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Doing 'detective work' to find a cancer: how are non-specific symptom pathways for cancer investigation organised, and what are the implications for safety and quality of care? A multisite qualitative approach. | PSNet

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April 05, 2023 - Commentary Doing 'detective work' to find a cancer: how are non-specific symptom pathways for cancer investigation organised, and what are the implications for safety and quality of care? A multisite qualitative approach. Citation Text: Black GB, Nicholson BD, Moreland J-A, et al. Doing …

Patient safety culture and the second victim phenomenon: connecting culture to staff distress in nurses. | PSNet

psnet.ahrq.gov/issue/patient-safety-culture-and-second-victim-phenomenon-connecting-culture-staff-distress-nurses

December 21, 2016 - Study Patient safety culture and the second victim phenomenon: connecting culture to staff distress in nurses. Citation Text: Quillivan RR, Burlison JD, Browne EK, et al. Patient Safety Culture and the Second Victim Phenomenon: Connecting Culture to Staff Distress in Nurses. Jt Comm J Qu…

Improved safety culture and teamwork climate are associated with decreases in patient harm and hospital mortality across a hospital system. | PSNet

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January 15, 2014 - Study Classic Improved safety culture and teamwork climate are associated with decreases in patient harm and hospital mortality across a hospital system. Citation Text: Berry JC, Davis JT, Bartman T, et al. Improved Safety Culture and Teamwork Climate Are Associ…

Balancing "no blame" with accountability in patient safety. | PSNet

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March 13, 2013 - Commentary Classic Balancing "no blame" with accountability in patient safety. Citation Text: Wachter R, Pronovost P. Balancing "no blame" with accountability in patient safety. New Engl J Med. 2009;361(14):1401-1406. doi:10.1056/NEJMsb0903885. Copy Citation…

Effective implementation of work-hour limits and systemic improvements. | PSNet

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September 28, 2010 - Study Classic Effective implementation of work-hour limits and systemic improvements. Citation Text: Landrigan CP, Czeisler CA, Barger LK, et al. Effective implementation of work-hour limits and systemic improvements. Jt Comm J Qual Patient Saf. 2007;33(11 Suppl…

Opportunities and challenges for quality and safety applications in ICD-11: an international survey of users of coded health data. | PSNet

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February 17, 2017 - Study Opportunities and challenges for quality and safety applications in ICD-11: an international survey of users of coded health data. Citation Text: Southern DA, Hall M, White DE, et al. Opportunities and challenges for quality and safety applications in ICD-11: an international surve…

Sequential implementation of the EQUIPPED geriatric medication safety program as a learning health system. | PSNet

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January 19, 2022 - Study Sequential implementation of the EQUIPPED geriatric medication safety program as a learning health system. Citation Text: Vandenberg AE, Kegler M, Hastings SN, et al. Sequential implementation of the EQUIPPED geriatric medication safety program as a learning health system. Int J Q…

High-risk medication in home care nursing: a Delphi study. | PSNet

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April 13, 2022 - Study High-risk medication in home care nursing: a Delphi study. Citation Text: Dumitrescu I, Casteels M, De Vliegher K, et al. High-risk medication in home care nursing: a Delphi study. J Patient Saf. 2022;18(5):435-443. doi:10.1097/pts.0000000000001023. Copy Citation Format: …

Care home safety incidents and safeguarding reports relating to hospital to care home transitions: a retrospective content analysis. | PSNet

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July 17, 2024 - Study Care home safety incidents and safeguarding reports relating to hospital to care home transitions: a retrospective content analysis. Citation Text: Newman C, Mulrine S, Brittain K, et al. Care home safety incidents and safeguarding reports relating to hospital to care home transiti…

Systematic review of types of safety incidents and the processes and systems used for safety incident reporting in care homes. | PSNet

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September 11, 2024 - Review Systematic review of types of safety incidents and the processes and systems used for safety incident reporting in care homes. Citation Text: Scott J, Sykes K, Waring J, et al. Systematic review of types of safety incidents and the processes and systems used for safety incident re…

Strength of improvement recommendations from injurious fall investigations: a retrospective multi-incident analysis. | PSNet

