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  1. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/43590/psn-pdf
    October 08, 2014 - Disentangling quality and safety indicator data: a longitudinal, comparative study of hand hygiene … Disentangling quality and safety indicator data: a longitudinal, comparative study of hand hygiene compliance … - hand-hygiene This large Australian study sought to examine whether hand hygiene compliance rates … The study revealed that hand hygiene rates across 118 acute hospitals in New South Wales improved from … A previous study from Canada found that increasing overall hand hygiene adherence did not result in
  2. psnet.ahrq.gov/issue/finding-and-preventing-patient-safety-incidents
    October 25, 2013 - : Fifth Annual Patient Safety in American Hospitals Study. … October 25, 2013 HealthGrades Sixth Annual Patient Safety in American Hospitals Study … January 4, 2017 HealthGrades Eighth Annual Patient Safety in American Hospitals Study … Hospitals Study. … Hospitals Study.
  3. psnet.ahrq.gov/issue/review-medication-administration-errors-reported-large-psychiatric-hospital-united-kingdom
    September 27, 2017 - Study A review of medication administration errors reported in a large psychiatric … September 27, 2017 Prescription errors in psychiatry - a multi-centre study. … 20, 2024 Exploring the causes of COPD misdiagnosis in primary care: a mixed methods study … November 9, 2022 Patients who die by suicide: a study of treatment patterns and patient … A qualitative study with nursing staff.
  4. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/44599/psn-pdf
    December 09, 2015 - Association between day of delivery and obstetric outcomes: observational study. … Association between day of delivery and obstetric outcomes: observational study. … https://psnet.ahrq.gov/issue/association-between-day-delivery-and-obstetric-outcomes-observational-study … In this retrospective observational study, investigators examined maternal and neonatal quality measures … This study is consistent with prior work suggesting patient safety vulnerabilities during the weekend
  5. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/44545/psn-pdf
    December 20, 2017 - Work conditions, mental workload and patient care quality: a multisource study in the emergency department … Work conditions, mental workload and patient care quality: a multisource study in the emergency department … https://psnet.ahrq.gov/issue/work-conditions-mental-workload-and-patient-care-quality-multisource-study … This mixed-method study in a medium-sized community emergency department (ED) found that ED personnels … Similar to a prior study by some of the same authors, interruptions were common and associated with
  6. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/36342/psn-pdf
    March 02, 2011 - Missed and delayed diagnoses in the ambulatory setting: a study of closed malpractice claims. … Missed and delayed diagnoses in the ambulatory setting: a study of closed malpractice claims. … https://psnet.ahrq.gov/issue/missed-and-delayed-diagnoses-ambulatory-setting-study-closed-malpractice … This study analyzed data from malpractice claims at four liability insurers, similar to companion studies … https://psnet.ahrq.gov/issue/missed-and-delayed-diagnoses-ambulatory-setting-study-closed-malpractice-claims
  7. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/39144/psn-pdf
    June 09, 2011 - Medication safety in community pharmacy: a qualitative study of the sociotechnical context. … Medication safety in community pharmacy: a qualitative study of the sociotechnical context. … https://psnet.ahrq.gov/issue/medication-safety-community-pharmacy-qualitative-study-sociotechnical- … context This human factors study examined components of the work environment in outpatient pharmacies … https://psnet.ahrq.gov/issue/medication-safety-community-pharmacy-qualitative-study-sociotechnical-context
  8. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/37256/psn-pdf
    July 28, 2010 - Evaluating physician performance at individualizing care: a pilot study tracking contextual errors in … Evaluating physician performance at individualizing care: a pilot study tracking contextual errors in … https://psnet.ahrq.gov/issue/evaluating-physician-performance-individualizing-care-pilot-study-tracking … - contextual-errors This study describes a methodology for measuring physician performance and focuses … https://psnet.ahrq.gov/issue/evaluating-physician-performance-individualizing-care-pilot-study-tracking-contextual-errors
  9. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/40836/psn-pdf
    October 12, 2011 - Exploring varieties of knowledge in safe work practices—an ethnographic study of surgical teams. … Exploring varieties of knowledge in safe work practices - an ethnographic study of surgical teams. … https://psnet.ahrq.gov/issue/exploring-varieties-knowledge-safe-work-practices-ethnographic-study- surgical-teams … This qualitative study used direct observation and in-depth interviews to analyze teamwork practices … https://psnet.ahrq.gov/issue/exploring-varieties-knowledge-safe-work-practices-ethnographic-study-surgical-teams
  10. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/38545/psn-pdf
    April 22, 2009 - Burns surgery handover study: trainees' assessment of current practice in the British Isles. … Burns surgery handover study: trainees' assessment of current practice in the British Isles. … https://psnet.ahrq.gov/issue/burns-surgery-handover-study-trainees-assessment-current-practice-british … - isles This study conducted telephone questionnaires of trainees and discovered several areas for … https://psnet.ahrq.gov/issue/burns-surgery-handover-study-trainees-assessment-current-practice-british-isles
  11. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/34818/psn-pdf
