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3701. Team experiences of the root cause analysis process after a sentinel event: a qualitative case study. | PSNet
      psnet.ahrq.gov/issue/team-experiences-root-cause-analysis-process-after-sentinel-event-qualitative-case-study
      October 07, 2020 - Study Team experiences of the root cause analysis process after a sentinel event: a qualitative case study. Citation Text: Liepelt S, Sundal H, Kirchhoff R. Team experiences of the root cause analysis process after a sentinel event: a qualitative case study. BMC Health Serv Res. 2023;23(…

3702. Emergency medicine physicians' perspectives on diagnostic accuracy in neurology: a qualitative study. | PSNet
      psnet.ahrq.gov/issue/emergency-medicine-physicians-perspectives-diagnostic-accuracy-neurology-qualitative-study
      July 21, 2021 - Study Emergency medicine physicians' perspectives on diagnostic accuracy in neurology: a qualitative study. Citation Text: Liberman AL, Cheng NT, Friedman BW, et al. Emergency medicine physicians’ perspectives on diagnostic accuracy in neurology: a qualitative study. Diagnosis (Berl). 20…

3703. Understanding the informal aspects of medication processes to maintain patient safety in hospitals: a sociotechnical ethnographic study in paediatric units. | PSNet
      psnet.ahrq.gov/issue/understanding-informal-aspects-medication-processes-maintain-patient-safety-hospitals
      March 06, 2024 - Study Understanding the informal aspects of medication processes to maintain patient safety in hospitals: a sociotechnical ethnographic study in paediatric units. Citation Text: Sutherland AB, Phipps DL, Grant S, et al. Understanding the informal aspects of medication processes to mainta…

3704. How differences between manager and clinician perceptions of safety culture impact hospital processes of care. | PSNet
      psnet.ahrq.gov/issue/how-differences-between-manager-and-clinician-perceptions-safety-culture-impact-hospital
      December 21, 2018 - Study How differences between manager and clinician perceptions of safety culture impact hospital processes of care. Citation Text: Richter J, Mazurenko O, Kazley AS, et al. How Differences Between Manager and Clinician Perceptions of Safety Culture Impact Hospital Processes of Care. J P…

3705. Prospective risk analysis of health care processes: a systematic evaluation of the use of HFMEA in Dutch health care. | PSNet
      psnet.ahrq.gov/issue/prospective-risk-analysis-health-care-processes-systematic-evaluation-use-hfmea-dutch-health
      March 10, 2010 - Study Prospective risk analysis of health care processes: a systematic evaluation of the use of HFMEA in Dutch health care. Citation Text: Habraken MMP, van der Schaaf TW, Leistikow IP, et al. Prospective risk analysis of health care processes: a systematic evaluation of the use of HFM…

3706. Parent engagement in perinatal mortality reviews: an online survey of clinicians from six high-income countries. | PSNet
      psnet.ahrq.gov/issue/parent-engagement-perinatal-mortality-reviews-online-survey-clinicians-six-high-income
      April 13, 2022 - Study Parent engagement in perinatal mortality reviews: an online survey of clinicians from six high-income countries. Citation Text: Boyle FM, Horey D, Siassakos D, et al. Parent engagement in perinatal mortality reviews: an online survey of clinicians from six high‐income countries. BJ…

3707. Deficiencies in the Community Care Network Credentialing Process of a Former VA Surgeon and Veterans Health Administration Oversight Failures. | PSNet
      psnet.ahrq.gov/issue/deficiencies-community-care-network-credentialing-process-former-va-surgeon-and-veterans
      November 29, 2023 - Book/Report Deficiencies in the Community Care Network Credentialing Process of a Former VA Surgeon and Veterans Health Administration Oversight Failures. Citation Text: Deficiencies in the Community Care Network Credentialing Process of a Former VA Surgeon and Veterans Health Administra…

3708. Effects of skilled nursing facility structure and process factors on medication errors during nursing home admission. | PSNet
      psnet.ahrq.gov/issue/effects-skilled-nursing-facility-structure-and-process-factors-medication-errors-during
      April 24, 2018 - Study Effects of skilled nursing facility structure and process factors on medication errors during nursing home admission. Citation Text: Lane SJ, Troyer JL, Dienemann JA, et al. Effects of skilled nursing facility structure and process factors on medication errors during nursing home a…

3709. Association of postoperative readmissions with surgical quality using a Delphi consensus process to identify relevant diagnosis codes. | PSNet
      psnet.ahrq.gov/issue/association-postoperative-readmissions-surgical-quality-using-delphi-consensus-process
      September 25, 2018 - Study Association of postoperative readmissions with surgical quality using a Delphi consensus process to identify relevant diagnosis codes. Citation Text: Mull HJ, Graham LA, Morris MS, et al. Association of Postoperative Readmissions With Surgical Quality Using a Delphi Consensus Proce…

3710. Medication errors and processes to reduce them in care homes in the United Kingdom: a scoping review. | PSNet
      psnet.ahrq.gov/issue/medication-errors-and-processes-reduce-them-care-homes-united-kingdom-scoping-review
      October 28, 2020 - Review Medication errors and processes to reduce them in care homes in the United Kingdom: a scoping review. Citation Text: Irons MW, Auta A, Portlock JC, et al. Medication errors and processes to reduce them in care homes in the United Kingdom: a scoping review. Home Health Care Serv Q.…

