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Risk factors for wrong-site surgery: a study of 1,166 reports of informed consent and schedule errors. | PSNet

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January 20, 2021 - Study Risk factors for wrong-site surgery: a study of 1,166 reports of informed consent and schedule errors. Citation Text: Taylor MA, Yonash RA. Risk factors for wrong-site surgery: a study of 1,166 reports of informed consent and schedule errors. Patient Safety. 2024;6(1):1-11. doi:10.…

Learning from patients' experiences related to diagnostic errors is essential for progress in patient safety. | PSNet

psnet.ahrq.gov/issue/learning-patients-experiences-related-diagnostic-errors-essential-progress-patient-safety

May 20, 2020 - Study Emerging Classic Learning from patients' experiences related to diagnostic errors is essential for progress in patient safety. Citation Text: Giardina TD, Haskell H, Menon S, et al. Learning From Patients' Experiences Related To Diagnostic Errors Is Essent…

Patient and public involvement in healthcare: a systematic mapping review of systematic reviews - identification of current research and possible directions for future research. | PSNet

psnet.ahrq.gov/issue/patient-and-public-involvement-healthcare-systematic-mapping-review-systematic-reviews

August 24, 2016 - Study Patient and public involvement in healthcare: a systematic mapping review of systematic reviews - identification of current research and possible directions for future research. Citation Text: Bergholtz J, Wolf A, Crine V, et al. Patient and public involvement in healthcare: a syst…

How does work environment relate to diagnostic quality? A prospective, mixed methods study in primary care. | PSNet

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September 07, 2022 - Study How does work environment relate to diagnostic quality? A prospective, mixed methods study in primary care. Citation Text: Khazen M, Sullivan EE, Arabadjis S, et al. How does work environment relate to diagnostic quality? A prospective, mixed methods study in primary care. BMJ Open…

Evaluating efforts to optimize TeamSTEPPS implementation in surgical and pediatric intensive care units. | PSNet

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April 12, 2014 - Study Evaluating efforts to optimize TeamSTEPPS implementation in surgical and pediatric intensive care units. Citation Text: Mayer CM, Cluff L, Lin W-T, et al. Evaluating efforts to optimize TeamSTEPPS implementation in surgical and pediatric intensive care units. Jt Comm J Qual Patie…

Electronic health record-based triggers to detect potential delays in cancer diagnosis. | PSNet

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January 19, 2012 - Study Electronic health record-based triggers to detect potential delays in cancer diagnosis. Citation Text: Murphy DR, Laxmisan A, Reis BA, et al. Electronic health record-based triggers to detect potential delays in cancer diagnosis. BMJ Qual Saf. 2014;23(1):8-16. doi:10.1136/bmjqs-201…

Catching those who fall through the cracks: integrating a follow-up process for emergency department patients with incidental radiologic findings. | PSNet

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September 09, 2020 - EMERGING INNOVATIONS Catching those who fall through the cracks: integrating a follow-up process for emergency department patients with incidental radiologic findings. Citation Text: Catching those who fall through the cracks: integrating a follow-up process for emergency department patients with …

Making Health Care Safer: A Critical Analysis of Patient Safety Practices. | PSNet

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July 27, 2018 - Book/Report Making Health Care Safer: A Critical Analysis of Patient Safety Practices. Citation Text: Making Health Care Safer: A Critical Analysis of Patient Safety Practices. Shojania KG, Duncan BW, McDonald KM, et al, eds. Rockville, MD: Agency for Healthcare Research and Quality; J…

Developing a high value care programme from the bottom up: a programme of faculty-resident improvement projects targeting harmful or unnecessary care. | PSNet

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December 16, 2020 - Study Developing a high value care programme from the bottom up: a programme of faculty-resident improvement projects targeting harmful or unnecessary care. Citation Text: Stinnett-Donnelly JM, Stevens PG, Hood VL. Developing a high value care programme from the bottom up: a programme of…

Sustaining reductions in central line-associated bloodstream infections in Michigan intensive care units: a 10-year analysis. | PSNet

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June 16, 2011 - Study Sustaining reductions in central line-associated bloodstream infections in Michigan intensive care units: a 10-year analysis. Citation Text: Pronovost P, Watson S, Goeschel CA, et al. Sustaining Reductions in Central Line-Associated Bloodstream Infections in Michigan Intensive Care…

