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Disorganized care: the findings of an iterative, in-depth analysis of surgical morbidity and mortality. | PSNet

psnet.ahrq.gov/issue/disorganized-care-findings-iterative-depth-analysis-surgical-morbidity-and-mortality

October 19, 2022 - Study Disorganized care: the findings of an iterative, in-depth analysis of surgical morbidity and mortality. Citation Text: Anderson CI, Nelson CS, Graham CF, et al. Disorganized care: the findings of an iterative, in-depth analysis of surgical morbidity and mortality. J Surg Res. 201…

Developing and implementing a standardized process for Global Trigger Tool application across a large health system. | PSNet

psnet.ahrq.gov/issue/developing-and-implementing-standardized-process-global-trigger-tool-application-across-large

July 18, 2017 - Study Developing and implementing a standardized process for Global Trigger Tool application across a large health system. Citation Text: Garrett PR, Sammer C, Nelson A, et al. Developing and implementing a standardized process for global trigger tool application across a large health …

Medication safety event reporting: factors that contribute to safety events during times of organizational stress. | PSNet

psnet.ahrq.gov/issue/medication-safety-event-reporting-factors-contribute-safety-events-during-times

June 21, 2023 - Study Medication safety event reporting: factors that contribute to safety events during times of organizational stress. Citation Text: Cohen TN, Berdahl CT, Coleman BL, et al. Medication safety event reporting: factors that contribute to safety events during times of organizational stre…

Observer-based tools for non-technical skills assessment in simulated and real clinical environments in healthcare: a systematic review. | PSNet

psnet.ahrq.gov/issue/observer-based-tools-non-technical-skills-assessment-simulated-and-real-clinical-environments

September 02, 2015 - Review Emerging Classic Observer-based tools for non-technical skills assessment in simulated and real clinical environments in healthcare: a systematic review. Citation Text: Higham H, Greig PR, Rutherford J, et al. Observer-based tools for non-technical skills…

Repeat prescribing of medications: a system-centred risk management model for primary care organisations. | PSNet

psnet.ahrq.gov/issue/repeat-prescribing-medications-system-centred-risk-management-model-primary-care

January 20, 2016 - Study Repeat prescribing of medications: a system-centred risk management model for primary care organisations. Citation Text: Price J, Man SL, Bartlett S, et al. Repeat prescribing of medications: A system-centred risk management model for primary care organisations. J Eval Clin Pract. …

Evaluation of an electronic health record structured discharge summary to provide real time adverse event reporting in thoracic surgery. | PSNet

psnet.ahrq.gov/issue/evaluation-electronic-health-record-structured-discharge-summary-provide-real-time-adverse

December 29, 2014 - Study Evaluation of an electronic health record structured discharge summary to provide real time adverse event reporting in thoracic surgery. Citation Text: Graham AJ, Ocampo W, Southern DA, et al. Evaluation of an electronic health record structured discharge summary to provide real ti…

A risk analysis method to evaluate the impact of a Computerized Provider Order Entry system on patient safety. | PSNet

psnet.ahrq.gov/issue/risk-analysis-method-evaluate-impact-computerized-provider-order-entry-system-patient-safety

September 15, 2021 - Study A risk analysis method to evaluate the impact of a Computerized Provider Order Entry system on patient safety. Citation Text: Bonnabry P, Despont-Gros C, Grauser D, et al. A risk analysis method to evaluate the impact of a computerized provider order entry system on patient safet…

Parent willingness to remind health care workers to perform hand hygiene. | PSNet

psnet.ahrq.gov/issue/parent-willingness-remind-health-care-workers-perform-hand-hygiene

October 19, 2022 - Study Parent willingness to remind health care workers to perform hand hygiene. Citation Text: Buser GL, Fisher BT, Shea JA, et al. Parent willingness to remind health care workers to perform hand hygiene. Am J Infect Control. 2013;41(6):492-6. doi:10.1016/j.ajic.2012.08.006. Copy Cit…

Locating errors through networked surveillance: a multimethod approach to peer assessment, hazard identification, and prioritization of patient safety efforts in cardiac surgery. | PSNet

psnet.ahrq.gov/issue/locating-errors-through-networked-surveillance-multimethod-approach-peer-assessment-hazard

May 24, 2012 - Study Locating errors through networked surveillance: a multimethod approach to peer assessment, hazard identification, and prioritization of patient safety efforts in cardiac surgery. Citation Text: Thompson DA, Marsteller JA, Pronovost P, et al. Locating Errors Through Networked Survei…

Readmission after delayed diagnosis of surgical site infection: a focus on prevention using the American College of Surgeons National Surgical Quality Improvement Program. | PSNet

psnet.ahrq.gov/issue/readmission-after-delayed-diagnosis-surgical-site-infection-focus-prevention-using-american

September 22, 2021 - Study Readmission after delayed diagnosis of surgical site infection: a focus on prevention using the American College of Surgeons National Surgical Quality Improvement Program. Citation Text: Gibson A, Tevis S, Kennedy G. Readmission after delayed diagnosis of surgical site infection: a…

Using a potentially aggressive/violent patient huddle to improve health care safety. | PSNet

psnet.ahrq.gov/issue/using-potentially-aggressiveviolent-patient-huddle-improve-health-care-safety

