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  1. Is it time for the mental health field to consider unplanned discharge a key metric of patient safety? | PSNet

    psnet.ahrq.gov/issue/it-time-mental-health-field-consider-unplanned-discharge-key-metric-patient-safety
    June 01, 2022 - Study Is it time for the mental health field to consider unplanned discharge a key metric of patient safety? Citation Text: Riblet NB, Gottlieb DJ, Watts BV, et al. Is it time for the mental health field to consider unplanned discharge a key metric of patient safety? J Nerv Ment Dis. 202…

  2. The presence and potential impact of psychological safety in the healthcare setting: an evidence synthesis. | PSNet

    psnet.ahrq.gov/issue/presence-and-potential-impact-psychological-safety-healthcare-setting-evidence-synthesis
    October 20, 2021 - Review The presence and potential impact of psychological safety in the healthcare setting: an evidence synthesis. Citation Text: Grailey KE, Murray E, Reader T, et al. The presence and potential impact of psychological safety in the healthcare setting: an evidence synthesis. BMC Health …

  3. Nurse-physician communication in the long-term care setting: perceived barriers and impact on patient safety. | PSNet

    psnet.ahrq.gov/issue/nurse-physician-communication-long-term-care-setting-perceived-barriers-and-impact-patient
    February 23, 2011 - Study Nurse-physician communication in the long-term care setting: perceived barriers and impact on patient safety. Citation Text: Tjia J, Mazor KM, Field T, et al. Nurse-physician communication in the long-term care setting: perceived barriers and impact on patient safety. J Patient S…

  4. Comparing the outcomes of reporting and trigger tool methods to capture adverse events in the emergency department. | PSNet

    psnet.ahrq.gov/issue/comparing-outcomes-reporting-and-trigger-tool-methods-capture-adverse-events-emergency
    May 04, 2017 - Study Comparing the outcomes of reporting and trigger tool methods to capture adverse events in the emergency department. Citation Text: Lee W-H, Zhang E, Chiang C-Y, et al. Comparing the Outcomes of Reporting and Trigger Tool Methods to Capture Adverse Events in the Emergency Department…

  5. Hospital nurses and physicians' experiences practicing patient safety work to recognize deteriorating patients: a qualitative study. | PSNet

    psnet.ahrq.gov/issue/hospital-nurses-and-physicians-experiences-practicing-patient-safety-work-recognize
    October 20, 2021 - Study Hospital nurses and physicians' experiences practicing patient safety work to recognize deteriorating patients: a qualitative study. Citation Text: Berg AMN, Werner A, Knutsen IR, et al. Hospital nurses and physicians’ experiences practicing patient safety work to recognize deterio…

  6. Effect of a quality improvement intervention with daily round checklists, goal setting, and clinician prompting on mortality of critically ill patients. | PSNet

    psnet.ahrq.gov/issue/effect-quality-improvement-intervention-daily-round-checklists-goal-setting-and-clinician
    June 25, 2014 - Study Classic Effect of a quality improvement intervention with daily round checklists, goal setting, and clinician prompting on mortality of critically ill patients. Citation Text: Network WG for the CHECKLIST-ICUI and the BR in IC, Cavalcanti AB, Bozza FA, et …

  7. Antimicrobial residual drug error in the intensive care unit; a single blinded prospective observational study. | PSNet

    psnet.ahrq.gov/issue/antimicrobial-residual-drug-error-intensive-care-unit-single-blinded-prospective
    November 21, 2021 - Study Antimicrobial residual drug error in the intensive care unit; a single blinded prospective observational study. Citation Text: Jarrett P, Keogh S, Roberts JA, et al. Antimicrobial residual drug error in the intensive care unit; a single blinded prospective observational study. Inte…

  8. Deferral of care for serious non-COVID-19 conditions: a hidden harm of COVID-19. | PSNet

    psnet.ahrq.gov/issue/deferral-care-serious-non-covid-19-conditions-hidden-harm-covid-19
    June 22, 2022 - Commentary Deferral of care for serious non-COVID-19 conditions: a hidden harm of COVID-19. Citation Text: DeJong C, Katz MH, Covinsky KE. Deferral of care for serious non-COVID-19 conditions: a hidden harm of COVID-19. JAMA Intern Med. 2020;181(2):274. doi:10.1001/jamainternmed.2020.401…

  9. Patient readmissions, emergency visits, and adverse events after software-assisted discharge from hospital: cluster randomized trial. | PSNet

    psnet.ahrq.gov/issue/patient-readmissions-emergency-visits-and-adverse-events-after-software-assisted-discharge
    November 16, 2022 - Study Patient readmissions, emergency visits, and adverse events after software-assisted discharge from hospital: cluster randomized trial. Citation Text: Graumlich JF, Novotny NL, Nace S, et al. Patient readmissions, emergency visits, and adverse events after software-assisted dischar…

  10. Can preventable adverse events be predicted among hospitalized older patients? The development and validation of a predictive model. | PSNet

    psnet.ahrq.gov/issue/can-preventable-adverse-events-be-predicted-among-hospitalized-older-patients-development-and
    March 18, 2013 - Study Can preventable adverse events be predicted among hospitalized older patients? The development and validation of a predictive model. Citation Text: Van De Steeg L, Langelaan M, Wagner C. Can preventable adverse events be predicted among hospitalized older patients? The development …

