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psnet.ahrq.gov/issue/impact-computerized-physician-order-entry-system
October 19, 2022 - Study
Impact of a computerized physician order-entry system. … Impact of a computerized physician order-entry system. … Implementation of a computerized provider order entry system improved efficiency but did not yield … Impact of a computerized physician order-entry system. … September 5, 2018
The impact of a computerized physician order entry system on medical
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psnet.ahrq.gov/issue/developing-and-evaluating-trigger-response-system
August 29, 2018 - Study
Developing and evaluating a trigger response system. … Developing and Evaluating a Trigger Response System. … This article discusses how one hospital developed, tested, and refined the activation system for its … Developing and Evaluating a Trigger Response System. … February 3, 2011
A 5-year analysis of rapid response system activation at an in-hospital
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psnet.ahrq.gov/issue/review-australian-incident-monitoring-system
July 23, 2008 - Study
Review of the Australian Incident Monitoring System. … Review of the Australian incident monitoring system. ANZ J Surg. 2005;75(8):657-61. … The authors surveyed users of the Australian Incident Monitoring System (AIMS) to determine its value … Review of the Australian incident monitoring system. ANZ J Surg. 2005;75(8):657-61. … Optimization of drug–drug interaction alert rules in a pediatric hospital's electronic health record system
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psnet.ahrq.gov/issue/national-costs-medical-liability-system
May 20, 2015 - Study
Classic
National costs of the medical liability system … National costs of the medical liability system. … billion, or 2.4% of total health care spending, attributed to the many highlighted elements of liability system … National costs of the medical liability system. … prescribing and patient pain in opioid-naive patients undergoing elective surgery in a large American health system
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psnet.ahrq.gov/issue/quest-ideal-redesign-medication-use-system
September 16, 2020 - Commentary
Quest for the ideal: a redesign of the medication use system. … Quest for the ideal: a redesign of the medication use system. J Nurs Care Qual. 2007;22(1):11-19. … describe the interdisciplinary planning and redesign of their hospital's medication administration system … Quest for the ideal: a redesign of the medication use system. … September 16, 2020
Fall prevention with the Smart Socks System reduces hospital fall
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psnet.ahrq.gov/issue/implementing-bar-code-medication-administration-system
May 11, 2014 - Commentary
Implementing a bar-code medication administration system. … Implementing a Bar-Code Medication Administration System. … commentary discusses a single hospital’s experience in implementing a bar-code medication administration system … Implementing a Bar-Code Medication Administration System.
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psnet.ahrq.gov/primer/systems-approach
June 15, 2024 - Instead, most accidents result from multiple, smaller errors in environments with serious underlying system … Reason used the terms active errors and latent errors to distinguish individual from system errors … involve frontline personnel and occur at the point of contact between a human and some aspect of a larger system … The blunt end refers to the many layers of the health care system not in direct contact with patients … revising how systems of care work, how protocols are designed, and how individuals interact with the system
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psnet.ahrq.gov/issue/detecting-patient-deterioration-using-artificial-intelligence-rapid-response-system
October 21, 2020 - Classic
Detecting patient deterioration using artificial intelligence in a rapid response system … Detecting patient deterioration using artificial intelligence in a rapid response system. … This study compared an artificial intelligence (AI)-based early warning system using machine learning … Detecting patient deterioration using artificial intelligence in a rapid response system. … rapid response system.
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psnet.ahrq.gov/issue/pharmacist-led-admission-medication-reconciliation-and-after-implementation-electronic
January 15, 2025 - medication reconciliation before and after the implementation of an electronic medication management system … medication reconciliation before and after the implementation of an electronic medication management system … Implementation of an electronic medication management system at an Australian hospital was associated … also more likely to receive formal medication reconciliation after implementation of the electronic system … June 14, 2019
Enabling a learning healthcare system with automated computer protocols
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psnet.ahrq.gov/issue/implementing-computerized-provider-order-entry-existing-clinical-information-system
October 19, 2022 - Implementing computerized provider order entry with an existing clinical information system … Implementing computerized provider order entry with an existing clinical information system. … In this study, a CPOE system was integrated within an existing clinical information system at an academic … Another study of successful implementation of a different CPOE system also demonstrated the importance … Implementing computerized provider order entry with an existing clinical information system.
