-
psnet.ahrq.gov/issue/crew-resource-management-intensive-care-unit-prospective-3-year-cohort-study
August 10, 2022 - August 10, 2016
Impact of interactions between drugs and laboratory test results on diagnostic … test interpretation—a systematic review. … November 21, 2018
Diagnostic error as a result of drug-laboratory test interactions.
-
psnet.ahrq.gov/issue/getting-it-right-patient-safety-specimen-collection-process-improvement-operating-room
July 16, 2013 - November 13, 2024
The delivery of safe and effective test result communication, management … Related Resources
Implementing a safer and more reliable system to monitor test … November 1, 2023
Interventions to improve follow-up of laboratory test results pending … , 2013
Frequency of failure to inform patients of clinically significant outpatient test
-
psnet.ahrq.gov/node/49871/psn-pdf
August 10, 2019 - berated for not having obtained what the physician assistant stated was an
important and essential test … Perhaps a creatinine test was ordered
but not done by the patient because of an accompanying unwanted … PSA test. … A PSA test is often ordered in this clinical situation but should not be performed without discussing … However, if a PSA test is done for BPH management and the result is elevated, a
https://psnet.ahrq.gov
-
psnet.ahrq.gov/issue/work-observation-study-nuclear-medicine-technologists-interruptions-resilience-and
May 25, 2011 - August 26, 2020
Data quality associated with handwritten laboratory test requests: classification … November 18, 2015
The delivery of safe and effective test result communication, management … September 27, 2023
Variation in electronic test results management and its implications … 2016
The impact of health information technology on the management and follow-up of test
-
psnet.ahrq.gov/node/40800/psn-pdf
December 09, 2014 - complaints and
adherence to recommendations), office tempo (including the availability of clinicians and test … /psnet.ahrq.gov/primer/patient-engagement-and-safety
https://psnet.ahrq.gov/issue/i-wish-i-had-seen-test-result-earlier-dissatisfaction-test-result-management-systems-primary
-
psnet.ahrq.gov/issue/safety-criterion-quality-critical-nursing-situation-index-paediatric-critical-care
March 01, 2011 - September 20, 2011
Impact of interactions between drugs and laboratory test results on … diagnostic test interpretation—a systematic review. … November 21, 2018
Diagnostic error as a result of drug-laboratory test interactions. … September 19, 2016
Clinical decision support improves the appropriateness of laboratory test
-
psnet.ahrq.gov/issue/safety-huddles-proactively-identify-and-address-electronic-health-record-safety
January 23, 2019 - October 26, 2011
Workarounds and test results follow-up in electronic health record–based … August 20, 2014
Electronic detection of delayed test result follow-up in patients with … March 19, 2018
Patient perceptions of receiving test results via online portals: a mixed-methods … April 12, 2019
How context affects electronic health record–based test result follow-up
-
psnet.ahrq.gov/node/49786/psn-pdf
March 01, 2017 - Describe why the likelihood of disease in a particular patient affects the interpretation of diagnostic
test … The overordering of the troponin test is exacerbated by the fear of missing
myocardial infarction (MI … "(7)
This problem with false positive test results can be demonstrated using a simple example. … In general, physicians perform poorly at such test interpretation. … Here we see how one inappropriately ordered test led to a
chain of overuse.
-
psnet.ahrq.gov/node/49612/psn-pdf
November 01, 2010 - Patient safety concerns arising from test results that return after
hospital discharge. … : dissatisfaction with test result management systems in primary care. … Communicating critical test results: safe practice
recommendations. … Frequency of failure to inform patients of clinically significant
outpatient test results. … Management of test results in family medicine offices.
Ann Fam Med. 2009;7:343-351.
