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psnet.ahrq.gov/issue/humanizing-harm-using-restorative-approach-heal-and-learn-adverse-events
November 30, 2022 - Commentary
Humanizing harm: using a restorative approach to heal and learn from adverse events.
Citation Text:
Wailling J, Kooijman A, Hughes J, et al. Humanizing harm: Using a restorative approach to heal and learn from adverse events. Health Expect. 2022;25(4):1192-1199. doi:10.1111/he…
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psnet.ahrq.gov/issue/development-concept-return-investment-large-scale-quality-improvement-programmes-healthcare
October 27, 2021 - Review
The development of the concept of return-on-investment from large-scale quality improvement programmes in healthcare: an integrative systematic literature review.
Citation Text:
Thusini S’thembile, Milenova M, Nahabedian N, et al. The development of the concept of return-on-invest…
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psnet.ahrq.gov/issue/avoiding-handover-fumbles-controlled-trial-structured-handover-tool-versus-traditional
January 19, 2022 - Study
Avoiding handover fumbles: a controlled trial of a structured handover tool versus traditional handover methods.
Citation Text:
Payne CE, Stein JM, Leong T, et al. Avoiding handover fumbles: a controlled trial of a structured handover tool versus traditional handover methods. BMJ…
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psnet.ahrq.gov/issue/absence-or-presence-silent-discourse-operating-room-and-impact-surgical-team-action
June 23, 2021 - Study
Absence or presence: silent discourse in the operating room and impact on surgical team action.
Citation Text:
Brommelsiek M, Said T, Gray M, et al. Absence or presence: silent discourse in the operating room and impact on surgical team action. Am J Surg. 2021;221(5):980-986. doi:1…
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psnet.ahrq.gov/issue/validation-second-victim-experience-and-support-tool-revised-neonatal-intensive-care-unit
September 24, 2017 - Study
Validation of the second victim experience and support tool-revised in the neonatal intensive care unit.
Citation Text:
Winning AM, Merandi J, Rausch JR, et al. Validation of the second victim experience and support tool-revised in the neonatal intensive care unit. J Patient Saf. 2…
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psnet.ahrq.gov/issue/physician-reporting-clinically-significant-events-through-computerized-patient-sign-out
January 25, 2023 - Study
Physician reporting of clinically significant events through a computerized patient sign-out system.
Citation Text:
Nabors C, Peterson SJ, Aronow WS, et al. Physician reporting of clinically significant events through a computerized patient sign-out system. J Patient Saf. 2011;7(…
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psnet.ahrq.gov/issue/principles-automation-patient-safety-intensive-care-learning-aviation
April 20, 2022 - Commentary
Principles of automation for patient safety in intensive care: learning from aviation.
Citation Text:
Dominiczak J, Khansa L. Principles of Automation for Patient Safety in Intensive Care: Learning From Aviation. Jt Comm J Qual Patient Saf. 2018;44(6):366-371. doi:10.1016/j.jc…
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psnet.ahrq.gov/perspective/medication-safety-nursing-homes-whats-wrong-and-how-fix-it
August 01, 2012 - and the hospital are very common in this patient population and add further to increasing the risk of medication … errors and preventable adverse drug events. … 28, 2021
Multicomponent pharmacist intervention did not reduce clinically important medication … errors for ambulatory patients initiating direct oral anticoagulants. … September 2, 2015
Patterns in nursing home medication errors: disproportionality analysis
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psnet.ahrq.gov/issue/us-delete-data-life-threatening-mistakes-website
July 14, 2010 - June 22, 2016
Analysis of Australian newspaper coverage of medication errors.
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psnet.ahrq.gov/issue/dennis-quaid-files-suit-over-drug-mishap
September 20, 2023 - More
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General Public
Neonatology and Intensive Care
Medication … Errors/Preventable Adverse Drug Events
Anticoagulants
Cognitive Errors ("Mistakes")
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psnet.ahrq.gov/issue/engaging-patients-safety-partners-guide-reducing-errors-and-improving-satisfaction
May 20, 2019 - September 20, 2017
Medication Errors. 2nd ed.
