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Implementing a robust process improvement program in the neonatal intensive care unit to reduce harm. | PSNet

psnet.ahrq.gov/issue/implementing-robust-process-improvement-program-neonatal-intensive-care-unit-reduce-harm

March 23, 2022 - Study Implementing a robust process improvement program in the neonatal intensive care unit to reduce harm. Citation Text: Nether KG, Thomas EJ, Khan A, et al. Implementing a robust process improvement program in the neonatal intensive care unit to reduce harm. J Healthc Qual. 2022;44(1)…

Discrepancy between emergency department admission diagnosis and hospital discharge diagnosis and its impact on length of stay, up-triage to the intensive care unit, and mortality. | PSNet

psnet.ahrq.gov/issue/discrepancy-between-emergency-department-admission-diagnosis-and-hospital-discharge-diagnosis

December 08, 2021 - Study Discrepancy between emergency department admission diagnosis and hospital discharge diagnosis and its impact on length of stay, up-triage to the intensive care unit, and mortality. Citation Text: Bastakoti M, Muhailan M, Nassar A, et al. Discrepancy between emergency department adm…

Descriptive analysis of patient misidentification from incident report system data in a large academic hospital federation. | PSNet

psnet.ahrq.gov/issue/descriptive-analysis-patient-misidentification-incident-report-system-data-large-academic

August 24, 2022 - Study Descriptive analysis of patient misidentification from incident report system data in a large academic hospital federation. Citation Text: Abraham P, Augey L, Duclos A, et al. Descriptive analysis of patient misidentification from incident report system data in a large academic hos…

Improving clinical handover between intensive care unit and general ward professionals at intensive care unit discharge. | PSNet

psnet.ahrq.gov/issue/improving-clinical-handover-between-intensive-care-unit-and-general-ward-professionals

January 30, 2019 - Review Improving clinical handover between intensive care unit and general ward professionals at intensive care unit discharge. Citation Text: van Sluisveld N, Hesselink G, van der Hoeven JG, et al. Improving clinical handover between intensive care unit and general ward professionals at…

Postdischarge adverse events among neonates admitted to the neonatal intensive care unit. | PSNet

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October 05, 2022 - Study Postdischarge adverse events among neonates admitted to the neonatal intensive care unit. Citation Text: Tsilimingras D, Natarajan G, Bajaj M, et al. Postdischarge adverse events among neonates admitted to the neonatal intensive care unit. J Patient Saf. 2022;18(5):462-469. doi:10.…

Analysis of errors in dictated clinical documents assisted by speech recognition software and professional transcriptionists. | PSNet

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July 06, 2022 - Study Emerging Classic Analysis of errors in dictated clinical documents assisted by speech recognition software and professional transcriptionists. Citation Text: Zhou L, Blackley SV, Kowalski L, et al. Analysis of Errors in Dictated Clinical Documents Assisted…

Indication documentation and indication-based prescribing within electronic prescribing systems: a systematic review and narrative synthesis. | PSNet

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December 18, 2019 - Review Indication documentation and indication-based prescribing within electronic prescribing systems: a systematic review and narrative synthesis. Citation Text: Feather C, Appelbaum N, Darzi A, et al. Indication documentation and indication-based prescribing within electronic prescrib…

Mortality due to hospital-acquired infection after cardiac surgery. | PSNet

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February 12, 2020 - Study Mortality due to hospital-acquired infection after cardiac surgery. Citation Text: Massart N, Mansour A, Ross JT, et al. Mortality due to hospital-acquired infection after cardiac surgery. J Thorac Cardiovasc Surg. 2022;163(6):2131-2140.e3. doi:10.1016/j.jtcvs.2020.08.094. Copy C…

Evaluation of communication and safety behaviors during hospital-wide code response simulation. | PSNet

psnet.ahrq.gov/issue/evaluation-communication-and-safety-behaviors-during-hospital-wide-code-response-simulation

February 23, 2022 - Study Evaluation of communication and safety behaviors during hospital-wide code response simulation. Citation Text: Ren DM, Abrams A, Banigan M, et al. Evaluation of communication and safety behaviors during hospital-wide code response simulation. Simul Healthc. 2022;17(1):e45-e50. doi:…

Racial disparities in preventable adverse events attributed to poor care coordination reported in a national study of older US adults. | PSNet

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January 18, 2023 - Study Racial disparities in preventable adverse events attributed to poor care coordination reported in a national study of older US adults. Citation Text: Pinheiro LC, Reshetnyak E, Safford MM, et al. Racial disparities in preventable adverse events attributed to poor care coordination …

Nursing strategies to safeguard COVID-19 patients from harm in the intensive care unit. | PSNet

psnet.ahrq.gov/issue/nursing-strategies-safeguard-covid-19-patients-harm-intensive-care-unit

July 31, 2013 - Commentary Nursing strategies to safeguard COVID-19 patients from harm in the intensive care unit. Citation Text: Shiner D, Bock B, Simpson C, et al. Nursing strategies to safeguard COVID-19 patients from harm in the intensive care unit. Crit Care Nurs Q. 2021;45(1):13-21. doi:10.1097/cn…

