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9441. Failures in Care Coordination and Reviewing a Patient's Death at the VA Salt Lake City Healthcare System in Utah. | PSNet
      psnet.ahrq.gov/issue/failures-care-coordination-and-reviewing-patients-death-va-salt-lake-city-healthcare-system
      April 19, 2023 - Book/Report Failures in Care Coordination and Reviewing a Patient's Death at the VA Salt Lake City Healthcare System in Utah. Citation Text: Failures in Care Coordination and Reviewing a Patient's Death at the VA Salt Lake City Healthcare System in Utah. Washington, DC: Department of Vet…

9442. Hospital surveys by the Centers for Medicare and Medicaid Services: an analysis of more than 34,000 deficiencies. | PSNet
      psnet.ahrq.gov/issue/hospital-surveys-centers-medicare-and-medicaid-services-analysis-more-34000-deficiencies
      May 26, 2021 - Study Hospital surveys by the Centers for Medicare and Medicaid Services: an analysis of more than 34,000 deficiencies. Citation Text: Antognini JF. Hospital surveys by the Centers for Medicare and Medicaid Services: an analysis of more than 34,000 deficiencies. J Patient Saf. 2021;17(4)…

9443. Assessing adverse events after chiropractic care at a chiropractic teaching clinic: an active-surveillance pilot study. | PSNet
      psnet.ahrq.gov/issue/assessing-adverse-events-after-chiropractic-care-chiropractic-teaching-clinic-active
      December 23, 2020 - Study Assessing adverse events after chiropractic care at a chiropractic teaching clinic: an active-surveillance pilot study. Citation Text: Pohlman KA, Funabashi M, Ndetan H, et al. Assessing adverse events after chiropractic care at a chiropractic teaching clinic: an active-surveillanc…

9444. Effectiveness of interventions to improve adverse drug reaction reporting by healthcare professionals over the last decade: A systematic review | PSNet
      psnet.ahrq.gov/issue/effectiveness-interventions-improve-adverse-drug-reaction-reporting-healthcare-professionals
      August 28, 2024 - Review Effectiveness of interventions to improve adverse drug reaction reporting by healthcare professionals over the last decade: A systematic review Citation Text: Li R, Zaidi STR, Chen T, et al. Effectiveness of interventions to improve adverse drug reaction reporting by healthcare pr…

9445. The effectiveness of checklists and error reporting systems in enhancing patient safety and reducing medical errors in hospital settings: a narrative review. | PSNet
      psnet.ahrq.gov/issue/effectiveness-checklists-and-error-reporting-systems-enhancing-patient-safety-and-reducing
      August 03, 2017 - Review The effectiveness of checklists and error reporting systems in enhancing patient safety and reducing medical errors in hospital settings: a narrative review. Citation Text: Chance EA, Florence D, Sardi Abdoul I. The effectiveness of checklists and error reporting systems in enhanc…

9446. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/38716/psn-pdf
      February 17, 2011 - Ending extra payment for "never events"—stronger incentives for patients' safety. February 17, 2011 Milstein A. Ending extra payment for "never events"--stronger incentives for patients' safety. N Engl J Med. 2009;360(23):2388-90. doi:10.1056/NEJMp0809125. https://psnet.ahrq.gov/issue/ending-extra-payment-never-ev…

9447. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/74018/psn-pdf
      October 27, 2021 - Anatomy of a medical device recall: how defective products can slip through an outdated system. October 27, 2021 Zipp R. Medical Tech Dive. October 18, 2021. https://psnet.ahrq.gov/issue/anatomy-medical-device-recall-how-defective-products-can-slip-through- outdated-system This article highlights systems influenc…

9448. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/50817/psn-pdf
      January 22, 2020 - Analysis of paediatric long-term ventilation incidents in the community January 22, 2020 Nawaz RF, Page B, Harrop E, et al. Analysis of paediatric long-term ventilation incidents in the community. Arch Dis Child. 2020;105(5):446-451. doi:10.1136/archdischild-2019-317965. https://psnet.ahrq.gov/issue/analysis-paedi…

9449. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/836879/psn-pdf
      April 27, 2022 - In Conversation With... Michael L. Millenson April 27, 2022 In Conversation With.. Michael L. Millenson. PSNet [internet]. 2022. https://psnet.ahrq.gov/perspective/conversation-michael-l-millenson December 16, 2021 Editor’s note: Michael L. Millenson is the President of Health Quality Advisors LLC, author of the c…

9450. Patient Safety Commissioner. Listening to Patients. | PSNet
      psnet.ahrq.gov/issue/patient-safety-commissioner-listening-patients
      December 20, 2024 - Multi-use Website Patient Safety Commissioner. Listening to Patients. Citation Text: Patient Safety Commissioner. Listening to Patients. London, England. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML EndNote 7 XML Endnote tagged PubMedId RIS Download …

