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We will not compete on safety: how children's hospitals have come together to hasten harm reduction. | PSNet

psnet.ahrq.gov/issue/we-will-not-compete-safety-how-childrens-hospitals-have-come-together-hasten-harm-reduction

August 10, 2022 - Study We will not compete on safety: how children's hospitals have come together to hasten harm reduction. Citation Text: Lyren A, Coffey M, Shepherd M, et al. We Will Not Compete on Safety: How Children's Hospitals Have Come Together to Hasten Harm Reduction. Jt Comm J Qual Patient Saf.…

Hospital leadership and quality improvement: rhetoric versus reality. | PSNet

psnet.ahrq.gov/issue/hospital-leadership-and-quality-improvement-rhetoric-versus-reality

May 07, 2014 - Study Hospital leadership and quality improvement: rhetoric versus reality. Citation Text: Levey S, Vaughn T, Koepke M, et al. Hospital Leadership and Quality Improvement. J Patient Saf. 2008;3(1). doi:10.1097/pts.0b013e3180311256. Copy Citation Format: DOI Google Scholar…

The "weekend effect" in pediatric surgery—increased mortality for children undergoing urgent surgery during the weekend. | PSNet

psnet.ahrq.gov/issue/weekend-effect-pediatric-surgery-increased-mortality-children-undergoing-urgent-surgery

February 01, 2012 - Study Classic The "weekend effect" in pediatric surgery—increased mortality for children undergoing urgent surgery during the weekend. Citation Text: Goldstein SD, Papandria DJ, Aboagye J, et al. The "weekend effect" in pediatric surgery - increased mortality fo…

Medication overdoses leading to emergency department visits among children. | PSNet

psnet.ahrq.gov/issue/medication-overdoses-leading-emergency-department-visits-among-children

March 05, 2008 - Study Medication overdoses leading to emergency department visits among children. Citation Text: Schillie SF, Shehab N, Thomas KE, et al. Medication overdoses leading to emergency department visits among children. Am J Prev Med. 2009;37(3):181-7. doi:10.1016/j.amepre.2009.05.018. Cop…

Preventability and causes of readmissions in a national cohort of general medicine patients. | PSNet

psnet.ahrq.gov/issue/preventability-and-causes-readmissions-national-cohort-general-medicine-patients

January 25, 2017 - Study Classic Preventability and causes of readmissions in a national cohort of general medicine patients. Citation Text: Auerbach AD, Kripalani S, Vasilevskis EE, et al. Preventability and Causes of Readmissions in a National Cohort of General Medicine Patients…

Impact of pharmacist-led admission medication reconciliation on patient outcomes in a large health system. | PSNet

psnet.ahrq.gov/issue/impact-pharmacist-led-admission-medication-reconciliation-patient-outcomes-large-health

March 17, 2010 - Study Impact of pharmacist-led admission medication reconciliation on patient outcomes in a large health system. Citation Text: Kramer JS, Hayley Burgess L, Warren C, et al. Impact of pharmacist-led admission medication reconciliation on patient outcomes in a large health system. J Patie…

Sustaining reliability on accountability measures at the Johns Hopkins Hospital. | PSNet

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January 19, 2014 - Study Sustaining reliability on accountability measures at the Johns Hopkins Hospital. Citation Text: Pronovost P, Demski R, Callender T, et al. Demonstrating high reliability on accountability measures at the Johns Hopkins Hospital. Jt Comm J Qual Patient Saf. 2013;39(12):531-544. Cop…

Nature of blame in patient safety incident reports: mixed methods analysis of a national database. | PSNet

psnet.ahrq.gov/issue/nature-blame-patient-safety-incident-reports-mixed-methods-analysis-national-database

October 12, 2016 - Study Nature of blame in patient safety incident reports: mixed methods analysis of a national database. Citation Text: Cooper J, Edwards A, Williams H, et al. Nature of Blame in Patient Safety Incident Reports: Mixed Methods Analysis of a National Database. Ann Fam Med. 2017;15(5):455-4…

US emergency department visits for outpatient adverse drug events, 2013–2014. | PSNet

psnet.ahrq.gov/issue/us-emergency-department-visits-outpatient-adverse-drug-events-2013-2014

February 23, 2018 - Study Classic US emergency department visits for outpatient adverse drug events, 2013–2014. Citation Text: Shehab N, Lovegrove MC, Geller AI, et al. US Emergency Department Visits for Outpatient Adverse Drug Events, 2013-2014. JAMA. 2016;316(20):2115-2125. doi:1…

Hospital-based medication reconciliation practices: a systematic review. | PSNet

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April 05, 2013 - Review Classic Hospital-based medication reconciliation practices: a systematic review. Citation Text: Mueller SK, Sponsler KC, Kripalani S, et al. Hospital-based medication reconciliation practices: a systematic review. Arch Intern Med. 2012;172(14):1057-69. do…