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psnet.ahrq.gov/issue/without-ounce-empathy-their-stories-show-dangers-being-black-and-pregnant
September 22, 2021 - October 4, 2023
Sick children face potentially deadly danger: medication errors.
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psnet.ahrq.gov/issue/walking-tightrope-balancing-risk-diagnostic-error-inpatient-pediatrics
May 29, 2019 - Commentary
Walking a tightrope: balancing the risk of diagnostic error in inpatient pediatrics.
Citation Text:
Berkwitt A, Osborn R, Grossman M. Walking a Tightrope: Balancing the Risk of Diagnostic Error in Inpatient Pediatrics. Hosp Pediatr. 2016;6(9):566-8. doi:10.1542/hpeds.2016-0043…
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psnet.ahrq.gov/issue/errors-mri-evaluation-musculoskeletal-tumors-and-tumorlike-lesions
September 04, 2019 - Study
Errors in the MRI evaluation of musculoskeletal tumors and tumorlike lesions.
Citation Text:
Heck RK, O'Malley AM, Kellum EL, et al. Errors in the MRI evaluation of musculoskeletal tumors and tumorlike lesions. Clin Orthop Relat Res. 2007;459:28-33.
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psnet.ahrq.gov/issue/clinical-criteria-screen-inpatient-diagnostic-errors-scoping-review
December 12, 2018 - Review
Clinical criteria to screen for inpatient diagnostic errors: a scoping review.
Citation Text:
Shenvi EC, El-Kareh R. Clinical criteria to screen for inpatient diagnostic errors: a scoping review. Diagnosis (Berl). 2015;2(1):3-19. doi:10.1515/dx-2014-0047.
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psnet.ahrq.gov/issue/hope-modified-association-between-distress-and-incidence-self-perceived-medical-errors-among
June 07, 2018 - Study
Hope modified the association between distress and incidence of self-perceived medical errors among practicing physicians: prospective cohort study.
Citation Text:
Hayashino Y, Utsugi-Ozaki M, Feldman MD, et al. Hope modified the association between distress and incidence of self-…
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psnet.ahrq.gov/issue/no-safety-no-quality-synthesis-research-hospital-and-patient-safety-1996-2007
January 04, 2010 - Review
No safety, no quality: synthesis of research on hospital and patient safety (1996-2007).
Citation Text:
Tzeng H-M, Yin C-Y. No safety, no quality: synthesis of research on hospital and patient safety (1996-2007). J Nurs Care Qual. 2007;22(4):299-306.
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psnet.ahrq.gov/issue/racialethnic-disparities-interhospital-transfer-conditions-mortality-benefit-transfer-among
April 14, 2021 - Study
Racial/ethnic disparities in interhospital transfer for conditions with a mortality benefit to transfer among patients with Medicare.
Citation Text:
Racial/ethnic disparities in interhospital transfer for conditions with a mortality benefit to transfer among patients with Medicare.…
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psnet.ahrq.gov/issue/impacts-pharmacist-managed-outpatient-clinic-and-chemotherapy-directed-electronic-order-sets
June 18, 2014 - Study
The impacts of a pharmacist-managed outpatient clinic and chemotherapy-directed electronic order sets for monitoring oral chemotherapy.
Citation Text:
Battis B, Clifford L, Huq M, et al. The impacts of a pharmacist-managed outpatient clinic and chemotherapy-directed electronic orde…
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psnet.ahrq.gov/issue/patients-use-internet-technology-report-when-things-go-wrong
July 21, 2009 - Study
Patients use an internet technology to report when things go wrong.
Citation Text:
Wasson JH, MacKenzie TA, Hall M. Patients use an internet technology to report when things go wrong. Qual Saf Health Care. 2007;16(3):213-5.
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