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4601. 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 …

4602. 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…

4603. Peer PLUS: A Client-Centered Digital Intervention for Addressing the Needs of Individuals with Substance Use Disorder | Digital Healthcare Research
      digital.ahrq.gov/ahrq-funded-projects/peer-plus-client-centered-digital-intervention-addressing-needs-individuals
      April 01, 2023 - Peer PLUS: A Client-Centered Digital Intervention for Addressing the Needs of Individuals with Substance Use Disorder Project Description The use of the Peer PLUS (People Leveraging Urgent Support) platform is expected to enhance the connection between those with substance use …

4604. A review of adverse event reports from emergency departments in the Veterans Health Administration. | PSNet
      psnet.ahrq.gov/issue/review-adverse-event-reports-emergency-departments-veterans-health-administration
      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-…

4605. Prompting rounding teams to address a daily best practice checklist in a pediatric intensive care unit. | PSNet
      psnet.ahrq.gov/issue/prompting-rounding-teams-address-daily-best-practice-checklist-pediatric-intensive-care-unit
      June 30, 2021 - Study Prompting rounding teams to address a daily best practice checklist in a pediatric intensive care unit. Citation Text: Cifra CL, Houston M, Otto A, et al. Prompting rounding teams to address a daily best practice checklist in a pediatric intensive care unit. Jt Comm J Qual Patient …

4606. 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…

4607. Hemodialysis bleeding events and deaths: an 18-year retrospective analysis of patient safety and root cause analysis reports in the Veterans Health Administration. | PSNet
      psnet.ahrq.gov/issue/hemodialysis-bleeding-events-and-deaths-18-year-retrospective-analysis-patient-safety-and
      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…

4608. Comparison of methods to reduce bias from clinical prediction models of postpartum depression. | PSNet
      psnet.ahrq.gov/issue/comparison-methods-reduce-bias-clinical-prediction-models-postpartum-depression
      April 15, 2020 - Study Comparison of methods to reduce bias from clinical prediction models of postpartum depression. Citation Text: Park Y, Hu J, Singh M, et al. Comparison of methods to reduce bias from clinical prediction models of postpartum depression. JAMA Netw Open. 2021;4(4):e213909. doi:10.1001/…

4609. Engaging hospital patients in the medication reconciliation process using tablet computers. | PSNet
      psnet.ahrq.gov/issue/engaging-hospital-patients-medication-reconciliation-process-using-tablet-computers
      January 07, 2015 - Study Engaging hospital patients in the medication reconciliation process using tablet computers. Citation Text: Prey JE, Polubriaginof F, Grossman L, et al. Engaging hospital patients in the medication reconciliation process using tablet computers. J Am Med Inform Assoc. 2018;25(11):146…

4610. Longitudinal evaluation of a pediatric rapid response system with realist evaluation framework. | PSNet
      psnet.ahrq.gov/issue/longitudinal-evaluation-pediatric-rapid-response-system-realist-evaluation-framework
      July 20, 2022 - Study Longitudinal evaluation of a pediatric rapid response system with realist evaluation framework. Citation Text: Acorda DE, Bracken J, Abela K, et al. Longitudinal evaluation of a pediatric rapid response system with realist evaluation framework. Jt Comm J Qual Patient Saf. 2022;48(4…

4611. Characterising the nature of primary care patient safety incident reports in the England and Wales National Reporting and Learning System: a mixed-methods agenda-setting study for general practice. | PSNet
      psnet.ahrq.gov/issue/characterising-nature-primary-care-patient-safety-incident-reports-england-and-wales-national
      December 16, 2015 - Book/Report Characterising the nature of primary care patient safety incident reports in the England and Wales National Reporting and Learning System: a mixed-methods agenda-setting study for general practice. Citation Text: Carson-Stevens A, Hibbert P, Williams H, et al. Characterising …

4612. Nature of blame in patient safety incident reports: mixed methods analysis of a national database. | PSNet
      psnet.ahrq.gov/issue/nature-blame-patient-safety-incident-reports-mixed-methods-analysis-national-database
      October 12, 2016 - Study Nature of blame in patient safety incident reports: mixed methods analysis of a national database. Citation Text: Cooper J, Edwards A, Williams H, et al. Nature of Blame in Patient Safety Incident Reports: Mixed Methods Analysis of a National Database. Ann Fam Med. 2017;15(5):455-4…

4613. Outcomes of daytime procedures performed by attending surgeons after night work. | PSNet
      psnet.ahrq.gov/issue/outcomes-daytime-procedures-performed-attending-surgeons-after-night-work
      December 18, 2014 - Study Classic Outcomes of daytime procedures performed by attending surgeons after night work. Citation Text: Govindarajan A, Urbach DR, Kumar M, et al. Outcomes of Daytime Procedures Performed by Attending Surgeons after Night Work. N Engl J Med. 2015;373(9):84…

4614. Health literacy-related safety events: a qualitative study of health literacy failures in patient safety events. | PSNet
      psnet.ahrq.gov/issue/health-literacy-related-safety-events-qualitative-study-health-literacy-failures-patient
      August 24, 2022 - Study Health literacy-related safety events: a qualitative study of health literacy failures in patient safety events. Citation Text: Morrison AK, Gibson C, Higgins C, et al. Health literacy-related safety events: a qualitative study of health literacy failures in patient safety events. …

4615. Impact of a national QI programme on reducing electronic health record notifications to clinicians. | PSNet
      psnet.ahrq.gov/issue/impact-national-qi-programme-reducing-electronic-health-record-notifications-clinicians
      February 24, 2021 - Study Classic Impact of a national QI programme on reducing electronic health record notifications to clinicians. Citation Text: Shah T, Patel-Teague S, Kroupa L, et al. Impact of a national QI programme on reducing electronic health record notifications to clin…

4616. Medication dosing safety for pediatric patients: recognizing gaps, safety threats, and best practices in the emergency medical services setting. A position statement and resource document from NAEMSP. | PSNet
      psnet.ahrq.gov/issue/medication-dosing-safety-pediatric-patients-recognizing-gaps-safety-threats-and-best
      March 01, 2023 - Organizational Policy/Guidelines Medication dosing safety for pediatric patients: recognizing gaps, safety threats, and best practices in the emergency medical services setting. A position statement and resource document from NAEMSP. Citation Text: Cicero MX, Adelgais K, Hoyle JD, et al.…

4617. 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…

4618. Evaluation of medication incidents in a long-term care facility using electronic medication administration records and barcode technology. | PSNet
      psnet.ahrq.gov/issue/evaluation-medication-incidents-long-term-care-facility-using-electronic-medication
      May 18, 2022 - Study Evaluation of medication incidents in a long-term care facility using electronic medication administration records and barcode technology. Citation Text: Fuller AEC, Guirguis LM, Sadowski CA, et al. Evaluation of medication incidents in a long-term care facility using electronic me…

4619. Stroke hospitalization after misdiagnosis of "benign dizziness" is lower in specialty care than general practice: a population-based cohort analysis of missed stroke using SPADE methods. | PSNet
      psnet.ahrq.gov/issue/stroke-hospitalization-after-misdiagnosis-benign-dizziness-lower-specialty-care-general
      May 12, 2021 - Study Stroke hospitalization after misdiagnosis of "benign dizziness" is lower in specialty care than general practice: a population-based cohort analysis of missed stroke using SPADE methods. Citation Text: Chang T-P, Bery AK, Wang Z, et al. Stroke hospitalization after misdiagnosis of …

4620. 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 …