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Effective interventions and implementation strategies to reduce adverse drug events in the Veterans Affairs (VA) system. | PSNet

psnet.ahrq.gov/issue/effective-interventions-and-implementation-strategies-reduce-adverse-drug-events-veterans

January 02, 2017 - Study Effective interventions and implementation strategies to reduce adverse drug events in the Veterans Affairs (VA) system. Citation Text: Mills PD, Neily J, Kinney LM, et al. Effective interventions and implementation strategies to reduce adverse drug events in the Veterans Affairs…

Lessons learned in implementing a chronic opioid therapy management system. | PSNet

psnet.ahrq.gov/issue/lessons-learned-implementing-chronic-opioid-therapy-management-system

July 13, 2022 - Study Lessons learned in implementing a chronic opioid therapy management system. Citation Text: Carlile N, Fuller TE, Benneyan JC, et al. Lessons learned in implementing a chronic opioid therapy management system. J Patient Saf. 2022;18(8):e1142-e1149. doi:10.1097/pts.0000000000001039. …

Correlation between hospital finances and quality and safety of patient care. | PSNet

psnet.ahrq.gov/issue/correlation-between-hospital-finances-and-quality-and-safety-patient-care

January 12, 2022 - Study Correlation between hospital finances and quality and safety of patient care. Citation Text: Akinleye DD, McNutt L-A, Lazariu V, et al. Correlation between hospital finances and quality and safety of patient care. PLoS One. 2019;14(8):e0219124. doi:10.1371/journal.pone.0219124. C…

Patient safety, resident well-being and continuity of care with different resident duty schedules in the intensive care unit: a randomized trial. | PSNet

psnet.ahrq.gov/issue/patient-safety-resident-well-being-and-continuity-care-different-resident-duty-schedules

July 23, 2010 - Study Patient safety, resident well-being and continuity of care with different resident duty schedules in the intensive care unit: a randomized trial. Citation Text: Parshuram CS, Amaral ACKB, Ferguson ND, et al. Patient safety, resident well-being and continuity of care with different …

Defining diagnostic error: a scoping review to assess the impact of the National Academies' report Improving Diagnosis in Health Care. | PSNet

psnet.ahrq.gov/issue/defining-diagnostic-error-scoping-review-assess-impact-national-academies-report-improving

March 03, 2021 - Review Defining diagnostic error: a scoping review to assess the impact of the National Academies' report Improving Diagnosis in Health Care. Citation Text: Giardina TD, Hunte H, Hill MA, et al. Defining diagnostic error: a scoping review to assess the impact of the National Academies' r…

We want to know: patient comfort speaking up about breakdowns in care and patient experience. | PSNet

psnet.ahrq.gov/issue/we-want-know-patient-comfort-speaking-about-breakdowns-care-and-patient-experience

May 20, 2020 - Study Emerging Classic We want to know: patient comfort speaking up about breakdowns in care and patient experience. Citation Text: Fisher K, Smith KM, Gallagher TH, et al. We want to know: patient comfort speaking up about breakdowns in care and patient experie…

Intensive care unit nurses' information needs and recommendations for integrated displays to improve nurses' situation awareness. | PSNet

psnet.ahrq.gov/issue/intensive-care-unit-nurses-information-needs-and-recommendations-integrated-displays-improve

March 01, 2011 - Study Intensive care unit nurses' information needs and recommendations for integrated displays to improve nurses' situation awareness. Citation Text: Koch SH, Weir C, Haar M, et al. Intensive care unit nurses' information needs and recommendations for integrated displays to improve nurs…

Critical care teamwork in the future: the role of TeamSTEPPS in the COVID-19 pandemic and implications for the future. | PSNet

psnet.ahrq.gov/issue/critical-care-teamwork-future-role-teamstepps-covid-19-pandemic-and-implications-future

December 14, 2022 - Study Critical care teamwork in the future: the role of TeamSTEPPS in the COVID-19 pandemic and implications for the future. Citation Text: Terregino CA, Jagpal S, Parikh P, et al. Critical Care Teamwork in the Future: The Role of Critical care teamwork in the future: the role of TeamSTE…

When safety event reporting is seen as punitive: "I've been PSN-ed!" | PSNet

psnet.ahrq.gov/issue/when-safety-event-reporting-seen-punitive-ive-been-psn-ed

September 02, 2020 - Study When safety event reporting is seen as punitive: "I've been PSN-ed!" Citation Text: Feeser VR, Jackson AK, Savage NM, et al. When safety event reporting is seen as punitive: "I've been PSN-ed!". Ann Emerg Med. 2021;77(4):449-458. doi:10.1016/j.annemergmed.2020.06.048. Copy Citati…

Preventing catheter-associated bloodstream infections: a survey of policies for insertion and care of central venous catheters from hospitals in the Prevention Epicenter Program. | PSNet

psnet.ahrq.gov/issue/preventing-catheter-associated-bloodstream-infections-survey-policies-insertion-and-care

June 14, 2023 - Study Preventing catheter-associated bloodstream infections: a survey of policies for insertion and care of central venous catheters from hospitals in the Prevention Epicenter Program. Citation Text: Warren DK, Yokoe D, Climo MW, et al. Preventing catheter-associated bloodstream infect…

