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9701. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/50605/psn-pdf
      October 30, 2019 - Report focuses on risk to patients from ED errors. October 30, 2019 Palmer J. Patient Saf Qual Healthcare. Sept/Oct 2019. https://psnet.ahrq.gov/issue/report-focuses-risk-patients-ed-errors The pace of emergency care delivery can reduce reliability. This news story discusses an analysis of medical liability claims…

9702. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/39980/psn-pdf
      January 13, 2014 - Common formats for patient safety data collection and event reporting. January 13, 2014 Agency for Healthcare Research and Quality. https://psnet.ahrq.gov/issue/common-formats-patient-safety-data-collection-and-event-reporting-0 Use of common formats allows for comparison between facilities. This website provides …

9703. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/34001/psn-pdf
      April 16, 2018 - Patient Safety Authority. April 16, 2018 Commonwealth of Pennsylvania https://psnet.ahrq.gov/issue/patient-safety-authority The Patient Safety Authority is an independent state agency charged with taking steps to reduce and eliminate medical errors by identifying problems and recommending solutions. The site inclu…

9704. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/60044/psn-pdf
      March 16, 2020 - Patient Safety in Medical, Nursing, and Other Clinical Education March 16, 2020 Howley LD, Hall KK, Fitall E. Patient Safety in Medical, Nursing, and Other Clinical Education . PSNet [internet]. 2020. https://psnet.ahrq.gov/perspective/patient-safety-medical-nursing-and-other-clinical-education Background Despit…

9705. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/36566/psn-pdf
      January 10, 2007 - Department of Defense Health Care Quality. January 10, 2007 Washington DC: Office of the Assistant Secretary of Defense; Tricare Management Activity: 2011. https://psnet.ahrq.gov/issue/department-defense-health-care-quality This report series discusses activities and achievements of the U.S. Department of Defense's…

9706. Trends in the prevalence of intraoperative adverse events at two academic hospitals after implementation of a mandatory reporting system. | PSNet
      psnet.ahrq.gov/issue/trends-prevalence-intraoperative-adverse-events-two-academic-hospitals-after-implementation
      August 09, 2017 - Study Trends in the prevalence of intraoperative adverse events at two academic hospitals after implementation of a mandatory reporting system. Citation Text: Wanderer JP, Gratch DM, St Jacques P, et al. Trends in the Prevalence of Intraoperative Adverse Events at Two Academic Hospitals …

9707. Slow progress on meeting hospital safety standards: learning from the Leapfrog Group's efforts. | PSNet
      psnet.ahrq.gov/issue/slow-progress-meeting-hospital-safety-standards-learning-leapfrog-groups-efforts
      May 13, 2020 - Government Resource Slow progress on meeting hospital safety standards: learning from the Leapfrog Group's efforts. Citation Text: Moran J, Scanlon D. Slow progress on meeting hospital safety standards: learning from the Leapfrog Group's efforts. Health Aff (Millwood). 2013;32(1):27-35…

9708. Introduction to the STS National Database Series: outcomes analysis, quality improvement, and patient safety. | PSNet
      psnet.ahrq.gov/issue/introduction-sts-national-database-series-outcomes-analysis-quality-improvement-and-patient
      August 04, 2021 - Commentary Introduction to the STS National Database Series: outcomes analysis, quality improvement, and patient safety. Citation Text: Fernandez FG, Shahian DM, Kormos R, et al. The Society of Thoracic Surgeons National Database 2019 Annual Report. Ann Thorac Surg. 2019;108(6):1625-1632…

9709. A systematic review of strategies for reporting of neonatal hospital–acquired bloodstream infections. | PSNet
      psnet.ahrq.gov/issue/systematic-review-strategies-reporting-neonatal-hospital-acquired-bloodstream-infections
      January 09, 2018 - Review A systematic review of strategies for reporting of neonatal hospital–acquired bloodstream infections. Citation Text: Folgori L, Bielicki J, Sharland M. A systematic review of strategies for reporting of neonatal hospital-acquired bloodstream infections. Arch Dis Child Fetal Neon…

9710. Error or "act of God"? A study of patients' and operating room team members' perceptions of error definition, reporting, and disclosure. | PSNet
      psnet.ahrq.gov/issue/error-or-act-god-study-patients-and-operating-room-team-members-perceptions-error-definition
      August 10, 2011 - Study Error or "act of God"? A study of patients' and operating room team members' perceptions of error definition, reporting, and disclosure. Citation Text: Espin S, Levinson W, Regehr G, et al. Error or "act of God"? A study of patients' and operating room team members' perceptions o…

9711. Special Issue: Progress at the Intersection of Patient Safety and Medical Liability. | PSNet
      psnet.ahrq.gov/issue/special-issue-progress-intersection-patient-safety-and-medical-liability
      May 21, 2014 - Special or Theme Issue Special Issue: Progress at the Intersection of Patient Safety and Medical Liability. Citation Text: Special Issue: Progress at the Intersection of Patient Safety and Medical Liability. Ridgely MS, Greenberg MD, Clancy CM, eds. Health Serv Res. 2016;51(suppl 3):2395…

