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201. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/867226/psn-pdf
     December 04, 2024 - The nature of the response to airway management incident reports in high income countries: a scoping … The nature of the response to airway management incident reports in high income countries: a scoping … https://psnet.ahrq.gov/issue/nature-response-airway-management-incident-reports-high-income-countries … https://psnet.ahrq.gov/issue/nature-response-airway-management-incident-reports-high-income-countries-scoping-review … https://psnet.ahrq.gov/issue/nature-response-airway-management-incident-reports-high-income-countries-scoping-review

202. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/47949/psn-pdf
     July 10, 2019 - Association of coworker reports about unprofessional behavior by surgeons with surgical complications … Association of Coworker Reports About Unprofessional Behavior by Surgeons With Surgical Complications … Investigators sought to determine whether patients whose surgeons had coworker reports of unprofessional … Surgeons at two academic medical centers who had coworker reports of unprofessional behavior in the … These findings highlight the importance of empowering team members to report unprofessional behavior

203. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/60053/psn-pdf
     January 01, 2021 - A review of adverse event reports from emergency departments in the Veterans Health Administration. … A Review of Adverse Event Reports From Emergency Departments in the Veterans Health Administration. … https://psnet.ahrq.gov/issue/review-adverse-event-reports-emergency-departments-veterans-health- administration … This retrospective cohort study used root cause analysis (RCA) to examine safety reports from emergency … https://psnet.ahrq.gov/issue/review-adverse-event-reports-emergency-departments-veterans-health-administration

204. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/60352/psn-pdf
     January 01, 2021 - Stakeholders in safety: patient reports on unsafe clinical behaviors distinguish hospital mortality … Stakeholders in safety: patient reports on unsafe clinical behaviors distinguish hospital mortality … https://psnet.ahrq.gov/issue/stakeholders-safety-patient-reports-unsafe-clinical-behaviors-distinguish … healthcare complaints) may differ from staff-generated information (derived from staff surveys and incident reports … https://psnet.ahrq.gov/issue/stakeholders-safety-patient-reports-unsafe-clinical-behaviors-distinguish-hospital-mortality

205. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/73588/psn-pdf
     August 11, 2021 - Reporting of death in US Food and Drug Administration medical device adverse event reports in categories … Reporting of death in US Food and Drug Administration medical device adverse event reports in categories … psnet.ahrq.gov/issue/reporting-death-us-food-and-drug-administration-medical-device-adverse- event-reports … //psnet.ahrq.gov/issue/reporting-death-us-food-and-drug-administration-medical-device-adverse-event-reports … //psnet.ahrq.gov/issue/reporting-death-us-food-and-drug-administration-medical-device-adverse-event-reports

206. Medication errors involving overrides of healthcare technology. | PSNet
     psnet.ahrq.gov/issue/medication-errors-involving-overrides-healthcare-technology
     January 11, 2017 - This article analyzes reports submitted to the Pennsylvania Patient Safety Authority to determine the … April 17, 2017 Wrong-patient medication errors: an analysis of event reports in Pennsylvania … a Tool for Improving Patient Safety March 29, 2023 ISMP medication error report … safety problems associated with information technology in general practice: an analysis of incident reports

207. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/853431/psn-pdf
     September 13, 2023 - Diagnostic errors in uncommon conditions: a systematic review of case reports of diagnostic errors. … Diagnostic errors in uncommon conditions: a systematic review of case reports of diagnostic errors. … https://psnet.ahrq.gov/issue/diagnostic-errors-uncommon-conditions-systematic-review-case-reports- diagnostic-errors … This article uses 560 case reports to classify contributing factors to diagnostic errors in rare conditions … https://psnet.ahrq.gov/issue/diagnostic-errors-uncommon-conditions-systematic-review-case-reports-diagnostic-errors

208. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/847535/psn-pdf
     April 12, 2023 - Using the Generic Analysis Method to analyze sentinel event reports across hospitals: a retrospective … Using the Generic Analysis Method to analyze sentinel event reports across hospitals: a retrospective … https://psnet.ahrq.gov/issue/using-generic-analysis-method-analyze-sentinel-event-reports-across- hospitals-retrospective … This study pooled sentinel event reports from 28 Dutch hospitals to identify common system-level contributing … https://psnet.ahrq.gov/issue/using-generic-analysis-method-analyze-sentinel-event-reports-across-hospitals-retrospective

209. The frequency of diagnostic errors in radiologic reports depends on the patient's age. | PSNet
     psnet.ahrq.gov/issue/frequency-diagnostic-errors-radiologic-reports-depends-patients-age
     March 09, 2022 - Study The frequency of diagnostic errors in radiologic reports depends on the patient's … The frequency of diagnostic errors in radiologic reports depends on the patient's age. … The frequency of diagnostic errors in radiologic reports depends on the patient's age. … reading of abdominal CT: retrospective analysis of the clinical importance of changes to radiology reports … August 3, 2016 Errare humanum est: frequency of laterality errors in radiology reports

210. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/74109/psn-pdf
     November 24, 2021 - Patient and caregiver factors in ambulatory incident reports: a mixed-methods analysis. … Patient and caregiver factors in ambulatory incident reports: a mixed-methods analysis. … https://psnet.ahrq.gov/issue/patient-and-caregiver-factors-ambulatory-incident-reports-mixed-methods- … This mixed-methods analysis of ambulatory safety reports identified three themes related to patient … https://psnet.ahrq.gov/issue/patient-and-caregiver-factors-ambulatory-incident-reports-mixed-methods-analysis

211. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/74205/psn-pdf
     January 01, 2022 - Communicating certainty in pathology reports: interpretation differences among staff pathologists, … Communicating certainty in pathology reports: interpretation differences among staff pathologists, clinicians … https://psnet.ahrq.gov/issue/communicating-certainty-pathology-reports-interpretation-differences-among … clinician agreement of commonly-used phrases used to describe diagnostic uncertainty in surgical pathology reports … https://psnet.ahrq.gov/issue/communicating-certainty-pathology-reports-interpretation-differences-among-staff-pathologists

212. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/61066/psn-pdf
     October 28, 2020 - Using event reports in real-time to identify and mitigate patient safety concerns during the COVID-19 … Using event reports in real-time to identify and mitigate patient safety concerns during the COVID-19 … https://psnet.ahrq.gov/issue/using-event-reports-real-time-identify-and-mitigate-patient-safety-concerns … https://psnet.ahrq.gov/issue/using-event-reports-real-time-identify-and-mitigate-patient-safety-concerns-during-covid … -19 https://psnet.ahrq.gov/issue/using-event-reports-real-time-identify-and-mitigate-patient-safety-concerns-during-covid

213. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/866908/psn-pdf
     October 09, 2024 - Risk factors for wrong-site surgery: a study of 1,166 reports of informed consent and schedule errors … Risk factors for wrong-site surgery: a study of 1,166 reports of informed consent and schedule errors … https://psnet.ahrq.gov/issue/risk-factors-wrong-site-surgery-study-1166-reports-informed-consent-and- … https://psnet.ahrq.gov/issue/risk-factors-wrong-site-surgery-study-1166-reports-informed-consent-and-schedule-errors … https://psnet.ahrq.gov/issue/risk-factors-wrong-site-surgery-study-1166-reports-informed-consent-and-schedule-errors

