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psnet.ahrq.gov/node/38199/psn-pdf
March 03, 2011 - Patient safety indicators for England from hospital
administrative data: case-control analysis and
comparison with US data.
March 3, 2011
Raleigh VS, Cooper J, Bremner SA, et al. Patient safety indicators for England from hospital administrative
data: case-control analysis and comparison with US data. BMJ. 2008;33…
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psnet.ahrq.gov/node/37453/psn-pdf
March 03, 2011 - Managing the prevention of retained surgical instruments:
what is the value of counting?
March 3, 2011
Egorova NN, Moskowitz A, Gelijns A, et al. Managing the prevention of retained surgical instruments: what
is the value of counting? Ann Surg. 2008;247(1):13-8.
https://psnet.ahrq.gov/issue/managing-prevention-ret…
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psnet.ahrq.gov/print/pdf/node/845971
January 01, 2024 - Value assessment of deprescribing interventions: suggestions for improvement. … safety-preservation-value
https://psnet.ahrq.gov/issue/value-assessment-deprescribing-interventions-suggestions-improvement
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psnet.ahrq.gov/node/40600/psn-pdf
September 09, 2011 - To make or buy patient safety solutions: a resource
dependence and transaction cost economics perspective.
September 9, 2011
Fareed N, Mick SS. To make or buy patient safety solutions: a resource dependence and transaction cost
economics perspective. Health Care Manage Rev. 2011;36(4):288-298.
doi:10.1097/HMR.0b01…
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psnet.ahrq.gov/node/46904/psn-pdf
August 20, 2018 - Effect of a pediatric early warning system on all-cause
mortality in hospitalized pediatric patients.
August 20, 2018
Parshuram CS, Dryden-Palmer K, Farrell C, et al. Effect of a Pediatric Early Warning System on All-Cause
Mortality in Hospitalized Pediatric Patients: The EPOCH Randomized Clinical Trial. JAMA.
201…
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psnet.ahrq.gov/node/44302/psn-pdf
August 04, 2015 - The Global Comparators project: international
comparison of 30-day in-hospital mortality by day of the
week.
August 4, 2015
Ruiz M, Bottle A, Aylin PP. The Global Comparators project: international comparison of 30-day in-hospital
mortality by day of the week. BMJ Qual Saf. 2015;24(8):492-504. doi:10.1136/bmjqs-20…
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psnet.ahrq.gov/node/36013/psn-pdf
September 22, 2010 - A new safety event reporting system improves physician
reporting in the surgical intensive care unit.
September 22, 2010
Schuerer DJE, Nast PA, Harris CB, et al. A new safety event reporting system improves physician reporting
in the surgical intensive care unit. J Am Coll Surg. 2006;202(6):881-887.
https://psnet.…
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psnet.ahrq.gov/periodic-issue/periodic-issue-298
June 30, 2021 - anesthetist suggested use of video-laryngoscopy equipment, but the attending anesthesiologist rejected the suggestion
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psnet.ahrq.gov/node/43969/psn-pdf
November 17, 2017 - Transparency when things go wrong: physician attitudes
about reporting medical errors to patients, peers, and
institutions.
November 17, 2017
Bell SK, White AA, Yi JC, et al. Transparency When Things Go Wrong. J Patient Saf. 2015;13(4):243-248.
doi:10.1097/pts.0000000000000153.
https://psnet.ahrq.gov/issue/transp…
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psnet.ahrq.gov/node/45314/psn-pdf
September 01, 2018 - The "Seven Pillars" response to patient safety incidents:
effects on medical liability processes and outcomes.
September 1, 2018
Lambert BL, Centomani NM, Smith KM, et al. The "Seven Pillars" Response to Patient Safety Incidents:
Effects on Medical Liability Processes and Outcomes. Health Serv Res. 2016;51(suppl 3)…
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psnet.ahrq.gov/node/44324/psn-pdf
September 09, 2015 - Prevalence, nature, severity and risk factors for
prescribing errors in hospital inpatients: prospective
study in 20 UK hospitals.
September 9, 2015
Ashcroft DM, Lewis PJ, Tully MP, et al. Prevalence, Nature, Severity and Risk Factors for Prescribing
Errors in Hospital Inpatients: Prospective Study in 20 UK Hospit…
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psnet.ahrq.gov/node/45118/psn-pdf
January 23, 2017 - Cluster randomized trial to evaluate the impact of team
training on surgical outcomes.
January 23, 2017
Duclos A, Peix JL, Piriou V, et al. Cluster randomized trial to evaluate the impact of team training on
surgical outcomes. Br J Surg. 2016;103(13):1804-1814. doi:10.1002/bjs.10295.
https://psnet.ahrq.gov/issue/c…
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psnet.ahrq.gov/primer/alert-fatigue
September 07, 2019 - A WebM&M provided several additional suggestions on how to minimize alert fatigue in CPOE systems:
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psnet.ahrq.gov/web-mm/how-do-providers-recover-errors
May 22, 2024 - Residents' suggestions for reducing errors in teaching hospitals. N Engl J Med. 2003;348:851-855.
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psnet.ahrq.gov/periodic-issue/periodic-issue-443
May 29, 2024 - June 5, 2024 Weekly Issue
PSNet highlights the latest patient safety literature, news, and expert commentary, including Weekly
Updates, WebM&M, and Perspectives on Safety. The current issue highlights what's new this week in patient
safety literature, news, conferences, reports, a…
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psnet.ahrq.gov/issue/five-rights-destination-without-map
September 07, 2022 - Newspaper/Magazine Article
The five rights: a destination without a map.
Citation Text:
The five rights: a destination without a map. ISMP Medication Safety Alert! Acute care edition. January 25, 2007.
Copy Citation
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psnet.ahrq.gov/node/49449/psn-pdf
June 01, 2004 - Lethal Vertigo
June 1, 2004
Furman JM. Lethal Vertigo. PSNet [internet]. 2004.
https://psnet.ahrq.gov/web-mm/lethal-vertigo
The Case
A 64-year-old woman, with no prior medical history, complained of sudden onset of severe vertigo and
vomiting, without headache. Her initial blood pressure in the emergency departme…
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psnet.ahrq.gov/periodic-issue/periodic-issue-348
May 16, 2022 - June 29, 2022 Weekly Issue
PSNet highlights the latest patient safety literature, news, and expert commentary, including Weekly
Updates, WebM&M, and Perspectives on Safety. The current issue highlights what's new this week in patient
safety literature, news, conferences, reports, …
-
psnet.ahrq.gov/node/43928/psn-pdf
April 08, 2018 - Missed diagnoses of acute myocardial infarction in the
emergency department: variation by patient and facility
characteristics.
April 8, 2018
Moy E, Barrett M, Coffey R, et al. Missed diagnoses of acute myocardial infarction in the emergency
department: variation by patient and facility characteristics. Diagnosis …
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psnet.ahrq.gov/periodic-issue/periodic-issue-311
September 29, 2021 - This workshop reviewed the evidence base examining challenges in cancer diagnosis, discussed suggestions