November 16, 2022 - Commentary Using a potentially aggressive/violent patient huddle to improve health care safety. Citation Text: Larson LA, Finley JL, Gross TL, et al. Using a Potentially Aggressive/Violent Patient Huddle to Improve Health Care Safety. Jt Comm J Qual Patient Saf. 2019;45(2):74-80. doi:10.…

Harnessing in situ simulation to identify human errors and latent safety threats in adult tracheostomy care. | PSNet

psnet.ahrq.gov/issue/harnessing-situ-simulation-identify-human-errors-and-latent-safety-threats-adult-tracheostomy

September 23, 2020 - Study Harnessing in situ simulation to identify human errors and latent safety threats in adult tracheostomy care. Citation Text: Hassan B, Tawfik M-M, Schiff E, et al. Harnessing in situ simulation to identify human errors and latent safety threats in adult tracheostomy care. Jt Comm J …

Medicare letters to curb overprescribing of controlled substances had no detectable effect on providers. | PSNet

psnet.ahrq.gov/issue/medicare-letters-curb-overprescribing-controlled-substances-had-no-detectable-effect

May 25, 2016 - Study Medicare letters to curb overprescribing of controlled substances had no detectable effect on providers. Citation Text: Sacarny A, Yokum D, Finkelstein A, et al. Medicare Letters To Curb Overprescribing Of Controlled Substances Had No Detectable Effect On Providers. Health Aff (Mil…

Examination of impact of after-hours admissions on hospital resource use, patient outcomes, and costs. | PSNet

psnet.ahrq.gov/issue/examination-impact-after-hours-admissions-hospital-resource-use-patient-outcomes-and-costs

November 30, 2022 - Study Examination of impact of after-hours admissions on hospital resource use, patient outcomes, and costs. Citation Text: Skead C, Thompson LH, Kuk H, et al. Examination of impact of after-hours admissions on hospital resource use, patient outcomes, and costs. Crit Care Res Pract. 2022…

Governing board, C-suite, and clinical management perceptions of quality and safety structures, processes, and priorities in US hospitals. | PSNet

psnet.ahrq.gov/issue/governing-board-c-suite-and-clinical-management-perceptions-quality-and-safety-structures

July 14, 2010 - Study Governing board, C-suite, and clinical management perceptions of quality and safety structures, processes, and priorities in US hospitals. Citation Text: Vaughn T, Koepke M, Levey S, et al. Governing board, C-suite, and clinical management perceptions of quality and safety structur…

Simulation based teamwork training for emergency department staff: does it improve clinical team performance when added to an existing didactic teamwork curriculum? | PSNet

psnet.ahrq.gov/issue/simulation-based-teamwork-training-emergency-department-staff-does-it-improve-clinical-team

December 22, 2009 - Study Classic Simulation based teamwork training for emergency department staff: does it improve clinical team performance when added to an existing didactic teamwork curriculum? Citation Text: Shapiro MJ, Morey JC, Small SD, et al. Simulation based teamwork t…

Preventing iatrogenic overdose: a review of in–emergency department opioid-related adverse drug events and medication errors. | PSNet

psnet.ahrq.gov/issue/preventing-iatrogenic-overdose-review-emergency-department-opioid-related-adverse-drug-events

August 12, 2020 - Study Preventing iatrogenic overdose: a review of in–emergency department opioid-related adverse drug events and medication errors. Citation Text: Beaudoin FL, Merchant RC, Janicki A, et al. Preventing iatrogenic overdose: a review of in-emergency department opioid-related adverse drug e…

Factors influencing witnesses' perception of patient safety during pre-hospital health care from emergency medical services: a multi-center cross-sectional study. | PSNet

psnet.ahrq.gov/issue/factors-influencing-witnesses-perception-patient-safety-during-pre-hospital-health-care

March 09, 2022 - Study Factors influencing witnesses' perception of patient safety during pre-hospital health care from emergency medical services: a multi-center cross-sectional study. Citation Text: Péculo-Carrasco J-A, Rodríguez-Ruiz H-J, Puerta-Córdoba A, et al. Factors influencing witnesses’ percept…

Risk of COVID-19-related bullying, harassment and stigma among healthcare workers: an analytical cross-sectional global study. | PSNet

psnet.ahrq.gov/issue/risk-covid-19-related-bullying-harassment-and-stigma-among-healthcare-workers-analytical

April 25, 2016 - Study Risk of COVID-19-related bullying, harassment and stigma among healthcare workers: an analytical cross-sectional global study. Citation Text: Dye TD, Alcantara L, Siddiqi S, et al. Risk of COVID-19-related bullying, harassment and stigma among healthcare workers: an analytical cros…

Implementing receiver-driven handoffs to the emergency department to reduce miscommunication. | PSNet

psnet.ahrq.gov/issue/implementing-receiver-driven-handoffs-emergency-department-reduce-miscommunication

December 05, 2018 - Study Implementing receiver-driven handoffs to the emergency department to reduce miscommunication. Citation Text: Huth K, Stack AM, Hatoun J, et al. Implementing receiver-driven handoffs to the emergency department to reduce miscommunication. BMJ Qual Saf. 2021;30(3):208-215. doi:10.113…

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