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We will not compete on safety: how children's hospitals have come together to hasten harm reduction. | PSNet

psnet.ahrq.gov/issue/we-will-not-compete-safety-how-childrens-hospitals-have-come-together-hasten-harm-reduction

August 10, 2022 - Study We will not compete on safety: how children's hospitals have come together to hasten harm reduction. Citation Text: Lyren A, Coffey M, Shepherd M, et al. We Will Not Compete on Safety: How Children's Hospitals Have Come Together to Hasten Harm Reduction. Jt Comm J Qual Patient Saf.…

Factors associated with hospital admission after outpatient surgery in the Veterans Health Administration. | PSNet

psnet.ahrq.gov/issue/factors-associated-hospital-admission-after-outpatient-surgery-veterans-health-administration

August 17, 2018 - Study Factors associated with hospital admission after outpatient surgery in the Veterans Health Administration. Citation Text: Mull HJ, Rosen AK, O'Brien WJ, et al. Factors Associated with Hospital Admission after Outpatient Surgery in the Veterans Health Administration. Health Serv Res…

Reducing automated dispensing cabinet overrides in the peri-anesthesia care unit: a quality improvement project. | PSNet

psnet.ahrq.gov/issue/reducing-automated-dispensing-cabinet-overrides-peri-anesthesia-care-unit-quality-improvement

June 07, 2023 - Study Reducing automated dispensing cabinet overrides in the peri-anesthesia care unit: a quality improvement project. Citation Text: Franciscovich CD, Bieniek A, Dunn K, et al. Reducing automated dispensing cabinet overrides in the peri-anesthesia care unit: a quality improvement projec…

Effects of an adverse-drug-event alert system on cost and quality outcomes in community hospitals. | PSNet

psnet.ahrq.gov/issue/effects-adverse-drug-event-alert-system-cost-and-quality-outcomes-community-hospitals

February 17, 2021 - Study Effects of an adverse-drug-event alert system on cost and quality outcomes in community hospitals. Citation Text: Piontek F, Kohli R, Conlon P, et al. Effects of an adverse-drug-event alert system on cost and quality outcomes in community hospitals. Am J Health Syst Pharm. 2010;6…

Impact of a reengineered electronic error-reporting system on medication event reporting and care process improvements at an urban medical center. | PSNet

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December 29, 2014 - Study Impact of a reengineered electronic error-reporting system on medication event reporting and care process improvements at an urban medical center. Citation Text: McKaig D, Collins C, Elsaid KA. Impact of a reengineered electronic error-reporting system on medication event reporting…

Impact of initial hospital diagnosis on mortality for acute myocardial infarction: a national cohort study. | PSNet

psnet.ahrq.gov/issue/impact-initial-hospital-diagnosis-mortality-acute-myocardial-infarction-national-cohort-study

April 19, 2017 - Study Impact of initial hospital diagnosis on mortality for acute myocardial infarction: a national cohort study. Citation Text: Wu J, Gale CP, Hall M, et al. Editor's Choice - Impact of initial hospital diagnosis on mortality for acute myocardial infarction: A national cohort study. Eur…

Risk factors for wrong-site surgery: a study of 1,166 reports of informed consent and schedule errors. | PSNet

psnet.ahrq.gov/issue/risk-factors-wrong-site-surgery-study-1166-reports-informed-consent-and-schedule-errors

January 20, 2021 - Study Risk factors for wrong-site surgery: a study of 1,166 reports of informed consent and schedule errors. Citation Text: Taylor MA, Yonash RA. Risk factors for wrong-site surgery: a study of 1,166 reports of informed consent and schedule errors. Patient Safety. 2024;6(1):1-11. doi:10.…

Neurobehavioral performance of residents after heavy night call vs after alcohol ingestion. | PSNet

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June 22, 2022 - Study Neurobehavioral performance of residents after heavy night call vs after alcohol ingestion. Citation Text: Arnedt JT, Owens J, Crouch M, et al. Neurobehavioral Performance of Residents After Heavy Night Call vs After Alcohol Ingestion. JAMA. 2005;294(9). doi:10.1001/jama.294.9.10…

He thought the "lady in the door" was the "lady in the window": a qualitative study of patient identification practices. | PSNet

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June 14, 2017 - Study He thought the "lady in the door" was the "lady in the window": a qualitative study of patient identification practices. Citation Text: Phipps E, Turkel M, Mackenzie ER, et al. He thought the "lady in the door" was the "lady in the window": a qualitative study of patient identifica…

Seroprevalence of SARS-CoV-2 among frontline health care personnel in a multistate hospital network--13 academic medical centers, April-June 2020. | PSNet

psnet.ahrq.gov/issue/seroprevalence-sars-cov-2-among-frontline-health-care-personnel-multistate-hospital-network

October 19, 2022 - Study Seroprevalence of SARS-CoV-2 among frontline health care personnel in a multistate hospital network--13 academic medical centers, April-June 2020. Citation Text: Self WH, Tenforde MW, Stubblefield WB, et al. Seroprevalence of SARS-CoV-2 among frontline health care personnel in a mu…