3711. Using failure mode and effects analysis to reduce patient safety risks related to the dispensing process in the community pharmacy setting. | PSNet
      psnet.ahrq.gov/issue/using-failure-mode-and-effects-analysis-reduce-patient-safety-risks-related-dispensing
      August 02, 2017 - Study Using failure mode and effects analysis to reduce patient safety risks related to the dispensing process in the community pharmacy setting. Citation Text: Stojkovic T, Marinkovic V, Jaehde U, et al. Using Failure mode and Effects Analysis to reduce patient safety risks related to t…

3712. A combined teamwork training and work standardisation intervention in operating theatres: controlled interrupted time series study. | PSNet
      psnet.ahrq.gov/issue/combined-teamwork-training-and-work-standardisation-intervention-operating-theatres
      January 20, 2015 - Study A combined teamwork training and work standardisation intervention in operating theatres: controlled interrupted time series study. Citation Text: Morgan L, Pickering S, Hadi M, et al. A combined teamwork training and work standardisation intervention in operating theatres: control…

3713. | Agency for Healthcare Research and Quality
      www.ahrq.gov/es/tools/index.html?page=3
      June 01, 2016 - Comprehensive Unit-based Safety Program (CUSP) The CUSP toolkit includes training tools to make care safer. More The SHARE Approach Five-step process for clinicians and their patients More EvidenceNOW Tools for Change Helping practices implement evidence More Tools The …

3714. Five topics health care simulation can address to improve patient safety: results from a consensus process. | PSNet
      psnet.ahrq.gov/issue/five-topics-health-care-simulation-can-address-improve-patient-safety-results-consensus
      June 28, 2023 - Study Five topics health care simulation can address to improve patient safety: results from a consensus process. Citation Text: Sollid SJM, Dieckman P, Aase K, et al. Five Topics Health Care Simulation Can Address to Improve Patient Safety: Results From a Consensus Process. J Patient Sa…

3715. Using the rapid response system to provide better oversight of patient care processes. | PSNet
      psnet.ahrq.gov/issue/using-rapid-response-system-provide-better-oversight-patient-care-processes
      January 07, 2015 - Commentary Using the rapid response system to provide better oversight of patient care processes. Citation Text: Moore MS, Howard SK, Lighthall GK. Using the rapid response system to provide better oversight of patient care processes. Jt Comm J Qual Patient Saf. 2007;33(11):695-8, 645. …

3716. Best practices for chemotherapy administration in pediatric oncology: quality and safety process improvements (2015). | PSNet
      psnet.ahrq.gov/issue/best-practices-chemotherapy-administration-pediatric-oncology-quality-and-safety-process
      September 23, 2020 - Commentary Best practices for chemotherapy administration in pediatric oncology: quality and safety process improvements (2015). Citation Text: Looper K, Winchester K, Robinson D, et al. Best Practices for Chemotherapy Administration in Pediatric Oncology: Quality and Safety Process Impr…

3717. Role of communicating diagnostic uncertainty in the safety-netting process: insights from a vignette study. | PSNet
      psnet.ahrq.gov/issue/role-communicating-diagnostic-uncertainty-safety-netting-process-insights-vignette-study
      February 20, 2019 - Study Role of communicating diagnostic uncertainty in the safety-netting process: insights from a vignette study. Citation Text: Cox C, Hatfield T, Fritz Z. Role of communicating diagnostic uncertainty in the safety-netting process: insights from a vignette study. BMJ Qual Saf. 2024;33(1…

3718. Measuring and improving diagnostic safety in primary care: addressing the “twin” pandemics of diagnostic error and clinician burnout. | PSNet
      psnet.ahrq.gov/issue/measuring-and-improving-diagnostic-safety-primary-care-addressing-twin-pandemics-diagnostic
      September 07, 2022 - Commentary Measuring and improving diagnostic safety in primary care: addressing the “twin” pandemics of diagnostic error and clinician burnout. Citation Text: Olson APJ, Linzer M, Schiff GD. Measuring and Improving Diagnostic Safety in Primary Care: Addressing the “Twin” Pandemics of Di…

3719. Analyzing and mitigating the risks of patient harm during operating room to intensive care unit patient handoffs. | PSNet
      psnet.ahrq.gov/issue/analyzing-and-mitigating-risks-patient-harm-during-operating-room-intensive-care-unit-patient
      October 05, 2022 - Commentary Analyzing and mitigating the risks of patient harm during operating room to intensive care unit patient handoffs. Citation Text: Martins NRS, Martinez EZ, Simões CM, et al. Analyzing and mitigating the risks of patient harm during operating room to intensive care unit patient …

3720. "Chance favors only the prepared mind": preparing minds to systematically reduce hazards in the testing process in primary care. | PSNet
      psnet.ahrq.gov/issue/chance-favors-only-prepared-mind-preparing-minds-systematically-reduce-hazards-testing
      April 23, 2014 - Study "Chance favors only the prepared mind": preparing minds to systematically reduce hazards in the testing process in primary care. Citation Text: Singh R, Hickner J, Mold J, et al. "Chance favors only the prepared mind": preparing minds to systematically reduce hazards in the testin…