9712. Handoffs, safety culture, and practices: evidence from the hospital survey on patient safety culture. | PSNet
      psnet.ahrq.gov/issue/handoffs-safety-culture-and-practices-evidence-hospital-survey-patient-safety-culture
      June 21, 2015 - Study Handoffs, safety culture, and practices: evidence from the hospital survey on patient safety culture. Citation Text: Lee S-H, Phan PH, Dorman T, et al. Handoffs, safety culture, and practices: evidence from the hospital survey on patient safety culture. BMC Health Serv Res. 2016;16…

9713. Laboratory testing in general practice: a patient safety blind spot. | PSNet
      psnet.ahrq.gov/issue/laboratory-testing-general-practice-patient-safety-blind-spot
      July 29, 2015 - Commentary Laboratory testing in general practice: a patient safety blind spot. Citation Text: Elder NC. Laboratory testing in general practice: a patient safety blind spot. BMJ Qual Saf. 2015;24(11):667-70. doi:10.1136/bmjqs-2015-004644. Copy Citation Format: DOI Google Sc…

9714. The World Federation of Chiropractic Global Patient Safety Task Force: a call to action. | PSNet
      psnet.ahrq.gov/issue/world-federation-chiropractic-global-patient-safety-task-force-call-action
      December 23, 2020 - Review The World Federation of Chiropractic Global Patient Safety Task Force: a call to action. Citation Text: Coleman BC, Rubinstein SM, Salsbury SA, et al. The World Federation of Chiropractic Global Patient Safety Task Force: a call to action. Chiropr Man Therap. 2024;32(1):15. doi:10…

9715. Creating a safer health care system: finding the constraint. | PSNet
      psnet.ahrq.gov/issue/creating-safer-health-care-system-finding-constraint
      February 24, 2011 - Commentary Creating a safer health care system: finding the constraint. Citation Text: Pauker SG, Zane EM, Salem D. Creating a safer health care system: finding the constraint. JAMA. 2005;294(22):2906-8. Copy Citation Format: Google Scholar PubMed BibTeX EndNote X3 XML En…

9716. Evaluation of Quality, Safety, and Value in Veterans Health Administration Facilities, FY 2020. | PSNet
      psnet.ahrq.gov/issue/evaluation-quality-safety-and-value-veterans-health-administration-facilities-fy-2020
      September 10, 2014 - Book/Report Evaluation of Quality, Safety, and Value in Veterans Health Administration Facilities, FY 2020. Citation Text: Evaluation of Quality, Safety, and Value in Veterans Health Administration Facilities, FY 2020. Washington, DC: Veterans Affairs Office of Inspector General; August …

9717. Building a framework for trust: critical event analysis of deaths in surgical care. | PSNet
      psnet.ahrq.gov/issue/building-framework-trust-critical-event-analysis-deaths-surgical-care
      June 23, 2009 - Study Building a framework for trust: critical event analysis of deaths in surgical care. Citation Text: Thompson A, Stonebridge PA. Building a framework for trust: critical event analysis of deaths in surgical care. BMJ. 2005;330(7500):1139-42. Copy Citation Format: Goog…

9718. Direct reporting of laboratory test results to patients by mail to enhance patient safety. | PSNet
      psnet.ahrq.gov/issue/direct-reporting-laboratory-test-results-patients-mail-enhance-patient-safety
      February 15, 2011 - Study Direct reporting of laboratory test results to patients by mail to enhance patient safety. Citation Text: Sung S, Forman-Hoffman VL, Wilson MC, et al. Direct reporting of laboratory test results to patients by mail to enhance patient safety. J Gen Intern Med. 2006;21(10):1075-8. …

9719. Medication report reduces number of medication errors when elderly patients are discharged from hospital. | PSNet
      psnet.ahrq.gov/issue/medication-report-reduces-number-medication-errors-when-elderly-patients-are-discharged
      February 04, 2009 - Study Medication report reduces number of medication errors when elderly patients are discharged from hospital. Citation Text: Midlöv P, Holmdahl L, Eriksson T, et al. Medication report reduces number of medication errors when elderly patients are discharged from hospital. Pharm World…

9720. Missing the near miss: recognizing valuable learning opportunities in radiation oncology. | PSNet
      psnet.ahrq.gov/issue/missing-near-miss-recognizing-valuable-learning-opportunities-radiation-oncology
      November 18, 2020 - Study Missing the near miss: recognizing valuable learning opportunities in radiation oncology. Citation Text: Kundu P, Jung OS, Valle LF, et al. Missing the near miss: recognizing valuable learning opportunities in radiation oncology. Pract Radiat Oncol. 2021;11(3):e256-e262. doi:10.101…