A review of adverse event reports from emergency departments in the Veterans Health Administration. | PSNet

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November 17, 2021 - Study A review of adverse event reports from emergency departments in the Veterans Health Administration. Citation Text: Gill S, Mills PD, Watts BV, et al. A Review of Adverse Event Reports From Emergency Departments in the Veterans Health Administration. J Patient Saf. 2021;17(8):e898-…

Hemodialysis bleeding events and deaths: an 18-year retrospective analysis of patient safety and root cause analysis reports in the Veterans Health Administration. | PSNet

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June 23, 2021 - Study Hemodialysis bleeding events and deaths: an 18-year retrospective analysis of patient safety and root cause analysis reports in the Veterans Health Administration. Citation Text: Walton E, Charles M, Morrish W, et al. Hemodialysis bleeding events and deaths: an 18-year retrospectiv…

Patient misidentification events in the Veterans Health Administration: a comprehensive review in the context of high-reliability health care. | PSNet

psnet.ahrq.gov/issue/patient-misidentification-events-veterans-health-administration-comprehensive-review-context

November 24, 2021 - Study Patient misidentification events in the Veterans Health Administration: a comprehensive review in the context of high-reliability health care. Citation Text: Kulju S, Morrish W, King LA, et al. Patient misidentification events in the Veterans Health Administration: a comprehensive …

Do patients who read visit notes on the patient portal have a higher rate of "loop closure" on diagnostic tests and referrals in primary care? A retrospective cohort study. | PSNet

psnet.ahrq.gov/issue/do-patients-who-read-visit-notes-patient-portal-have-higher-rate-loop-closure-diagnostic

January 31, 2024 - Study Do patients who read visit notes on the patient portal have a higher rate of "loop closure" on diagnostic tests and referrals in primary care? A retrospective cohort study. Citation Text: Bell SK, Amat MJ, Anderson TS, et al. Do patients who read visit notes on the patient portal h…

Two-state collaborative study of a multifaceted intervention to decrease ventilator-associated events. | PSNet

psnet.ahrq.gov/issue/two-state-collaborative-study-multifaceted-intervention-decrease-ventilator-associated-events

January 15, 2014 - Study Two-state collaborative study of a multifaceted intervention to decrease ventilator-associated events. Citation Text: Rawat N, Yang T, Ali KJ, et al. Two-State Collaborative Study of a Multifaceted Intervention to Decrease Ventilator-Associated Events. Crit Care Med. 2017;45(7):120…

Using a network organisational architecture to support the development of Learning Healthcare Systems. | PSNet

psnet.ahrq.gov/issue/using-network-organisational-architecture-support-development-learning-healthcare-systems

December 02, 2014 - Study Using a network organisational architecture to support the development of Learning Healthcare Systems. Citation Text: Britto MT, Fuller SC, Kaplan HC, et al. Using a network organisational architecture to support the development of Learning Healthcare Systems. BMJ Qual Saf. 2018;27…

An evidence and consensus-based definition of second victim: a strategic topic in healthcare quality, patient safety, person-centeredness and human resource management. | PSNet

psnet.ahrq.gov/issue/evidence-and-consensus-based-definition-second-victim-strategic-topic-healthcare-quality

September 13, 2023 - Commentary An evidence and consensus-based definition of second victim: a strategic topic in healthcare quality, patient safety, person-centeredness and human resource management. Citation Text: Vanhaecht K, Seys D, Russotto S, et al. An evidence and consensus-based definition of second …

Early diagnosis of cancer: systems approach to support clinicians in primary care. | PSNet

psnet.ahrq.gov/issue/early-diagnosis-cancer-systems-approach-support-clinicians-primary-care

December 14, 2022 - Commentary Early diagnosis of cancer: systems approach to support clinicians in primary care. Citation Text: Black GB, Lyratzopoulos G, Vincent CA, et al. Early diagnosis of cancer: systems approach to support clinicians in primary care. BMJ. 2023;380:e071225. doi:10.1136/bmj-2022-071225…

Has the COVID pandemic strengthened or weakened health care teams? A field guide to healthy workforce best practices. | PSNet

psnet.ahrq.gov/issue/has-covid-pandemic-strengthened-or-weakened-health-care-teams-field-guide-healthy-workforce

August 14, 2019 - Commentary Has the COVID pandemic strengthened or weakened health care teams? A field guide to healthy workforce best practices. Citation Text: Thompson R, Kusy M. Has the COVID pandemic strengthened or weakened health care teams? A field guide to healthy workforce best practices. Nurs …

Medication use leading to emergency department visits for adverse drug events in older adults. | PSNet

psnet.ahrq.gov/issue/medication-use-leading-emergency-department-visits-adverse-drug-events-older-adults

March 05, 2008 - Study Classic Medication use leading to emergency department visits for adverse drug events in older adults. Citation Text: Budnitz DS, Shehab N, Kegler SR, et al. Medication use leading to emergency department visits for adverse drug events in older adults. A…

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