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461. Lost surgical specimens, lost opportunities. | PSNet
     psnet.ahrq.gov/issue/lost-surgical-specimens-lost-opportunities
     April 16, 2018 - November 28, 2018 Patient Safety Authority Annual Reports. … Analysis of incident reports from a patient safety organization. … February 15, 2010 Classifying laboratory incident reports to identify problems that jeopardize

462. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/34001/psn-pdf
     April 16, 2018 - The PA-PRS releases annual reports summarizing incidents and serious safety events.  … psnet.ahrq.gov/issue/patient-safety-authority https://psnet.ahrq.gov/issue/patient-safety-authority-annual-reports

463. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/43434/psn-pdf
     August 06, 2014 - issue/maryland-hospitals-arent-reporting-all-errors-and-complications-experts-say This news article reports … Limited public access to comprehensive incident reports and insufficient performance measurement hinder … maryland-hospitals-arent-reporting-all-errors-and-complications-experts-say https://psnet.ahrq.gov/issue/maryland-hospital-patient-safety-program-annual-report

464. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/39522/psn-pdf
     May 12, 2010 - /reporting-trends-regional-medication-error-data-sharing-system Sharing voluntary medication error reports … Pennsylvania hospitals resulted in increased reporting rates, but it was unclear if the increase in reports

465. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/39902/psn-pdf
     December 29, 2014 - psnet.ahrq.gov/issue/clinical-handover-incident-reporting-one-uk-general-hospital Analysis of incident reports … revealed a lower than expected number of reports involving handoffs, most of which did not result in

466. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/39863/psn-pdf
     January 04, 2011 - improving-quality-drug-error-reporting This analysis of voluntarily reported medication errors found that the reports … error theory, to improve reporting systems to enhance the ease of reporting and the quality of error reports

467. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/44480/psn-pdf
     October 14, 2015 - Improving radiology report quality by rapidly notifying radiologist of report errors. … Improving Radiology Report Quality by Rapidly Notifying Radiologist of Report Errors. … https://psnet.ahrq.gov/issue/improving-radiology-report-quality-rapidly-notifying-radiologist-report-errors … In this study, researchers designed an algorithm for flagging radiology reports that may contain gender … https://psnet.ahrq.gov/issue/errare-humanum-est-frequency-laterality-errors-radiology-reports

468. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/45047/psn-pdf
     April 13, 2016 - https://psnet.ahrq.gov/issue/misdiagnosis-inevitable This news article reports on the prevalence of … frequency-diagnostic-errors-outpatient-care-estimations-three-large-observational-studies https://psnet.ahrq.gov/issue/root-cause-analysis-reports-help-identify-common-factors-delayed-diagnosis-and-treatment

469. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/41538/psn-pdf
     August 15, 2012 - Consumer reports. 2012;77(8):20-8. … psnet.ahrq.gov/issue/how-safe-your-hospital-our-new-ratings-find-some-are-riskier-others This news article reports

470. State-Wide Initiative to Standardize the Compounding of Oral Liquids in Pediatrics. | PSNet
     psnet.ahrq.gov/issue/state-wide-initiative-standardize-compounding-oral-liquids-pediatrics
     January 23, 2017 - January 23, 2017 Communicating certainty in pathology reports: interpretation differences … May 13, 2024 MHA and MHA Keystone Center Annual Reports. … View More Related Resources National Healthcare Quality and Disparities Reports

471. Prohibition of Excessive Overtime for Nurses Act. | PSNet
     psnet.ahrq.gov/issue/prohibition-excessive-overtime-nurses-act
     August 01, 2007 - Safety events impacting hospitalized patients following motor vehicle crashes: a qualitative study of reports … View More Related Resources Adverse Health Events in Minnesota: Annual Reports … June 4, 2024 Patient Safety Authority Annual Reports.

472. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/44442/psn-pdf
     August 26, 2015 - August 26, 2015 Consumer Reports. July 29, 2015. … https://psnet.ahrq.gov/issue/how-your-hospital-can-make-you-sick This news article reports on health

473. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/44300/psn-pdf
     July 29, 2015 - Learning From Serious Failings in Care: Main Report. … July 29, 2015 Short-Life Working Group on Hospital Reports. … https://psnet.ahrq.gov/issue/learning-serious-failings-care-main-report Substantive reports of failures … https://psnet.ahrq.gov/issue/learning-serious-failings-care-main-report https://psnet.ahrq.gov/issue/ … report-mid-staffordshire-nhs-foundation-trust-public-inquiry https://psnet.ahrq.gov/issue/after-mid-staffordshire-acknowledgement-through-learning-improvement

474. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/44636/psn-pdf
     November 04, 2015 - This news article discusses bedside shift reports as a strategy to improve communication among nursing … bedside-shift-shift-handoffs-systematic-review-literature https://psnet.ahrq.gov/issue/making-transition-nursing-bedside-shift-reports

475. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/46628/psn-pdf
     December 18, 2017 - patient-feedback-reporting-tool-opennotes-implications-patient-clinician-safety-and-quality https://psnet.ahrq.gov/issue/confidential-physician-feedback-reports-designing-optimal-impact-performance … https://psnet.ahrq.gov/issue/confidential-physician-feedback-reports-designing-optimal-impact-performance

476. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/45581/psn-pdf
     October 19, 2016 - This news article reports how health systems, academic medical centers, and ambulatory care facilities … diagnostic-performance-medical-students-working-individually-or-teams https://psnet.ahrq.gov/issue/using-voluntary-reports-physicians-learn-diagnostic-errors-emergency-medicine

477. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/39349/psn-pdf
     March 23, 2011 - improvement efforts are often guided by error data that are gathered retrospectively (e.g., incident reports … This study reports on a collaborative process used to prospectively identify safety hazards and improvement

478. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/38387/psn-pdf
     February 04, 2009 - Obstetrician-gynecologists' opinions about patient safety: costs and liability remain problems; are mandated reports … Obstetrician-gynecologists' opinions about patient safety: costs and liability remain problems; are mandated reports

479. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/38307/psn-pdf
     January 07, 2009 - national observational study based on retrospective analysis of 12 months of patient safety incident reports … national observational study based on retrospective analysis of 12 months of patient safety incident reports

480. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/38261/psn-pdf
     December 03, 2008 - systematic-assessment-culture-review-tool-assess-errors-clinical-microbiology- laboratory This study discovered that errors from positive culture reports … The authors suggest that careful review of such reports could prevent clinical laboratory errors.