214. Hemodialysis bleeding events and deaths: an 18-year retrospective analysis of patient safety and root cause analysis reports in the Veterans Health Administration. | PSNet
     psnet.ahrq.gov/issue/hemodialysis-bleeding-events-and-deaths-18-year-retrospective-analysis-patient-safety-and
     June 23, 2021 - bleeding events and deaths: an 18-year retrospective analysis of patient safety and root cause analysis reports … bleeding events and deaths: an 18-year retrospective analysis of patient safety and root cause analysis reports … bleeding events and deaths: an 18-year retrospective analysis of patient safety and root cause analysis reports … September 29, 2021 A review of adverse event reports from emergency departments in the … January 19, 2011 Errors in ABO labeling of deceased donor kidneys: case reports and approach

215. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/44744/psn-pdf
     June 21, 2016 - Can patient safety incident reports be used to compare hospital safety? … Can Patient Safety Incident Reports Be Used to Compare Hospital Safety? … https://psnet.ahrq.gov/issue/can-patient-safety-incident-reports-be-used-compare-hospital-safety-results … Incident reports provide one lens into patient safety, despite concerns about under-reporting. … Numerous incident reports may indicate either a high number of errors or a robust safety culture that

216. Comparing process- and outcome-oriented approaches to voluntary incident reporting in two hospitals. | PSNet
     psnet.ahrq.gov/issue/comparing-process-and-outcome-oriented-approaches-voluntary-incident-reporting-two-hospitals
     June 15, 2011 - This study categorized more than 2200 incident reports into whether they described aberrant care processes … The authors advocate for hospitals to focus their IR systems on process-driven reports that encourage … January 16, 2008 Contributing factors identified by hospital incident report narratives … March 12, 2014 Semi-supervised classification of patient safety event reports. … January 7, 2009 Contributing factors identified by hospital incident report narratives

217. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/854985/psn-pdf
     November 01, 2023 - A systematic narrative review of coroners’ Prevention of Future Deaths reports (PFDs): a tool for patient … A systematic narrative review of coroners’ Prevention of Future Deaths reports (PFDs): a tool for patient … https://psnet.ahrq.gov/issue/systematic-narrative-review-coroners-prevention-future-deaths-reports-pfds … In the UK, coroners may issue Prevention of Future Death reports (PFD) when they determine taking actions … https://psnet.ahrq.gov/issue/systematic-narrative-review-coroners-prevention-future-deaths-reports-pfds-tool-patient

218. The Orthopaedic Error Index: development and application of a novel national indicator for assessing the relative safety of hospital care using a cross-sectional approach. | PSNet
     psnet.ahrq.gov/issue/orthopaedic-error-index-development-and-application-novel-national-indicator-assessing
     July 18, 2016 - Investigators used reports from the National Reporting and Learning System to develop a tool that identifies … July 18, 2016 Characterising the nature of primary care patient safety incident reports … October 12, 2016 Harms from discharge to primary care: mixed methods analysis of incident reports … September 26, 2018 Nature of blame in patient safety incident reports: mixed methods … care-associated harm amongst vulnerable children in primary care: mixed methods analysis of national safety reports

219. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/48152/psn-pdf
     July 17, 2019 - Safety incident reports associated with blood transfusions. … Safety incident reports associated with blood transfusions. … https://psnet.ahrq.gov/issue/safety-incident-reports-associated-blood-transfusions This analysis of … transfusion-related safety incident reports found that such events were more commonly reported for pediatric … https://psnet.ahrq.gov/issue/safety-incident-reports-associated-blood-transfusions https://psnet.ahrq.gov

220. PReSaFe: A model of barriers and facilitators to patients providing feedback on experiences of safety. | PSNet
     psnet.ahrq.gov/issue/presafe-model-barriers-and-facilitators-patients-providing-feedback-experiences-safety
     January 08, 2020 - Receipt of safety reports from patients and family is an important aspect of patient engagement . … inability to separate safety from overall satisfaction with care, insufficient understanding of how to report … October 5, 2016 Care home safety incidents and safeguarding reports relating to hospital … August 20, 2018 Gross Negligence Manslaughter in Healthcare: The Report of a Rapid Policy … February 8, 2018 Report of the Announced Inspection of Medication Safety at the Midland