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psnet.ahrq.gov/node/35611/psn-pdf
June 23, 2010 - Error or "act of God"? A study of patients' and operating
room team members' perceptions of error definition,
reporting, and disclosure.
June 23, 2010
Espin S, Levinson W, Regehr G, et al. Error or "act of God"? A study of patients' and operating room team
members' perceptions of error definition, reporting, and d…
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psnet.ahrq.gov/node/39655/psn-pdf
July 07, 2010 - Errors of diagnosis in pediatric practice: a multisite
survey.
July 7, 2010
Singh H, Thomas EJ, Wilson L, et al. Errors of diagnosis in pediatric practice: a multisite survey. Pediatrics.
2010;126(1):70-9. doi:10.1542/peds.2009-3218.
https://psnet.ahrq.gov/issue/errors-diagnosis-pediatric-practice-multisite-survey…
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psnet.ahrq.gov/node/40548/psn-pdf
March 23, 2012 - Potentially inappropriate medications defined by STOPP
criteria and the risk of adverse drug events in older
hospitalized patients.
March 23, 2012
Hamilton H, Gallagher P, Ryan C, et al. Potentially inappropriate medications defined by STOPP criteria
and the risk of adverse drug events in older hospitalized patien…
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psnet.ahrq.gov/node/40750/psn-pdf
September 07, 2011 - Are temporary staff associated with more severe
emergency department medication errors?
September 7, 2011
Pham JC, Andrawis M, Shore AD, et al. Are temporary staff associated with more severe emergency
department medication errors? J Healthc Qual. 2011;33(4):9-18. doi:10.1111/j.1945-1474.2010.00116.x.
https://psne…
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psnet.ahrq.gov/node/38608/psn-pdf
January 02, 2017 - Using consumer-based kiosk technology to improve and
standardize medication reconciliation in a specialty care
setting.
January 2, 2017
Lesselroth B, Adams S, Felder R, et al. Using consumer-based kiosk technology to improve and
standardize medication reconciliation in a specialty care setting. Jt Comm J Qual Pati…
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psnet.ahrq.gov/node/46892/psn-pdf
June 13, 2018 - AHRQ National Scorecard on Hospital-Acquired
Conditions Updated Baseline Rates and Preliminary
Results 2014–2016.
June 13, 2018
Rockville, MD: Agency for Healthcare Research and Quality; June 2018.
https://psnet.ahrq.gov/issue/ahrq-national-scorecard-hospital-acquired-conditions-updated-baseline-rates-
and-prelim…
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psnet.ahrq.gov/node/43707/psn-pdf
November 26, 2014 - America's Hospitals: Improving Quality and Safety: The
Joint Commission's Annual Report 2014.
November 26, 2014
Oakbrook Terrace, IL: The Joint Commission; November 2014.
https://psnet.ahrq.gov/issue/americas-hospitals-improving-quality-and-safety-joint-commissions-annual-
report-2014
This Joint Commission annual…
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psnet.ahrq.gov/node/46827/psn-pdf
March 14, 2018 - Prevalence and Economic Burden of Medication Errors in
the NHS England.
March 14, 2018
Elliott RA, Camacho E, Campbell F, et al. Policy Research Unit in Economic Evaluation of Health and Care
Interventions. Sheffield, United Kingdom: University of Sheffield and University of York; 2018.
https://psnet.ahrq.gov/issu…
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psnet.ahrq.gov/node/43258/psn-pdf
May 01, 2015 - Interventions employed to improve intrahospital
handover: a systematic review.
May 1, 2015
Robertson ER, Morgan L, Bird S, et al. Interventions employed to improve intrahospital handover: a
systematic review. BMJ Qual Saf. 2014;23(7):600-7. doi:10.1136/bmjqs-2013-002309.
https://psnet.ahrq.gov/issue/interventions-…
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psnet.ahrq.gov/node/45473/psn-pdf
April 24, 2018 - Navigating a ship with a broken compass: evaluating
standard algorithms to measure patient safety.