Strategies to prevent missed nursing care: an international qualitative study based upon a positive deviance approach. | PSNet

psnet.ahrq.gov/issue/strategies-prevent-missed-nursing-care-international-qualitative-study-based-upon-positive

May 18, 2022 - Study Strategies to prevent missed nursing care: an international qualitative study based upon a positive deviance approach. Citation Text: Longhini J, Papastavrou E, Efstathiou G, et al. Strategies to prevent missed nursing care: an international qualitative study based upon a positive …

Attending to the emotional well-being of the health care workforce in a New York City health system during the COVID-19 pandemic. | PSNet

psnet.ahrq.gov/issue/attending-emotional-well-being-health-care-workforce-new-york-city-health-system-during-covid

December 23, 2020 - Commentary Emerging Classic Attending to the emotional well-being of the health care workforce in a New York City health system during the COVID-19 pandemic. Citation Text: Ripp JA, Peccoralo L, Charney D. Attending to the emotional well-being of the health care…

A surgical safety checklist to reduce morbidity and mortality in a global population. | PSNet

psnet.ahrq.gov/issue/surgical-safety-checklist-reduce-morbidity-and-mortality-global-population

February 09, 2011 - Study Classic A surgical safety checklist to reduce morbidity and mortality in a global population. Citation Text: Haynes AB, Weiser TG, Berry WR, et al. A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med. 2009;3…

A multi-stakeholder consensus-driven research agenda for better understanding and supporting the emotional impact of harmful events on patients and families. | PSNet

psnet.ahrq.gov/issue/multi-stakeholder-consensus-driven-research-agenda-better-understanding-and-supporting

September 01, 2018 - Commentary A multi-stakeholder consensus-driven research agenda for better understanding and supporting the emotional impact of harmful events on patients and families. Citation Text: Bell SK, Etchegaray J, Gaufberg E, et al. A Multi-Stakeholder Consensus-Driven Research Agenda for Bette…

Eliminating central line-associated bloodstream infections: a national patient safety imperative. | PSNet

psnet.ahrq.gov/issue/eliminating-central-line-associated-bloodstream-infections-national-patient-safety-imperative

March 21, 2012 - Study Eliminating central line-associated bloodstream infections: a national patient safety imperative. Citation Text: Berenholtz SM, Lubomski LH, Weeks K, et al. Eliminating central line-associated bloodstream infections: a national patient safety imperative. Infect Control Hosp Epidem…

A descriptive study of morbidity and mortality conferences and their conformity to medical incident analysis models: results of the morbidity and mortality conference improvement study, phase 1. | PSNet

psnet.ahrq.gov/issue/descriptive-study-morbidity-and-mortality-conferences-and-their-conformity-medical-incident

September 28, 2010 - Study A descriptive study of morbidity and mortality conferences and their conformity to medical incident analysis models: results of the morbidity and mortality conference improvement study, phase 1. Citation Text: Aboumatar HJ, Blackledge CG, Dickson C, et al. A descriptive study of …

Association between workarounds and medication administration errors in bar-code-assisted medication administration in hospitals. | PSNet

psnet.ahrq.gov/issue/association-between-workarounds-and-medication-administration-errors-bar-code-assisted

August 26, 2020 - Study Classic Association between workarounds and medication administration errors in bar-code-assisted medication administration in hospitals. Citation Text: van der Veen W, van den Bemt PMLA, Wouters H, et al. Association between workarounds and medication adm…

Hierarchy and medical error: speaking up when witnessing an error. | PSNet

psnet.ahrq.gov/issue/hierarchy-and-medical-error-speaking-when-witnessing-error

April 14, 2011 - Review Emerging Classic Hierarchy and medical error: speaking up when witnessing an error. Citation Text: Peadon R (R), Hurley J, Hutchinson M. Hierarchy and medical error: speaking up when witnessing an error. Safety Sci. 2020;125:104648. doi:10.1016/j.ssci.202…

Breakdowns in the initial patient-provider encounter are a frequent source of diagnostic error among ischemic stroke cases included in a large medical malpractice claims database. | PSNet

psnet.ahrq.gov/issue/breakdowns-initial-patient-provider-encounter-are-frequent-source-diagnostic-error-among

January 23, 2019 - Review Breakdowns in the initial patient-provider encounter are a frequent source of diagnostic error among ischemic stroke cases included in a large medical malpractice claims database. Citation Text: Liberman AL, Skillings J, Greenberg P, et al. Breakdowns in the initial patient-provid…

Analysis of clinical decision support system malfunctions: a case series and survey. | PSNet

psnet.ahrq.gov/issue/analysis-clinical-decision-support-system-malfunctions-case-series-and-survey

April 29, 2018 - Study Analysis of clinical decision support system malfunctions: a case series and survey. Citation Text: Wright A, Hickman T-TT, McEvoy D, et al. Analysis of clinical decision support system malfunctions: a case series and survey. J Am Med Inform Assoc. 2016;23(6):1068-1076. doi:10.1093…

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