-
psnet.ahrq.gov/issue/analysis-electronic-health-record-related-patient-safety-concerns
January 21, 2019 - 2021
Application of human factors methods to understand missed follow-up of abnormal test … November 11, 2020
Graphical display of diagnostic test results in electronic health records … July 16, 2015
How context affects electronic health record–based test result follow-up … January 19, 2012
Notification of abnormal lab test results in an electronic medical record
-
psnet.ahrq.gov/issue/electronic-triggers-identify-delays-follow-mammography-harnessing-power-big-data-health-care
September 28, 2016 - September 28, 2016
Electronic detection of delayed test result follow-up in patients … June 21, 2023
Workarounds and test results follow-up in electronic health record–based … 2016
Application of human factors methods to understand missed follow-up of abnormal test … June 13, 2012
Notification of abnormal lab test results in an electronic medical record
-
psnet.ahrq.gov/node/40628/psn-pdf
July 20, 2011 - issue/entire-upmc-transplant-team-missed-hepatitis-alert
This newspaper article reports how a missed test … entire-upmc-transplant-team-missed-hepatitis-alert
https://psnet.ahrq.gov/issue/notification-abnormal-lab-test-results-electronic-medical-record-do-any-safety-concerns
-
psnet.ahrq.gov/node/38992/psn-pdf
April 16, 2018 - safe-patient-outcomes-occur-timely-standardized-communication-critical-
values
This article reports on failures surrounding critical test … safe-patient-outcomes-occur-timely-standardized-communication-critical-values
https://psnet.ahrq.gov/issue/communicating-critical-test-results
-
psnet.ahrq.gov/issue/liquid-based-papanicolaou-tests-endometrial-carcinoma-diagnosis-performance-error-root-cause
September 01, 2012 - View More
Related Resources
The delivery of safe and effective test … 2022
Application of human factors methods to understand missed follow-up of abnormal test … March 28, 2012
Direct reporting of laboratory test results to patients by mail to enhance
-
psnet.ahrq.gov/node/35298/psn-pdf
August 08, 2018 - safety-still-compromised-computer-weaknesses
The Institute for Safe Medication Practices (ISMP) reports on a 2005 field test … The results show no improvement in
such systems since the last field test in 1999.
-
psnet.ahrq.gov/web-mm/premature-extubation
May 25, 2011 - While on rounds, the intensivist planned to ask the respiratory therapist to test for a cuff leak prior … However, no formal order for a cuff leak test was placed. … place an order for cuff leak and had assumed that the respiratory therapist would know to perform the test … Thus, it is unknown if 30 minutes is an adequate test for patients who have failed their first SBT or … Cuff-leak test for predicting postextubation airway complications: a systematic review.
-
psnet.ahrq.gov/node/49647/psn-pdf
February 01, 2012 - review, it was determined that the nature of this error centered upon the communication of an
amended test … Often the resident who ordered the original
test is no longer in the hospital. … Several groups have developed best practice guidelines for communicating critical test results (Figure … Communicating critical test results: safe practice
recommendations. … Communicating critical test
results: safe practice recommendations.
-
psnet.ahrq.gov/issue/comprehensive-overview-medical-error-hospitals-using-incident-reporting-systems-patient
October 16, 2013 - October 17, 2018
Impact of interactions between drugs and laboratory test results on … diagnostic test interpretation—a systematic review. … November 21, 2018
Diagnostic error as a result of drug-laboratory test interactions. … The Patient-Reported Incident in Hospital Instrument (PRIH-I): assessments of data quality, test–retest
-
psnet.ahrq.gov/node/42617/psn-pdf
January 24, 2018 - improving-your-office-testing-process-step-step-guide-rapid-cycle-patient-safety-and-quality
https://psnet.ahrq.gov/issue/timely-follow-abnormal-diagnostic-imaging-test-results-outpatient-setting-are-electronic … https://psnet.ahrq.gov/issue/timely-follow-abnormal-diagnostic-imaging-test-results-outpatient-setting-are-electronic
-
psnet.ahrq.gov/node/49680/psn-pdf
March 01, 2013 - Preanalytic phase: clinician test selection, test ordering, specimen procurement, patient and
specimen … Postanalytic phase: receipt of the test results by the clinician followed by clinician interpretation … of
the test results, and clinical action based on that interpretation. … Active errors include heuristic biases related to diagnostic decision making and ancillary test
ordering … and pertinent clinical information, procuring high-quality
specimens, providing timely follow-up on test