Safety climate and its association with office type and team involvement in primary care. | PSNet

psnet.ahrq.gov/issue/safety-climate-and-its-association-office-type-and-team-involvement-primary-care

August 08, 2012 - Study Safety climate and its association with office type and team involvement in primary care. Citation Text: Gehring K, Schwappach DLB, Battaglia M, et al. Safety climate and its association with office type and team involvement in primary care. Int J Qual Health Care. 2013;25(4):394-4…

The relationship of self-report of quality to practice size and health information technology. | PSNet

psnet.ahrq.gov/issue/relationship-self-report-quality-practice-size-and-health-information-technology

April 12, 2011 - Study The relationship of self-report of quality to practice size and health information technology. Citation Text: Gorman PN, O'Malley JP, Fagnan LJ. The relationship of self-report of quality to practice size and health information technology. J Am Board Fam Med. 2012;25(5):614-24. do…

Concept and development of a discharge alert filter for abnormal laboratory values coupled with computerized provider order entry: a tool for quality improvement and hospital risk management. | PSNet

psnet.ahrq.gov/issue/concept-and-development-discharge-alert-filter-abnormal-laboratory-values-coupled

June 27, 2018 - Study Concept and development of a discharge alert filter for abnormal laboratory values coupled with computerized provider order entry: a tool for quality improvement and hospital risk management. Citation Text: Mathew G, Kho A, Dexter P, et al. Concept and development of a discharge a…

How safe is prehospital care? A systematic review. | PSNet

psnet.ahrq.gov/issue/how-safe-prehospital-care-systematic-review

February 24, 2021 - Review How safe is prehospital care? A systematic review. Citation Text: O’Connor P, O’malley R, Lambe KA, et al. How safe is prehospital care? A systematic review. Int J Qual Health Care. 2021;33(4):mzab138. doi:10.1093/intqhc/mzab138. Copy Citation Format: DOI Google Scho…

Factors associated with wrong blood in tube errors: an international case series - The BEST collaborative study. | PSNet

psnet.ahrq.gov/issue/factors-associated-wrong-blood-tube-errors-international-case-series-best-collaborative-study

September 29, 2021 - Study Factors associated with wrong blood in tube errors: an international case series - The BEST collaborative study. Citation Text: Dunbar NM, Kaufman RM. Factors associated with wrong blood in tube errors: an international case series – The BEST collaborative study. Transfusion (Paris…

Systematic review of safety checklists for use by medical care teams in acute hospital settings—limited evidence of effectiveness. | PSNet

psnet.ahrq.gov/issue/systematic-review-safety-checklists-use-medical-care-teams-acute-hospital-settings-limited

July 29, 2020 - Review Systematic review of safety checklists for use by medical care teams in acute hospital settings—limited evidence of effectiveness. Citation Text: Ko HCH, Turner TJ, Finnigan MA. Systematic review of safety checklists for use by medical care teams in acute hospital settings--limi…

Processes for identifying and reviewing adverse events and near misses at an academic medical center. | PSNet

psnet.ahrq.gov/issue/processes-identifying-and-reviewing-adverse-events-and-near-misses-academic-medical-center

September 25, 2024 - Study Processes for identifying and reviewing adverse events and near misses at an academic medical center. Citation Text: Martinez W, Lehmann LS, Hu Y-Y, et al. Processes for Identifying and Reviewing Adverse Events and Near Misses at an Academic Medical Center. Jt Comm J Qual Patient S…

Impact of the 2011 ACGME resident duty hour reform on hospital patient experience and processes-of-care. | PSNet

psnet.ahrq.gov/issue/impact-2011-acgme-resident-duty-hour-reform-hospital-patient-experience-and-processes-care

September 07, 2016 - Study Impact of the 2011 ACGME resident duty hour reform on hospital patient experience and processes-of-care. Citation Text: Rajaram R, Saadat L, Chung JW, et al. Impact of the 2011 ACGME resident duty hour reform on hospital patient experience and processes-of-care. BMJ Qual Saf. 2016;…

Videos of simulated after action reviews: a training resource to support social and inclusive learning from patient safety events. | PSNet

psnet.ahrq.gov/issue/videos-simulated-after-action-reviews-training-resource-support-social-and-inclusive-learning

May 22, 2024 - Commentary Videos of simulated after action reviews: a training resource to support social and inclusive learning from patient safety events. Citation Text: McCarthy SE, Hogan C, Jenkins L, et al. Videos of simulated after action reviews: a training resource to support social and inclusi…

Quality improvement initiative to decrease central line-associated bloodstream infections during the COVID-19 pandemic: a "zero harm" approach. | PSNet

psnet.ahrq.gov/issue/quality-improvement-initiative-decrease-central-line-associated-bloodstream-infections-during

November 16, 2022 - Commentary Quality improvement initiative to decrease central line-associated bloodstream infections during the COVID-19 pandemic: a "zero harm" approach. Citation Text: Redstone CS, Zadeh M, Wilson M-A, et al. Quality improvement initiative to decrease central line-associated bloodstrea…

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