Prevalence, severity, and nature of preventable patient harm across medical care settings: systematic review and meta-analysis. | PSNet

psnet.ahrq.gov/issue/prevalence-severity-and-nature-preventable-patient-harm-across-medical-care-settings

February 17, 2021 - Study Classic Prevalence, severity, and nature of preventable patient harm across medical care settings: systematic review and meta-analysis. Citation Text: Panagioti M, Khan K, Keers RN, et al. Prevalence, severity, and nature of preventable patient harm across…

Clinical safety of England's national programme for IT: a retrospective analysis of all reported safety events 2005 to 2011. | PSNet

psnet.ahrq.gov/issue/clinical-safety-englands-national-programme-it-retrospective-analysis-all-reported-safety

December 31, 2014 - Study Classic Clinical safety of England's national programme for IT: a retrospective analysis of all reported safety events 2005 to 2011. Citation Text: Magrabi F, Baker M, Sinha I, et al. Clinical safety of England's national programme for IT: a retrospective …

The tradeoffs between safety and alert fatigue: data from a national evaluation of hospital medication-related clinical decision support. | PSNet

psnet.ahrq.gov/issue/tradeoffs-between-safety-and-alert-fatigue-data-national-evaluation-hospital-medication

March 17, 2021 - Study The tradeoffs between safety and alert fatigue: data from a national evaluation of hospital medication-related clinical decision support. Citation Text: Co Z, Holmgren AJ, Classen DC, et al. The tradeoffs between safety and alert fatigue: data from a national evaluation of hospital…

Methodological variations and their effects on reported medication administration error rates. | PSNet

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January 15, 2025 - Review Methodological variations and their effects on reported medication administration error rates. Citation Text: McLeod MC, Barber N, Franklin BD. Methodological variations and their effects on reported medication administration error rates. BMJ Qual Saf. 2013;22(4):278-89. doi:10.…

Application of a trigger tool in near real time to inform quality improvement activities: a prospective study in a general medicine ward. | PSNet

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September 26, 2012 - Study Application of a trigger tool in near real time to inform quality improvement activities: a prospective study in a general medicine ward. Citation Text: Wong BM, Dyal S, Etchells E, et al. Application of a trigger tool in near real time to inform quality improvement activities: a p…

Potential biases in machine learning algorithms using electronic health record data. | PSNet

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June 12, 2019 - Commentary Classic Potential biases in machine learning algorithms using electronic health record data. Citation Text: Gianfrancesco MA, Tamang S, Yazdany J, et al. Potential Biases in Machine Learning Algorithms Using Electronic Health Record Data. JAMA Intern …

Multispecialty physician online survey reveals that burnout related to adverse event involvement may be mitigated by peer support. | PSNet

psnet.ahrq.gov/issue/multispecialty-physician-online-survey-reveals-burnout-related-adverse-event-involvement-may

July 13, 2022 - Study Multispecialty physician online survey reveals that burnout related to adverse event involvement may be mitigated by peer support. Citation Text: Gupta K, Rivadeneira NA, Lisker S, et al. Multispecialty physician online survey reveals that burnout related to adverse event involveme…

Types of unintended consequences related to computerized provider order entry. | PSNet

psnet.ahrq.gov/issue/types-unintended-consequences-related-computerized-provider-order-entry

February 18, 2011 - Study Classic Types of unintended consequences related to computerized provider order entry. Citation Text: Campbell EM, Sittig DF, Ash JS, et al. Types of unintended consequences related to computerized provider order entry. J Am Med Inform Assoc. 2006;13(5):…

Integrating incident data from five reporting systems to assess patient safety: making sense of the elephant. | PSNet

psnet.ahrq.gov/issue/integrating-incident-data-five-reporting-systems-assess-patient-safety-making-sense-elephant

November 25, 2009 - Study Classic Integrating incident data from five reporting systems to assess patient safety: making sense of the elephant. Citation Text: Levtzion-Korach O, Frankel A, Alcalai H, et al. Integrating incident data from five reporting systems to assess patient saf…

Incidence of adverse drug events and potential adverse drug events: implications for prevention. | PSNet

psnet.ahrq.gov/issue/incidence-adverse-drug-events-and-potential-adverse-drug-events-implications-prevention

February 10, 2011 - Study Classic Incidence of adverse drug events and potential adverse drug events: implications for prevention. Citation Text: Bates DW, Cullen DJ, Laird N, et al. Incidence of adverse drug events and potential adverse drug events. Implications for prevention. …

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