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  1. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/846762/psn-pdf
    March 29, 2023 - Hospital ‘black boxes’ put surgical practices under the microscope. March 29, 2023 Sadick B. Wall Street Journal. March 19, 2023. https://psnet.ahrq.gov/issue/hospital-black-boxes-put-surgical-practices-under-microscope Safety information systems that track action in real time can reveal a trove of data about how …

  2. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/43302/psn-pdf
    August 21, 2014 - A medication-based trigger tool to identify adverse events in pediatric anesthesiology. August 21, 2014 Taghon T, Elsey N, Miler V, et al. A medication-based trigger tool to identify adverse events in pediatric anesthesiology. Jt Comm J Qual Patient Saf. 2014;40(7):326-334. https://psnet.ahrq.gov/issue/medication-…

  3. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/74850/psn-pdf
    February 16, 2022 - Medicare penalizes dozens of hospitals it also gives five stars. February 16, 2022 Rau J. Kaiser Health News. February 8, 2022.  https://psnet.ahrq.gov/issue/medicare-penalizes-dozens-hospitals-it-also-gives-five-stars Rating systems face challenges to accurately represent the safety and quality of patient ca…

  4. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/73615/psn-pdf
    August 18, 2021 - Ripped apart: medical misdiagnosis and malpractice. August 18, 2021 Kast S, Gerr M, Black D, et al. “On the Record.” WYPR. August 3, 2021 https://psnet.ahrq.gov/issue/ripped-apart-medical-misdiagnosis-and-malpractice Misdiagnosis is a persistent challenge for patients and families to navigate. This audio news …

  5. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/41614/psn-pdf
    September 26, 2012 - Automated electronic reminders to prevent miscommunication among primary medical, surgical and anaesthesia providers: a root cause analysis. September 26, 2012 Freundlich RE, Grondin L, Tremper KK, et al. Automated electronic reminders to prevent miscommunication among primary medical, surgical and anaesthesia pro…

  6. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/38976/psn-pdf
    October 07, 2009 - Radiology errors: are we learning from our mistakes? October 7, 2009 Mankad K, Hoey ETD, Jones JB, et al. Radiology errors: are we learning from our mistakes? Clin Radiol. 2009;64(10):988-93. doi:10.1016/j.crad.2009.06.002. https://psnet.ahrq.gov/issue/radiology-errors-are-we-learning-our-mistakes This survey stud…

  7. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/34033/psn-pdf
    April 11, 2011 - Adverse events and preventable adverse events in children. April 11, 2011 Woods D, Thomas EJ, Holl JL, et al. Adverse events and preventable adverse events in children. Pediatrics. 2005;115(1):155-60. https://psnet.ahrq.gov/issue/adverse-events-and-preventable-adverse-events-children Adverse events in hospitalize…

  8. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/842779/psn-pdf
    January 12, 2011 - Resilience Engineering in Practice: a Guidebook. January 12, 2011 Hollnagel E, Parie?s J, Woods DD et al eds. Farnham UK; Ashgate, 2011. ISBN: 9781472420749 https://psnet.ahrq.gov/issue/resilience-engineering-practice-guidebook Safety-critical industries rely on organizational aptitude to respond to disr…

  9. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/44806/psn-pdf
    February 03, 2016 - Are Workarounds Ethical? Managing Moral Problems in Health Care Systems. February 3, 2016 Berlinger N. New York, NY: Oxford University Press; 2016. ISBN: 9780190269296. https://psnet.ahrq.gov/issue/are-workarounds-ethical-managing-moral-problems-health-care-systems Workarounds indicate process weaknesses that can …

  10. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/855002/psn-pdf
    November 01, 2023 - Temporarily holding medication orders safely in order to prevent patient harm. November 1, 2023 ISMP Medication Safety Alert! Acute care edition. October 19, 2023;28(21):1-4. https://psnet.ahrq.gov/issue/temporarily-holding-medication-orders-safely-order-prevent-patient-harm Process disconnects can cause administr…

  11. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/864864/psn-pdf
    March 20, 2024 - Systemic failures in health care oversight. March 20, 2024 Campbell JL. Ga L Rev. 2024;58(2):737-802. https://psnet.ahrq.gov/issue/systemic-failures-health-care-oversight Questions exist as to why practitioners with known performance issues continue to practice and affect patient safety. This article suggests a sh…

  12. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/41205/psn-pdf
    June 15, 2012 - Quality assessment of spontaneous triggered adverse event reports received by the Food and Drug Administration. June 15, 2012 Brajovic S, Piazza-Hepp T, Swartz L, et al. Quality assessment of spontaneous triggered adverse event reports received by the Food and Drug Administration. Pharmacoepidemiol Drug Saf. 2012;…

