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Training situational awareness to reduce surgical errors in the operating room. | PSNet

psnet.ahrq.gov/issue/training-situational-awareness-reduce-surgical-errors-operating-room

November 21, 2012 - Review Training situational awareness to reduce surgical errors in the operating room. Citation Text: Graafland M, Schraagen JMC, Boermeester MA, et al. Training situational awareness to reduce surgical errors in the operating room. Br J Surg. 2015;102(1):16-23. doi:10.1002/bjs.9643. C…

Involving users in the design of a system for sharing lessons from adverse incidents in anaesthesia. | PSNet

psnet.ahrq.gov/issue/involving-users-design-system-sharing-lessons-adverse-incidents-anaesthesia

April 24, 2018 - Study Involving users in the design of a system for sharing lessons from adverse incidents in anaesthesia. Citation Text: Sharma S, Smith AF, Rooksby J, et al. Involving users in the design of a system for sharing lessons from adverse incidents in anaesthesia. Anaesthesia. 2006;61(4):3…

Medical errors in neurosurgery. | PSNet

psnet.ahrq.gov/issue/medical-errors-neurosurgery

February 14, 2018 - Review Medical errors in neurosurgery. Citation Text: Rolston JD, Zygourakis CC, Han SJ, et al. Medical errors in neurosurgery. Surg Neurol Int. 2014;5(Suppl 10):S435-40. doi:10.4103/2152-7806.142777. Copy Citation Format: DOI Google Scholar PubMed BibTeX EndNote X3 XML End…

The next phase of health care improvement: what can we learn from social movements? | PSNet

psnet.ahrq.gov/issue/next-phase-health-care-improvement-what-can-we-learn-social-movements

July 22, 2010 - Commentary The next phase of health care improvement: what can we learn from social movements? Citation Text: Bate P, Robert G, Bevan H. The next phase of healthcare improvement: what can we learn from social movements? Qual Saf Health Care. 2004;13(1):62-6. Copy Citation Format:…

Improving measurement in clinical handover. | PSNet

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August 12, 2009 - Commentary Improving measurement in clinical handover. Citation Text: Jeffcott SA, Evans SM, Cameron PA, et al. Improving measurement in clinical handover. Qual Saf Health Care. 2009;18(4):272-7. doi:10.1136/qshc.2007.024570. Copy Citation Format: DOI Google Scholar PubMed…

An observational study of practice during transfer of patients from anaesthetic room to operating theatre. | PSNet

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September 27, 2016 - Study An observational study of practice during transfer of patients from anaesthetic room to operating theatre. Citation Text: Broom MA, Slater J, Ure DS. An observational study of practice during transfer of patients from anaesthetic room to operating theatre. Anaesthesia. 2006;61(10…

Changing operating room culture: implementation of a postoperative debrief and improved safety culture. | PSNet

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December 03, 2014 - Study Changing operating room culture: implementation of a postoperative debrief and improved safety culture. Citation Text: Magill ST, Wang DD, Rutledge C, et al. Changing Operating Room Culture: Implementation of a Postoperative Debrief and Improved Safety Culture. World Neurosurg. 201…

Changing the medical malpractice system to align with what we know about patient safety and quality improvement. | PSNet

psnet.ahrq.gov/issue/changing-medical-malpractice-system-align-what-we-know-about-patient-safety-and-quality

September 20, 2012 - Commentary Changing the medical malpractice system to align with what we know about patient safety and quality improvement. Citation Text: Sklar DP. Changing the Medical Malpractice System to Align With What We Know About Patient Safety and Quality Improvement. Acad Med. 2017;92(7):891-8…

Retractions in the medical literature: how many patients are put at risk by flawed research? | PSNet

psnet.ahrq.gov/issue/retractions-medical-literature-how-many-patients-are-put-risk-flawed-research

August 31, 2011 - Study Retractions in the medical literature: how many patients are put at risk by flawed research? Citation Text: Steen G. Retractions in the medical literature: how many patients are put at risk by flawed research? J Med Ethics. 2011;37(11):688-92. doi:10.1136/jme.2011.043133. Copy …

What constitutes a prescribing error in paediatrics? | PSNet

psnet.ahrq.gov/issue/what-constitutes-prescribing-error-paediatrics

March 05, 2010 - Study What constitutes a prescribing error in paediatrics? Citation Text: Ghaleb MA, Barber N, Franklin D, et al. What constitutes a prescribing error in paediatrics? Qual Saf Health Care. 2005;14(5):352-7. Copy Citation Format: Google Scholar PubMed BibTeX EndNote X3 XML…

Creating a highly reliable neonatal intensive care unit through safer systems of care. | PSNet

psnet.ahrq.gov/issue/creating-highly-reliable-neonatal-intensive-care-unit-through-safer-systems-care