    April 22, 2011 - The Canadian Adverse Events Study: the incidence of adverse events among hospital patients in Canada … The Canadian Adverse Events Study: the incidence of adverse events among hospital patients in Canada … https://psnet.ahrq.gov/issue/canadian-adverse-events-study-incidence-adverse-events-among-hospital- … patients-canada Using methodology originally developed for the Harvard Medical Practice Study, the authors … https://psnet.ahrq.gov/issue/canadian-adverse-events-study-incidence-adverse-events-among-hospital-patients-canada
  12. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/47199/psn-pdf
    October 03, 2018 - Patient safety in palliative care: a mixed-methods study of reports to a national database of serious … Patient safety in palliative care: A mixed-methods study of reports to a national database of serious … https://psnet.ahrq.gov/issue/patient-safety-palliative-care-mixed-methods-study-reports-national-database … In this mixed-methods study, researchers analyzed patient safety incidents among patients receiving … psnet.ahrq.gov/issue/patients-perception-types-errors-palliative-care-results-qualitative-interview-study
  13. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/43013/psn-pdf
    March 12, 2014 - Laboratory test ordering and results management systems: a qualitative study of safety risks identified … Laboratory test ordering and results management systems: a qualitative study of safety risks identified … https://psnet.ahrq.gov/issue/laboratory-test-ordering-and-results-management-systems-qualitative-study … - safety-risks In this qualitative study, outpatient practice administrators identified weaknesses … This study underscores persisting concerns related to test results management, despite longstanding
  14. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/38515/psn-pdf
    March 03, 2011 - Errors in administration of parenteral drugs in intensive care units: multinational prospective study … Errors in administration of parenteral drugs in intensive care units: multinational prospective study … psnet.ahrq.gov/issue/errors-administration-parenteral-drugs-intensive-care-units-multinational- prospective-study … This cross-sectional study, conducted at hospitals in 27 countries, fused voluntary error reports to … psnet.ahrq.gov/issue/errors-administration-parenteral-drugs-intensive-care-units-multinational-prospective-study
  15. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/845074/psn-pdf
    March 02, 2011 - Preventable hospital admissions related to medication (HARM): cost analysis of the HARM study. … Preventable hospital admissions related to medication (HARM): cost analysis of the HARM study. … //psnet.ahrq.gov/issue/preventable-hospital-admissions-related-medication-harm-cost-analysis-harm- study … This study used data from the earlier Hospital Admissions Related to Medication (HARM) study to estimate … https://psnet.ahrq.gov/issue/preventable-hospital-admissions-related-medication-harm-cost-analysis-harm-study
  16. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/37926/psn-pdf
    July 30, 2008 - Adaptive coordination in cardiac anaesthesia: a study of situational changes in coordination patterns … Adaptive coordination in cardiac anaesthesia: a study of situational changes in coordination patterns … https://psnet.ahrq.gov/issue/adaptive-coordination-cardiac-anaesthesia-study-situational-changes- coordination-patterns … This study used direct observation to evaluate how anesthesia teams engaged in teamwork during cardiac … https://psnet.ahrq.gov/issue/adaptive-coordination-cardiac-anaesthesia-study-situational-changes-coordination-patterns
  17. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/35529/psn-pdf
    May 27, 2011 - Case study: identifying potential problems at the human/technical interface in complex clinical systems … Case study: identifying potential problems at the human/technical interface in complex clinical systems … https://psnet.ahrq.gov/issue/case-study-identifying-potential-problems-humantechnical-interface-complex … - clinical-systems The authors present a case study to illustrate system vulnerabilities related to … https://psnet.ahrq.gov/issue/case-study-identifying-potential-problems-humantechnical-interface-complex-clinical-systems
  18. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/39177/psn-pdf
    May 04, 2010 - The impact of organisational and individual factors on team communication in surgery: a qualitative study … The impact of organisational and individual factors on team communication in surgery: a qualitative study … psnet.ahrq.gov/issue/impact-organisational-and-individual-factors-team-communication-surgery- qualitative-study … This qualitative study used interviews with operating room personnel to identify aspects of interpersonal … psnet.ahrq.gov/issue/impact-organisational-and-individual-factors-team-communication-surgery-qualitative-study
  19. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/42760/psn-pdf
    May 29, 2014 - Senior charge nurses' leadership behaviours in relation to hospital ward safety: a mixed method study … Senior charge nurses' leadership behaviours in relation to hospital ward safety: a mixed method study … psnet.ahrq.gov/issue/senior-charge-nurses-leadership-behaviours-relation-hospital-ward-safety- mixed-method-study … This study conducted in the United Kingdom indicates that supportive, safety-oriented behaviors by … psnet.ahrq.gov/issue/senior-charge-nurses-leadership-behaviours-relation-hospital-ward-safety-mixed-method-study
  20. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/38657/psn-pdf
    September 27, 2016 - Medication Administration Time Study (MATS): nursing staff performance of medication administration. … Medication Administration Time Study (MATS): nursing staff performance of medication administration. … https://psnet.ahrq.gov/issue/medication-administration-time-study-mats-nursing-staff-performance- medication-administration … This study analyzed nursing workflow during medication administration and found that the potential … https://psnet.ahrq.gov/issue/medication-administration-time-study-mats-nursing-staff-performance-medication-administration

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