  13. Filespecifications Nis 1993 Hospital Trendwt

    hcup-us.ahrq.gov/db/nation/nis/weights/FileSpecifications_NIS_1993_HOSPITAL_TrendWt.TXT
    January 01, 1993 - Data Set Name: NIS_1993_HOSPITAL_TRENDWT Number of Observations: 913 Total Record Length: 20 Total Number of Data Elements: 3 Columns Description ======= =========== 1- 3 Database name 5- 8 Discharge year of data 10- 25 File name 27- 29 Data element number 31- 59 Data element name 61- 63…

  14. Filespecifications Nis 2004 Hospital Trendwt

    hcup-us.ahrq.gov/db/nation/nis/weights/FileSpecifications_NIS_2004_HOSPITAL_TrendWt.TXT
    January 01, 2004 - Data Set Name: NIS_2004_HOSPITAL_TRENDWT Number of Observations: 1004 Total Record Length: 20 Total Number of Data Elements: 3 Columns Description ======= =========== 1- 3 Database name 5- 8 Discharge year of data 10- 25 File name 27- 29 Data element number 31- 59 Data element name 61- 6…

  15. Filespecifications Nis 1997 Hospital Trendwt

    hcup-us.ahrq.gov/db/nation/nis/weights/FileSpecifications_NIS_1997_HOSPITAL_TrendWt.TXT
    January 01, 1997 - Data Set Name: NIS_1997_HOSPITAL_TRENDWT Number of Observations: 1012 Total Record Length: 20 Total Number of Data Elements: 3 Columns Description ======= =========== 1- 3 Database name 5- 8 Discharge year of data 10- 25 File name 27- 29 Data element number 31- 59 Data element name 61- 6…

  16. Filespecifications Nis 2007 Hospital Trendwt

    hcup-us.ahrq.gov/db/nation/nis/weights/FileSpecifications_NIS_2007_HOSPITAL_TrendWt.TXT
    January 01, 2007 - Data Set Name: NIS_2007_HOSPITAL_TRENDWT Number of Observations: 1044 Total Record Length: 20 Total Number of Data Elements: 3 Columns Description ======= =========== 1- 3 Database name 5- 8 Discharge year of data 10- 25 File name 27- 29 Data element number 31- 59 Data element name 61- 6…

  17. Filespecifications Nis 1996 Hospital Trendwt

    hcup-us.ahrq.gov/db/nation/nis/weights/FileSpecifications_NIS_1996_HOSPITAL_TrendWt.TXT
    January 01, 1996 - Data Set Name: NIS_1996_HOSPITAL_TRENDWT Number of Observations: 906 Total Record Length: 20 Total Number of Data Elements: 3 Columns Description ======= =========== 1- 3 Database name 5- 8 Discharge year of data 10- 25 File name 27- 29 Data element number 31- 59 Data element name 61- 63…

  18. Filespecifications Nis 1998 Hospital Trendwt

    hcup-us.ahrq.gov/db/nation/nis/weights/FileSpecifications_NIS_1998_HOSPITAL_TrendWt.TXT
    January 01, 1998 - Data Set Name: NIS_1998_HOSPITAL_TRENDWT Number of Observations: 984 Total Record Length: 20 Total Number of Data Elements: 3 Columns Description ======= =========== 1- 3 Database name 5- 8 Discharge year of data 10- 25 File name 27- 29 Data element number 31- 59 Data element name 61- 63…

  19. Filespecifications Nis 1999 Hospital Trendwt

    hcup-us.ahrq.gov/db/nation/nis/weights/FileSpecifications_NIS_1999_HOSPITAL_TrendWt.TXT
    January 01, 1999 - Data Set Name: NIS_1999_HOSPITAL_TRENDWT Number of Observations: 984 Total Record Length: 20 Total Number of Data Elements: 3 Columns Description ======= =========== 1- 3 Database name 5- 8 Discharge year of data 10- 25 File name 27- 29 Data element number 31- 59 Data element name 61- 63…

  20. Filespecifications Nis 2005 Hospital Trendwt

    hcup-us.ahrq.gov/db/nation/nis/weights/FileSpecifications_NIS_2005_HOSPITAL_TrendWt.TXT
    January 01, 2005 - Data Set Name: NIS_2005_HOSPITAL_TRENDWT Number of Observations: 1054 Total Record Length: 20 Total Number of Data Elements: 3 Columns Description ======= =========== 1- 3 Database name 5- 8 Discharge year of data 10- 25 File name 27- 29 Data element number 31- 59 Data element name 61- 6…
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