January 12, 2011 - Review Creating a highly reliable neonatal intensive care unit through safer systems of care. Citation Text: Panagos PG, Pearlman SA. Creating a Highly Reliable Neonatal Intensive Care Unit Through Safer Systems of Care. Clin Perinatol. 2017;44(3):645-662. doi:10.1016/j.clp.2017.05.006. …

An observational study of laterality errors in a sample of clinical records. | PSNet

psnet.ahrq.gov/issue/observational-study-laterality-errors-sample-clinical-records

April 19, 2011 - Study An observational study of laterality errors in a sample of clinical records. Citation Text: Elghrably I, Fraser SG. An observational study of laterality errors in a sample of clinical records. Eye (Lond). 2008;22(3):340-3. Copy Citation Format: Google Scholar PubMed…

Health care serial murder: a patient safety orphan. | PSNet

psnet.ahrq.gov/issue/health-care-serial-murder-patient-safety-orphan

July 28, 2014 - Commentary Health care serial murder: a patient safety orphan. Citation Text: Kizer KW, Yorker BC. Health care serial murder: a patient safety orphan. Jt Comm J Qual Saf. 2010;36(4):186-191. Copy Citation Format: Google Scholar PubMed BibTeX EndNote X3 XML EndNote 7 XML End…

The investigation and analysis of critical incidents and adverse events in healthcare. | PSNet

psnet.ahrq.gov/issue/investigation-and-analysis-critical-incidents-and-adverse-events-healthcare

March 05, 2014 - Study Classic The investigation and analysis of critical incidents and adverse events in healthcare. Citation Text: Woloshynowych M, Rogers S, Taylor-Adams S, et al. The investigation and analysis of critical incidents and adverse events in healthcare. Health …

Frequency and severity of harm of medication errors related to the parenteral nutrition process in a large university teaching hospital. | PSNet

psnet.ahrq.gov/issue/frequency-and-severity-harm-medication-errors-related-parenteral-nutrition-process-large

January 16, 2019 - Study Frequency and severity of harm of medication errors related to the parenteral nutrition process in a large university teaching hospital. Citation Text: Sacks GS, Rough S, Kudsk KA. Frequency and severity of harm of medication errors related to the parenteral nutrition process in a…

Team working in intensive care: current evidence and future endeavors. | PSNet

psnet.ahrq.gov/issue/team-working-intensive-care-current-evidence-and-future-endeavors

April 24, 2018 - Review Team working in intensive care: current evidence and future endeavors. Citation Text: Richardson J, West MA, Cuthbertson BH. Team working in intensive care: current evidence and future endeavors. Curr Opin Crit Care. 2010;16(6):643-8. doi:10.1097/MCC.0b013e32833e9731. Copy Cit…

Orienting frames and private routines: the role of cultural process in critical care safety. | PSNet

psnet.ahrq.gov/issue/orienting-frames-and-private-routines-role-cultural-process-critical-care-safety

December 31, 2014 - Study Orienting frames and private routines: the role of cultural process in critical care safety. Citation Text: Hazlehurst B, McMullen C. Orienting frames and private routines: the role of cultural process in critical care safety. Int J Med Inform. 2007;76 Suppl 1:S129-35. Copy Cit…

An evaluation of medication errors—the pediatric surgical service experience. | PSNet

psnet.ahrq.gov/issue/evaluation-medication-errors-pediatric-surgical-service-experience

March 02, 2011 - Study An evaluation of medication errors—the pediatric surgical service experience. Citation Text: Engum SA, Breckler FD. An evaluation of medication errors-the pediatric surgical service experience. J Pediatr Surg. 2008;43(2):348-52. doi:10.1016/j.jpedsurg.2007.10.042. Copy Citation…

The incidence and cost of adverse events in Victorian hospitals 2003-04. | PSNet

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July 13, 2010 - Study The incidence and cost of adverse events in Victorian hospitals 2003-04. Citation Text: Ehsani JP, Jackson T, Duckett SJ. The incidence and cost of adverse events in Victorian hospitals 2003-04. Med J Aust. 2006;184(11):551-5. Copy Citation Format: Google Scholar P…

Implementing a national strategy for patient safety: lessons from the National Health Service in England. | PSNet

psnet.ahrq.gov/issue/implementing-national-strategy-patient-safety-lessons-national-health-service-england

March 02, 2011 - Commentary Implementing a national strategy for patient safety: lessons from the National Health Service in England. Citation Text: Lewis RQ, Fletcher M. Implementing a national strategy for patient safety: lessons from the National Health Service in England. Qual Saf Health Care. 2005…

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