | PSNet

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November 29, 2023 - Book/Report Healthcare Inspection—Emergency Department Patient Deaths: Memphis VAMC, Memphis, Tennessee. Citation Text: Healthcare Inspection—Emergency Department Patient Deaths: Memphis VAMC, Memphis, Tennessee. Washington, DC: Department of Veterans Affairs, Office of Inspector…

Comparative issues in aviation and surgical crew resource management: (1) are we too solution focused? | PSNet

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October 30, 2013 - Commentary Comparative issues in aviation and surgical crew resource management: (1) are we too solution focused? Citation Text: Hunt GJF, Callaghan KSN. COMPARATIVE ISSUES IN AVIATION AND SURGICAL CREW RESOURCE MANAGEMENT: (1) ARE WE TOO SOLUTION FOCUSED? ANZ J Surg. 2008;78(8). doi:1…

Building a safety net. | PSNet

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December 21, 2009 - Newspaper/Magazine Article Building a safety net. Citation Text: Rogoski RR. Building a safety net. By leveraging huge amounts of data and applying it to a wide array of projects and purposes, hospitals stay focused on patient safety and make headway. Health management technology. 2006…

Attitude is everything?: The impact of workload, safety climate, and safety tools on medical errors: a study of intensive care units. | PSNet

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March 11, 2020 - Study Attitude is everything?: The impact of workload, safety climate, and safety tools on medical errors: a study of intensive care units. Citation Text: Steyrer J, Schiffinger M, Huber C, et al. Attitude is everything? The impact of workload, safety climate, and safety tools on med…

Reducing medical error in the Military Health System: how can team training help? | PSNet

psnet.ahrq.gov/issue/reducing-medical-error-military-health-system-how-can-team-training-help

March 29, 2007 - Commentary Reducing medical error in the Military Health System: how can team training help? Citation Text: Alonso A, Baker DP, Holtzman A, et al. Reducing medical error in the Military Health System: How can team training help? Human Resource Management Review. 2006;16(3). doi:10.101…

Preventable adverse drug events and their causes and contributing factors: the analysis of register data. | PSNet

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August 01, 2016 - Study Preventable adverse drug events and their causes and contributing factors: the analysis of register data. Citation Text: Jylhä V, Saranto K, Bates DW. Preventable adverse drug events and their causes and contributing factors: the analysis of register data. Int J Qual Health Care. 2…

Changes in nursing practice: associations with responses to and coping with errors. | PSNet

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October 19, 2022 - Study Changes in nursing practice: associations with responses to and coping with errors. Citation Text: Karga M, Kiekkas P, Aretha D, et al. Changes in nursing practice: associations with responses to and coping with errors. J Clin Nurs. 2011;20(21-22):3246-55. doi:10.1111/j.1365-2702…

Learning from preventable adverse events in health care organizations: development of a multilevel model of learning and propositions. | PSNet

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June 28, 2010 - Commentary Learning from preventable adverse events in health care organizations: development of a multilevel model of learning and propositions. Citation Text: Chuang Y-T, Ginsburg LR, Berta WB. Learning from preventable adverse events in health care organizations: development of a mu…

Untenable expectations: nurses' work in the context of medication administration, error, and the organization. | PSNet

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September 21, 2022 - Study Untenable expectations: nurses' work in the context of medication administration, error, and the organization. Citation Text: Hawkins SF, Morse JM. Untenable expectations: nurses' work in the context of medication administration, error, and the organization. Glob Qual Nurs Res. 202…

Patient safety in home health care: a grounded theory study. | PSNet

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September 25, 2019 - Study Patient safety in home health care: a grounded theory study. Citation Text: Shahrestanaki SK, Rafii F, Najafi Ghezeljeh T, et al. Patient safety in home health care: a grounded theory study. BMC Health Serv Res. 2023;23(1):467. doi:10.1186/s12913-023-09458-9. Copy Citation Fo…

A work observation study of nuclear medicine technologists: interruptions, resilience and implications for patient safety. | PSNet