April 24, 2018
Hefner JL, Huerta T, McAlearney AS, et al. Navigating a ship with a broken compass: evaluating standard
algorithms to measure patient safety. J Am Med Inform Assoc. 2017;24(2):310-315.
doi:10.1093/jami…
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psnet.ahrq.gov/node/36174/psn-pdf
September 29, 2010 - Performance of International Classification of Diseases,
9th Revision, Clinical Modification codes as an adverse
drug event surveillance system.
September 29, 2010
Hougland P, Xu W, Pickard S, et al. Performance of International Classification Of Diseases, 9th Revision,
Clinical Modification codes as an adverse dr…
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psnet.ahrq.gov/primer/patient-engagement-and-safety
August 30, 2023 - Patient Engagement and Safety
Citation Text:
Patient Engagement and Safety. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2019.
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Format:
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psnet.ahrq.gov/node/33841/psn-pdf
September 01, 2017 - It represented
substantial progress when electronic health records began to be organized around the
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psnet.ahrq.gov/node/36364/psn-pdf
February 14, 2017 - National surveillance of emergency department visits for
outpatient adverse drug events.
February 14, 2017
Budnitz DS, Pollock DA, Weidenbach KN, et al. National surveillance of emergency department visits for
outpatient adverse drug events. JAMA. 2006;296(15):1858-66.
https://psnet.ahrq.gov/issue/national-surveil…
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psnet.ahrq.gov/node/37345/psn-pdf
May 26, 2011 - Impact of computerized prescriber order entry on the
incidence of adverse drug events in pediatric inpatients.
May 26, 2011
Holdsworth MT, Fichtl RE, Raisch DW, et al. Impact of computerized prescriber order entry on the
incidence of adverse drug events in pediatric inpatients. Pediatrics. 2007;120(5):1058-66.
htt…
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psnet.ahrq.gov/node/46560/psn-pdf
January 24, 2019 - The hidden cost of regulation: the administrative cost of
reporting serious reportable events.
January 24, 2019
Blanchfield BB, Acharya B, Mort E. The Hidden Cost of Regulation: The Administrative Cost of Reporting
Serious Reportable Events. Jt Comm J Qual Patient Saf. 2018;44(4):212-218.
doi:10.1016/j.jcjq.2017.0…
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psnet.ahrq.gov/node/42154/psn-pdf
January 07, 2015 - Paper- and computer-based workarounds to electronic
health record use at three benchmark institutions.
January 7, 2015
Flanagan ME, Saleem JJ, Millitello LG, et al. Paper- and computer-based workarounds to electronic health
record use at three benchmark institutions. J Am Med Inform Assoc. 2013;20(e1):e59-66.
doi:…
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psnet.ahrq.gov/node/44542/psn-pdf
December 22, 2018 - The prevalence of medical error related to end-of-life
communication in Canadian hospitals: results of a
multicentre observational study.
December 22, 2018
Heyland DK, Ilan R, Jiang X, et al. The prevalence of medical error related to end-of-life communication in
Canadian hospitals: results of a multicentre observ…
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psnet.ahrq.gov/node/39777/psn-pdf
November 04, 2012 - The Economic Measurement of Medical Errors.
November 4, 2012
Shreve J, van Den Bos J, Gray T, Halford M, Rustagi K, Ziemkiewicz E. Schaumburg, IL: The Society of
Actuaries; 2010.
https://psnet.ahrq.gov/issue/economic-measurement-medical-errors
Although the Institute of Medicine's estimate of up to 98,000 deaths ye…
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psnet.ahrq.gov/node/46435/psn-pdf
August 20, 2018 - Patients' experiences with communication-and-resolution
programs after medical injury.
August 20, 2018
Moore J, Bismark M, Mello MM. Patients' Experiences With Communication-and-Resolution Programs After
Medical Injury. JAMA Intern Med. 2017;177(11):1595-1603. doi:10.1001/jamainternmed.2017.4002.
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