'Care left undone' during nursing shifts: associations with workload and perceived quality of care. | PSNet

psnet.ahrq.gov/issue/care-left-undone-during-nursing-shifts-associations-workload-and-perceived-quality-care

July 19, 2019 - Study 'Care left undone' during nursing shifts: associations with workload and perceived quality of care. Citation Text: Ball JE, Murrells T, Rafferty AM, et al. 'Care left undone' during nursing shifts: associations with workload and perceived quality of care. BMJ Qual Saf. 2014;23(2)…

Resident duty hours in surgery for ensuring patient safety, providing optimum resident education and training, and promoting resident well-being: a response from the American College of Surgeons to the Report of the Institute of Medicine, "Resident Duty Hours: Enhancing Sleep, Supervision, and Safety." | PSNet

psnet.ahrq.gov/issue/resident-duty-hours-surgery-ensuring-patient-safety-providing-optimum-resident-education-and

August 26, 2011 - Commentary Resident duty hours in surgery for ensuring patient safety, providing optimum resident education and training, and promoting resident well-being: a response from the American College of Surgeons to the Report of the Institute of Medicine, "Resident Duty Hours: Enhancing Sleep, Supervision…

Successful implementation of a unit-based quality nurse to reduce central line-associated bloodstream infections. | PSNet

psnet.ahrq.gov/issue/successful-implementation-unit-based-quality-nurse-reduce-central-line-associated-bloodstream

September 23, 2020 - Study Successful implementation of a unit-based quality nurse to reduce central line-associated bloodstream infections. Citation Text: Thom KA, Li S, Custer M, et al. Successful implementation of a unit-based quality nurse to reduce central line-associated bloodstream infections. Am J …

Patient safety culture in care homes for older people: a scoping review. | PSNet

psnet.ahrq.gov/issue/patient-safety-culture-care-homes-older-people-scoping-review

January 08, 2020 - Review Patient safety culture in care homes for older people: a scoping review. Citation Text: Gartshore E, Waring J, Timmons S. Patient safety culture in care homes for older people: a scoping review. BMC Health Serv Res. 2017;17(1):752. doi:10.1186/s12913-017-2713-2. Copy Citation …

Effect of barcode technology on medication preparation safety: a quasi-experimental study. | PSNet

psnet.ahrq.gov/issue/effect-barcode-technology-medication-preparation-safety-quasi-experimental-study

December 01, 2021 - Study Effect of barcode technology on medication preparation safety: a quasi-experimental study. Citation Text: Küng K, Aeschbacher K, Rütsche A, et al. Effect of barcode technology on medication preparation safety: a quasi-experimental study. Int J Qual Health Care. 2021;33(1). doi:10.1…

A systematic review of interventions used to enhance implementation of and compliance with the World Health Organization surgical safety checklist in adult surgery. | PSNet

psnet.ahrq.gov/issue/systematic-review-interventions-used-enhance-implementation-and-compliance-world-health

March 08, 2023 - Review A systematic review of interventions used to enhance implementation of and compliance with the World Health Organization surgical safety checklist in adult surgery. Citation Text: Liu LQ, Mehigan S. A systematic review of interventions used to enhance implementation of and complia…

Improving detection of intraoperative medical errors (iMEs) and intraoperative adverse events (iAEs) and their contribution to postoperative outcomes. | PSNet

psnet.ahrq.gov/issue/improving-detection-intraoperative-medical-errors-imes-and-intraoperative-adverse-events-iaes

June 04, 2014 - Study Improving detection of intraoperative medical errors (iMEs) and intraoperative adverse events (iAEs) and their contribution to postoperative outcomes. Citation Text: Chen Q, Rosen AK, Amirfarzan H, et al. Improving detection of intraoperative medical errors (iMEs) and intraoperativ…

Teamwork- Part 1: Divided We Fall; Part 2: Cursed By Knowledge: Building a Culture of Psychological Safety; and Part 3: The Not-My-Problem Problem. | PSNet

psnet.ahrq.gov/issue/teamwork-part-1-divided-we-fall-part-2-cursed-knowledge-building-culture-psychological-safety

August 02, 2015 - Commentary Emerging Classic Teamwork- Part 1: Divided We Fall; Part 2: Cursed By Knowledge: Building a Culture of Psychological Safety; and Part 3: The Not-My-Problem Problem. Citation Text: Rosenbaum L. Divided We Fall. N Engl J Med. 2019;380(7):684-688. doi:10…

The effects of harm events on 30-day readmission in surgical patients. | PSNet

psnet.ahrq.gov/issue/effects-harm-events-30-day-readmission-surgical-patients

July 31, 2019 - Study The effects of harm events on 30-day readmission in surgical patients. Citation Text: Kandagatla P, Su W-TK, Adrianto I, et al. The effects of harm events on 30-day readmission in surgical patients. J Healthc Qual. 2021;43(2):101-109. doi:10.1097/jhq.0000000000000261. Copy Citati…

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