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May 25, 2011 - Study A work observation study of nuclear medicine technologists: interruptions, resilience and implications for patient safety. Citation Text: Larcos G, Prgomet M, Georgiou A, et al. A work observation study of nuclear medicine technologists: interruptions, resilience and implications f…

Lessons learned from implementation of a computerized application for pending tests at hospital discharge. | PSNet

psnet.ahrq.gov/issue/lessons-learned-implementation-computerized-application-pending-tests-hospital-discharge

March 04, 2015 - Study Lessons learned from implementation of a computerized application for pending tests at hospital discharge. Citation Text: Dalal A, Poon EG, Karson A, et al. Lessons learned from implementation of a computerized application for pending tests at hospital discharge. J Hosp Med. 2011…

A review of medical error taxonomies: a human factors perspective. | PSNet

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July 25, 2012 - Review A review of medical error taxonomies: a human factors perspective. Citation Text: Taib IA, McIntosh AS, Caponecchia C, et al. A review of medical error taxonomies: A human factors perspective. Saf Sci. 2011;49(5):607-615. doi:10.1016/j.ssci.2010.12.014. Copy Citation Forma…

Strengthening leadership as a catalyst for enhanced patient safety culture: a repeated cross-sectional experimental study. | PSNet

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June 28, 2011 - Study Strengthening leadership as a catalyst for enhanced patient safety culture: a repeated cross-sectional experimental study. Citation Text: Kristensen S, Christensen KB, Jaquet A, et al. Strengthening leadership as a catalyst for enhanced patient safety culture: a repeated cross-sect…

A systematic review of behavioural marker systems in healthcare: what do we know about their attributes, validity and application? | PSNet

psnet.ahrq.gov/issue/systematic-review-behavioural-marker-systems-healthcare-what-do-we-know-about-their

January 23, 2019 - Review A systematic review of behavioural marker systems in healthcare: what do we know about their attributes, validity and application? Citation Text: Dietz AS, Pronovost P, Benson KN, et al. A systematic review of behavioural marker systems in healthcare: what do we know about their a…

An initiative to improve the management of clinically significant test results in a large health care network. | PSNet

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November 26, 2014 - Study An initiative to improve the management of clinically significant test results in a large health care network. Citation Text: Roy CL, Rothschild JM, Dighe AS, et al. An initiative to improve the management of clinically significant test results in a large health care network. Jt …

Interprofessional teamwork and team interventions in chronic care: a systematic review. | PSNet

psnet.ahrq.gov/issue/interprofessional-teamwork-and-team-interventions-chronic-care-systematic-review

April 24, 2019 - Review Interprofessional teamwork and team interventions in chronic care: a systematic review. Citation Text: Körner M, Bütof S, Müller C, et al. Interprofessional teamwork and team interventions in chronic care: A systematic review. J Interprof Care. 2016;30(1):15-28. doi:10.3109/135618…

To err is system: a comparison of methodologies for the investigation of adverse outcomes in healthcare. | PSNet

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January 26, 2022 - Commentary To err is system: a comparison of methodologies for the investigation of adverse outcomes in healthcare. Citation Text: Isherwood P, Waterson P. To err is system: a comparison of methodologies for the investigation of adverse outcomes in healthcare. J Patient Saf Risk Manag. 2…

Nursing home patient safety culture perceptions among US and immigrant nurses. | PSNet

psnet.ahrq.gov/issue/nursing-home-patient-safety-culture-perceptions-among-us-and-immigrant-nurses

January 14, 2011 - Study Nursing home patient safety culture perceptions among US and immigrant nurses. Citation Text: Wagner LM, Brush BL, Castle NG, et al. Nursing Home Patient Safety Culture Perceptions Among US and Immigrant Nurses. J Patient Saf. 2020;16(3):238-244. doi:10.1097/pts.0000000000000271. …

Qualitative content analysis: a framework for the substantive review of hospital incident reports. | PSNet

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March 16, 2022 - Commentary Qualitative content analysis: a framework for the substantive review of hospital incident reports. Citation Text: Stephens S. Qualitative content analysis: a framework for the substantive review of hospital incident reports. J Healthc Risk Manag. 2022;41(4):17-26. doi:10.1002/…

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