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August 17, 2022 - Study Strength of improvement recommendations from injurious fall investigations: a retrospective multi-incident analysis. Citation Text: Paulik O, Hallen J, Lapkin S, et al. Strength of improvement recommendations from injurious fall investigations: a retrospective multi-incident analys…

Unit-based incident reporting and root cause analysis: variation at three hospital unit types. | PSNet

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April 14, 2011 - Study Unit-based incident reporting and root cause analysis: variation at three hospital unit types. Citation Text: Wagner C, Merten H, Zwaan L, et al. Unit-based incident reporting and root cause analysis: variation at three hospital unit types. BMJ Open. 2016;6(6):e011277. doi:10.1136/…

Time to listen: a review of methods to solicit patient reports of adverse events. | PSNet

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November 23, 2016 - Review Time to listen: a review of methods to solicit patient reports of adverse events. Citation Text: King A, Daniels J, Lim J, et al. Time to listen: a review of methods to solicit patient reports of adverse events. Qual Saf Health Care. 2010;19(2):148-57. doi:10.1136/qshc.2008.0301…

Association of a web-based handoff tool with rates of medical errors. | PSNet

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April 12, 2023 - Study Association of a web-based handoff tool with rates of medical errors. Citation Text: Mueller SK, Yoon CS, Schnipper JL. Association of a Web-Based Handoff Tool With Rates of Medical Errors. JAMA Intern Med. 2016;176(9):1400-2. doi:10.1001/jamainternmed.2016.4258. Copy Citation …

Disclosure of hospital adverse events and its association with patients' ratings of the quality of care. | PSNet

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December 29, 2014 - Study Disclosure of hospital adverse events and its association with patients' ratings of the quality of care. Citation Text: López L, Weissman JS, Schneider EC, et al. Disclosure of hospital adverse events and its association with patients' ratings of the quality of care. Arch Intern Me…

Do user-applied safety labels on medication syringes reduce the incidence of medication errors during rapid medical response intervention for deteriorating patients in wards? A systematic search and review. | PSNet

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February 28, 2024 - Review Do user-applied safety labels on medication syringes reduce the incidence of medication errors during rapid medical response intervention for deteriorating patients in wards? A systematic search and review. Citation Text: Mikhail J, Grantham H, King L. Do User-Applied Safety Label…

Exploring relationships between hospital patient safety culture and Consumer Reports safety scores. | PSNet

psnet.ahrq.gov/issue/exploring-relationships-between-hospital-patient-safety-culture-and-consumer-reports-safety

July 21, 2016 - Study Exploring relationships between hospital patient safety culture and Consumer Reports safety scores. Citation Text: Smith SA, Yount N, Sorra J. Exploring relationships between hospital patient safety culture and Consumer Reports safety scores. BMC Health Serv Res. 2017;17(1):143. do…

Delayed recognition of deterioration of patients in general wards is mostly caused by human related monitoring failures: a root cause analysis of unplanned ICU admissions. | PSNet

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December 21, 2017 - Study Delayed recognition of deterioration of patients in general wards is mostly caused by human related monitoring failures: a root cause analysis of unplanned ICU admissions. Citation Text: van Galen LS, Struik PW, Driesen BEJM, et al. Delayed Recognition of Deterioration of Patients …

Mortality among hospitalized Medicare beneficiaries in the first 2 years following ACGME resident duty hour reform. | PSNet

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February 17, 2009 - Study Classic Mortality among hospitalized Medicare beneficiaries in the first 2 years following ACGME resident duty hour reform. Citation Text: Meltzer DO, Arora VM. Evaluating Resident Duty Hour Reforms. JAMA. 2007;298(9). doi:10.1001/jama.298.9.1055. Copy…

Evaluating serial strategies for preventing wrong-patient orders in the NICU. | PSNet

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November 03, 2015 - Study Evaluating serial strategies for preventing wrong-patient orders in the NICU. Citation Text: Adelman JS, Aschner JL, Schechter CB, et al. Evaluating Serial Strategies for Preventing Wrong-Patient Orders in the NICU. Pediatrics. 2017;139(5). doi:10.1542/peds.2016-2863. Copy Citati…

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