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Public sector organizational failure: a study of collective denial in the UK national health service. | PSNet

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June 03, 2020 - Study Public sector organizational failure: a study of collective denial in the UK national health service. Citation Text: Hendy J, Tucker DA. Public sector organizational failure: a study of collective denial in the UK national health service. J Bus Ethics. 2020;2021;172:691–706. doi:10…

Developing an intervention to reduce harm in hospitalized patients: patients and families in research. | PSNet

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December 21, 2018 - Study Developing an intervention to reduce harm in hospitalized patients: patients and families in research. Citation Text: Schenk EC, Bryant RA, Van Son CR, et al. Developing an Intervention to Reduce Harm in Hospitalized Patients: Patients and Families in Research. J Nurs Care Qual. 20…

Preventing wrong site, procedure, and patient events using a common cause analysis. | PSNet

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October 03, 2017 - Study Preventing wrong site, procedure, and patient events using a common cause analysis. Citation Text: Mallett R, Conroy M, Saslaw LZ, et al. Preventing wrong site, procedure, and patient events using a common cause analysis. Am J Med Qual. 2012;27(1):21-9. doi:10.1177/10628606114120…

The WHO World Alliance for Patient Safety: a new challenge or an old one neglected? | PSNet

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February 14, 2024 - Commentary The WHO World Alliance for Patient Safety: a new challenge or an old one neglected? Citation Text: Edwards R. The WHO World Alliance for Patient Safety: a new challenge or an old one neglected? Drug Saf. 2005;28(5):379-86. Copy Citation Format: Google Scholar P…

Does the concept of safety culture help or hinder systems thinking in safety? | PSNet

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October 12, 2011 - Commentary Does the concept of safety culture help or hinder systems thinking in safety? Citation Text: Reiman T, Rollenhagen C. Does the concept of safety culture help or hinder systems thinking in safety? Accid Anal Prev. 2014;68(July):5-15. doi:10.1016/j.aap.2013.10.033. Copy Citati…

Improving patient safety reporting with the common formats: common data representation for Patient Safety Organizations. | PSNet

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October 19, 2022 - Commentary Improving patient safety reporting with the common formats: common data representation for Patient Safety Organizations. Citation Text: Elkin PL, Johnson HC, Callahan MR, et al. Improving patient safety reporting with the common formats: Common data representation for Patient …

Medication errors in critical care: risk factors, prevention and disclosure. | PSNet

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November 30, 2016 - Review Medication errors in critical care: risk factors, prevention and disclosure. Citation Text: Camiré E, Moyen E, Stelfox HT. Medication errors in critical care: risk factors, prevention and disclosure. CMAJ. 2009;180(9):936-43. doi:10.1503/cmaj.080869. Copy Citation Format: …

Focus on the Quadruple Aim: development of a resiliency center to promote faculty and staff wellness initiatives. | PSNet

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February 10, 2015 - Commentary Focus on the Quadruple Aim: development of a resiliency center to promote faculty and staff wellness initiatives. Citation Text: Morrow E, Call M, Marcus R, et al. Focus on the Quadruple Aim: Development of a Resiliency Center to Promote Faculty and Staff Wellness Initiatives.…

Risk of misdiagnosis and delayed diagnosis with COVID-19: a syndemic approach. | PSNet

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November 04, 2020 - Commentary Risk of misdiagnosis and delayed diagnosis with COVID-19: a syndemic approach. Citation Text: Muhrer JC. Risk of misdiagnosis and delayed diagnosis with COVID-19. Nurs Pract. 2021;46(2):44-49. doi:10.1097/01.npr.0000731572.91985.98. Copy Citation Format: DOI Goo…

Don't go to the hospital alone: ensuring safe, highly reliable patient visitation. | PSNet

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May 12, 2021 - Commentary Don't go to the hospital alone: ensuring safe, highly reliable patient visitation. Citation Text: Gandhi TK. Don't go to the hospital alone: ensuring safe, highly reliable patient visitation. Jt Comm J Qual Patient Saf. 2022;48(1):61-64. doi:10.1016/j.jcjq.2021.10.006. Copy …

The mixed blessings of smart infusion devices and health care IT. | PSNet

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March 13, 2024 - Study The mixed blessings of smart infusion devices and health care IT. Citation Text: Nemeth CP, Brown J, Crandall B, et al. The mixed blessings of smart infusion devices and health care IT. Mil Med. 2014;179(8 Suppl):4-10. doi:10.7205/MILMED-D-13-00505. Copy Citation Format: …