9451. Common formats for patient safety data collection and event reporting. | PSNet
      psnet.ahrq.gov/issue/common-formats-patient-safety-data-collection-and-event-reporting
      January 06, 2010 - Press Release/Announcement Common formats for patient safety data collection and event reporting. Citation Text: Agency for Healthcare Research and Quality. Fed Register. September 2, 2009;74:45457-45458. Copy Citation Save Print Share Fa…

9452. Organising a manuscript reporting quality improvement or patient safety research. | PSNet
      psnet.ahrq.gov/issue/organising-manuscript-reporting-quality-improvement-or-patient-safety-research
      May 11, 2011 - Commentary Organising a manuscript reporting quality improvement or patient safety research. Citation Text: Holzmueller CG, Pronovost P. Organising a manuscript reporting quality improvement or patient safety research. BMJ Qual Saf. 2013;22(9):777-85. doi:10.1136/bmjqs-2012-001603. Co…

9453. Clinical handover incident reporting in one UK general hospital. | PSNet
      psnet.ahrq.gov/issue/clinical-handover-incident-reporting-one-uk-general-hospital
      May 03, 2023 - Study Clinical handover incident reporting in one UK general hospital. Citation Text: Pezzolesi C, Schifano F, Pickles J, et al. Clinical handover incident reporting in one UK general hospital. Int J Qual Health Care. 2010;22(5):396-401. doi:10.1093/intqhc/mzq048. Copy Citation For…

9454. Surgical adverse outcome reporting as part of routine clinical care. | PSNet
      psnet.ahrq.gov/issue/surgical-adverse-outcome-reporting-part-routine-clinical-care
      March 23, 2011 - Study Surgical adverse outcome reporting as part of routine clinical care. Citation Text: Kievit J, Krukerink M, van de Mheen PJM-. Surgical adverse outcome reporting as part of routine clinical care. Qual Saf Health Care. 2010;19(6):e20. doi:10.1136/qshc.2008.027458. Copy Citation …

9455. Impact of an electronic health record transition on chemotherapy error reporting | PSNet
      psnet.ahrq.gov/issue/impact-electronic-health-record-transition-chemotherapy-error-reporting
      June 17, 2020 - Study Impact of an electronic health record transition on chemotherapy error reporting Citation Text: Hess E, Palmer SE, Stivers A, et al. Impact of an electronic health record transition on chemotherapy error reporting. J Oncol Pharm Pract. 2019:1078155219870590. doi:10.1177/10781552198…

9456. Common formats for patient safety data collection and event reporting. | PSNet
      psnet.ahrq.gov/issue/common-formats-patient-safety-data-collection-and-event-reporting-0
      December 24, 2008 - Multi-use Website Common formats for patient safety data collection and event reporting. Citation Text: Common formats for patient safety data collection and event reporting. Agency for Healthcare Research and Quality. Copy Citation Save Save to your library …

9457. Scrutinizing incident reporting in anaesthesia: why is an incident perceived as critical? | PSNet
      psnet.ahrq.gov/issue/scrutinizing-incident-reporting-anaesthesia-why-incident-perceived-critical
      February 23, 2011 - Study Scrutinizing incident reporting in anaesthesia: why is an incident perceived as critical? Citation Text: Maaløe R, la Cour M, Hansen A, et al. Scrutinizing incident reporting in anaesthesia: why is an incident perceived as critical? Acta Anaesthesiol Scand. 2006;50(8):1005-13. …

9458. The content and context of change of shift report on medical and surgical units. | PSNet
      psnet.ahrq.gov/issue/content-and-context-change-shift-report-medical-and-surgical-units
      September 24, 2016 - Study The content and context of change of shift report on medical and surgical units. Citation Text: Staggers N, Jennings BM. The content and context of change of shift report on medical and surgical units. J Nurs Adm. 2009;39(9):393-8. doi:10.1097/NNA.0b013e3181b3b63a. Copy Citatio…

9459. Critical Issues in Food Allergy: A National Academies Consensus Report. | PSNet
      psnet.ahrq.gov/issue/critical-issues-food-allergy-national-academies-consensus-report
      November 16, 2022 - Commentary Critical Issues in Food Allergy: A National Academies Consensus Report. Citation Text: Sicherer SH, Allen K, Lack G, et al. Critical Issues in Food Allergy: A National Academies Consensus Report. Pediatrics. 2017;140(2). doi:10.1542/peds.2017-0194. Copy Citation Format: …

9460. Improving patient safety—five years after the IOM report. | PSNet
      psnet.ahrq.gov/issue/improving-patient-safety-five-years-after-iom-report
      February 18, 2011 - Commentary Classic Improving patient safety—five years after the IOM report. Citation Text: Altman DE, Clancy CM, Blendon RJ. Improving Patient Safety — Five Years after the IOM Report. New Engl J Med. 2004;351(20):2041-2043. doi:10.1056/nejmp048243. Copy Ci…