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psnet.ahrq.gov/issue/effects-adverse-drug-event-alert-system-cost-and-quality-outcomes-community-hospitals
February 17, 2021 - Study
Effects of an adverse-drug-event alert system on cost and quality outcomes … Effects of an adverse-drug-event alert system on cost and quality outcomes in community hospitals. … This retrospective observational study evaluated the impact of an ADE alert system in seven community … hospitals; two network hospitals that did not implement the system served as controls. … Effects of an adverse-drug-event alert system on cost and quality outcomes in community hospitals.
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psnet.ahrq.gov/issue/simulation-based-adverse-event-reporting-system-development-and-feasibility
July 08, 2020 - Study
Simulation based adverse event reporting system: development and feasibility … Simulation Based Adverse Event Reporting System: Development and Feasibility. … This study introduced an online adverse event reporting system into simulation training for nursing … Simulation Based Adverse Event Reporting System: Development and Feasibility. … December 15, 2014
Health system redesign of cardiac monitoring oversight to optimize
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psnet.ahrq.gov/issue/how-americas-health-care-system-fails-women-pain
November 01, 2023 - Newspaper/Magazine Article
How America’s health care system fails women in pain. … How America’s health care system fails women in pain. The Hill. … This two-part story discusses system and biological factors that affect pain treatment for women and … How America’s health care system fails women in pain. The Hill. … Situation awareness errors in anesthesia and critical care in 200 cases of a critical incident reporting system
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psnet.ahrq.gov/issue/accuracy-adverse-drug-event-reports-collected-using-automated-dispensing-system
April 06, 2022 - Accuracy of adverse-drug-event reports collected using an automated dispensing system … Accuracy of adverse-drug-event reports collected using an automated dispensing system. … The authors evaluated the effectiveness and accuracy of using an automated dispensing system to report … They found that the automated system was successful in increasing reporting of ADEs. … Accuracy of adverse-drug-event reports collected using an automated dispensing system.
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psnet.ahrq.gov/issue/national-reporting-and-learning-system-research-and-development
April 06, 2016 - Book/Report
National Reporting and Learning System Research and Development. … Citation Text:
National Reporting and Learning System Research and Development. … Incident reporting has achieved varying levels of success in encouraging transparency and facilitating system … reporting initiatives in the National Health Service and focuses on the importance of considering system … Cite
Citation
Citation Text:
National Reporting and Learning System
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psnet.ahrq.gov/issue/risk-society-and-system-failure
November 29, 2023 - Commentary
Risk, society and system failure. … Risk, society and system failure. … Risk, society and system failure.
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psnet.ahrq.gov/issue/risks-patient-safety-health-system-expansions
May 13, 2020 - Emerging Classic
The risks to patient safety from health system … The Risks to Patient Safety From Health System Expansions. … This commentary explored how system expansion affects safety. … The authors highlight the need for leadership to use system data to plan for and manage the impact … The Risks to Patient Safety From Health System Expansions.
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psnet.ahrq.gov/curated-library/artificial-intelligence-system-level-considerations
March 27, 2024 - The PSNet Collection
Curated Libraries
Subscribed
Artificial Intelligence: System-Level … 2025
Description
This curated library explores overarching components that inform system-level … Through interviews with health system executives, clinicians, and artificial intelligence (AI) experts
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psnet.ahrq.gov/innovation/algorithm-based-decision-support-system-guides-trauma-staff-during-initial-treatment
May 31, 2023 - Algorithm-Based Decision Support System Guides Trauma Staff During Initial Treatment, Leading to Fewer … System implementation led to the hiring of two critical care nursing project officers. … Device integration: The system connects to the hospital's Cerner computer system, thus making it easier … Electronic patient file: All information entered into the system is integrated via the TR&R® system … System implementation led to the hiring of two critical care nursing project officers.
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psnet.ahrq.gov/issue/misdiagnosis-emergency-department-time-system-solution
March 25, 2020 - Commentary
Misdiagnosis in the emergency department: time for a system solution. … Misdiagnosis in the emergency department: time for a system solution. … Medical errors should be examined in the context of system failure to generate lasting opportunities … suggests a focus on care delivery processes over individuals, definitions, error rate review, and system … Misdiagnosis in the emergency department: time for a system solution.