The quality 'journey' at Ascension Health: how we've prevented at least 1,500 avoidable deaths a year—and aim to do even better. | PSNet

psnet.ahrq.gov/issue/quality-journey-ascension-health-how-weve-prevented-least-1500-avoidable-deaths-year-and-aim

June 06, 2018 - Commentary The quality 'journey' at Ascension Health: how we've prevented at least 1,500 avoidable deaths a year—and aim to do even better. Citation Text: Pryor D, Hendrich A, Henkel RJ, et al. The quality 'journey' at Ascension Health: how we've prevented at least 1,500 avoidable deaths…

Operating room traffic as a modifiable risk factor for surgical site infection. | PSNet

psnet.ahrq.gov/issue/operating-room-traffic-modifiable-risk-factor-surgical-site-infection

April 24, 2018 - Study Operating room traffic as a modifiable risk factor for surgical site infection. Citation Text: Wanta BT, Glasgow AE, Habermann EB, et al. Operating Room Traffic as a Modifiable Risk Factor for Surgical Site Infection. Surg Infect (Larchmt). 2016;17(6):755-760. Copy Citation F…

Frontiers in measuring structural racism and its health effects. | PSNet

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April 06, 2022 - Commentary Frontiers in measuring structural racism and its health effects. Citation Text: Brown TH, Homan PA. Frontiers in measuring structural racism and its health effects. Health Serv Res. 2022;57(3):443-447. doi:10.1111/1475-6773.13978. Copy Citation Format: DOI Google…

Safety of patients isolated for infection control. | PSNet

psnet.ahrq.gov/issue/safety-patients-isolated-infection-control

January 15, 2020 - Study Classic Safety of patients isolated for infection control. Citation Text: Stelfox HT, Bates DW, Redelmeier DA. Safety of patients isolated for infection control. JAMA. 2003;290(14):1899-1905. Copy Citation Format: Google Scholar PubMed BibT…

The systems approach at the sharp end. | PSNet

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April 21, 2021 - Commentary The systems approach at the sharp end. Citation Text: Cross SRH. The systems approach at the sharp end. Future Healthc J. 2019;5(3):176-180. doi:10.7861/futurehosp.5-3-176. Copy Citation Format: DOI Google Scholar BibTeX EndNote X3 XML EndNote 7 XML Endnote tagge…

Relationship between psychological safety and reporting nonadherence to a safety checklist. | PSNet

psnet.ahrq.gov/issue/relationship-between-psychological-safety-and-reporting-nonadherence-safety-checklist

April 06, 2022 - Study Relationship between psychological safety and reporting nonadherence to a safety checklist. Citation Text: Gilmartin HM, Langner P, Gokhale M, et al. Relationship Between Psychological Safety and Reporting Nonadherence to a Safety Checklist. J Nurs Care Qual. 2018;33(1):53-60. doi:…

Errors in surgery: a case control study. | PSNet

psnet.ahrq.gov/issue/errors-surgery-case-control-study

May 01, 2024 - Study Errors in surgery: a case control study. Citation Text: Marsh KM, Turrentine FE, Schenk WG, et al. Errors in surgery: a case control study. Ann Surg. 2022;276(5):e347-e352. doi:10.1097/sla.0000000000005664. Copy Citation Format: DOI Google Scholar BibTeX EndNote X3 XM…

Blueprint for restructuring a department of surgery in concert with the health care system during a pandemic: the University of Wisconsin Experience. | PSNet

psnet.ahrq.gov/issue/blueprint-restructuring-department-surgery-concert-health-care-system-during-pandemic

September 27, 2017 - Commentary Blueprint for restructuring a department of surgery in concert with the health care system during a pandemic: the University of Wisconsin Experience. Citation Text: Zarzaur BL, Stahl CC, Greenberg JA, et al. Blueprint for restructuring a department of surgery in concert with t…

Electronic health record use issues and diagnostic error: a scoping review and framework. | PSNet

psnet.ahrq.gov/issue/electronic-health-record-use-issues-and-diagnostic-error-scoping-review-and-framework

September 14, 2011 - Review Electronic health record use issues and diagnostic error: a scoping review and framework. Citation Text: Dixit RA, Boxley CL, Samuel S, et al. Electronic health record use issues and diagnostic error: a scoping review and framework. J Patient Saf. 2023;19(1):e25-e30. doi:10.1097/p…

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