  11. Disclosing adverse events in clinical practice: the delicate act of being open. | PSNet

    psnet.ahrq.gov/issue/disclosing-adverse-events-clinical-practice-delicate-act-being-open
    April 14, 2021 - Review Disclosing adverse events in clinical practice: the delicate act of being open. Citation Text: Myren BJ, de Hullu JA, Bastiaans S, et al. Disclosing adverse events in clinical practice: the delicate act of being open. Health Commun. 2022;37(2):191-201. doi:10.1080/10410236.2020.18…

  12. An alternative strategy for studying adverse events in medical care. | PSNet

    psnet.ahrq.gov/issue/alternative-strategy-studying-adverse-events-medical-care
    June 03, 2020 - Study Classic An alternative strategy for studying adverse events in medical care. Citation Text: Andrews LB, Stocking C, Krizek T, et al. An alternative strategy for studying adverse events in medical care. Lancet. 1997;349(9048):309-13. Copy Citation Fo…

  13. Analysis of clinical decision support system malfunctions: a case series and survey. | PSNet

    psnet.ahrq.gov/issue/analysis-clinical-decision-support-system-malfunctions-case-series-and-survey
    April 29, 2018 - Study Analysis of clinical decision support system malfunctions: a case series and survey. Citation Text: Wright A, Hickman T-TT, McEvoy D, et al. Analysis of clinical decision support system malfunctions: a case series and survey. J Am Med Inform Assoc. 2016;23(6):1068-1076. doi:10.1093…

  14. The influence of professional identity on how the receiver receives and responds to a speaking up message: a cross-sectional study. | PSNet

    psnet.ahrq.gov/issue/influence-professional-identity-how-receiver-receives-and-responds-speaking-message-cross
    August 10, 2022 - Study The influence of professional identity on how the receiver receives and responds to a speaking up message: a cross-sectional study. Citation Text: Barlow M, Watson B, Jones EW, et al. The influence of professional identity on how the receiver receives and responds to a speaking up …

  15. Narrative review: do state laws make it easier to say "I'm sorry"? | PSNet

    psnet.ahrq.gov/issue/narrative-review-do-state-laws-make-it-easier-say-im-sorry
    June 16, 2010 - Review Narrative review: do state laws make it easier to say "I'm sorry"? Citation Text: McDonnell WM, Guenther E. Narrative review: do state laws make it easier to say "I'm sorry?". Ann Intern Med. 2008;149(11):811-816. Copy Citation Format: Google Scholar PubMed BibTeX En…

  16. Disclosure of medical errors: what factors influence how patients respond? | PSNet

    psnet.ahrq.gov/issue/disclosure-medical-errors-what-factors-influence-how-patients-respond
    December 23, 2008 - Study Classic Disclosure of medical errors: what factors influence how patients respond? Citation Text: Mazor KM, Reed G, Yood RA, et al. Disclosure of medical errors: what factors influence how patients respond? J Gen Intern Med. 2006;21(7):704-10. Copy Cit…

  17. Patient harm resulting from medication reconciliation process failures: a study of serious events reported by Pennsylvania hospitals. | PSNet

    psnet.ahrq.gov/issue/patient-harm-resulting-medication-reconciliation-process-failures-study-serious-events
    October 07, 2020 - Study Patient harm resulting from medication reconciliation process failures: a study of serious events reported by Pennsylvania hospitals. Citation Text: Harper A, Kukielka E, Jones RM. Patient harm resulting from medication reconciliation process failures: a study of serious events rep…

  18. Handling polypharmacy--a qualitative study using focus group interviews with older patients, their relatives, and healthcare professionals. | PSNet

    psnet.ahrq.gov/issue/handling-polypharmacy-qualitative-study-using-focus-group-interviews-older-patients-their
    August 03, 2022 - Study Handling polypharmacy--a qualitative study using focus group interviews with older patients, their relatives, and healthcare professionals. Citation Text: Mikkelsen TH, Søndergaard J, Kjaer NK, et al. Handling polypharmacy –a qualitative study using focus group interviews with olde…

  19. In the eye of the storm: the role of the pharmacist in medication safety during the COVID-19 pandemic at an urban teaching hospital. | PSNet

    psnet.ahrq.gov/issue/eye-storm-role-pharmacist-medication-safety-during-covid-19-pandemic-urban-teaching-hospital
    June 02, 2021 - Commentary In the eye of the storm: the role of the pharmacist in medication safety during the COVID-19 pandemic at an urban teaching hospital. Citation Text: Kanaan AO, Sullivan KM, Seed SM, et al. In the eye of the storm: the role of the pharmacist in medication safety during the COVID…

  20. Decreased incidence of cesarean surgical site infection rate with hospital-wide perioperative bundle. | PSNet

    psnet.ahrq.gov/issue/decreased-incidence-cesarean-surgical-site-infection-rate-hospital-wide-perioperative-bundle
    September 08, 2021 - Study Decreased incidence of cesarean surgical site infection rate with hospital-wide perioperative bundle. Citation Text: Sood N, Lee RE, To JK, et al. Decreased incidence of cesarean surgical site infection rate with hospital‐wide perioperative bundle. Birth. 2022;49(1):141-146. doi:10…
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