Communicating Critical Test Results.

Special or Theme Issue

Communicating Critical Test Results.

March 6, 2005

Schiff GD, Bates DW, Leape LL, eds. Jt Comm J Qual Patient Saf. 2005;31(2):62-119.

View more articles from the same authors.

PubMed citations

Free full text

Related Resources From the Same Author(s)

Ability of practitioners to identify solid oral dosage tablets.

May 24, 2006

Medication safety technologies: what is and is not working.

July 29, 2009

The 2004 John M. Eisenberg Patient Safety and Quality Awards.

March 6, 2005

Reducing Adverse Drug Events.

March 6, 2005

2009 John M. Eisenberg Patient Safety and Quality Awards.

November 25, 2009

Implementing, Studying, and Reporting Health System Improvement in the Era of Electronic Health Records.

June 24, 2020

The 2015 John M. Eisenberg Patient Safety and Quality Awards.

May 25, 2016

Health Care Equity

January 31, 2024

2007 John M. Eisenberg Patient Safety and Quality Awards.

December 12, 2007

The 2016 John M. Eisenberg Patient Safety and Quality Awards.

June 28, 2017

The 2019 John M. Eisenberg Patient Safety and Quality Awards.

July 8, 2020

2018 John M. Eisenberg Patient Safety and Quality Awards.

July 17, 2019

Perioperative Handoffs.

August 2, 2023

American Hospital Association-McKesson Quest for Quality Prize.

October 10, 2007

2012 John M. Eisenberg Patient Safety and Quality Awards.

May 29, 2013

Perspective: a culture of respect—part 1 and part 2.

June 20, 2012

2017 John M. Eisenberg Patient Safety and Quality Awards.

July 18, 2018

Preventable adverse drug events in hospitalized patients: a comparative study of intensive care and general care units.

March 6, 2005

Transparency and public reporting are essential for a safe health care system.

April 7, 2010

American Hospital Association-McKesson Quest for Quality Prize.

October 11, 2006

The 2021 John M. Eisenberg Patient Safety and Quality Awards.

August 3, 2022

Knowledge for Improvement.

April 27, 2011

Patient Safety as an Exercise in Behavioral Change.

October 24, 2012

Risk and Event Assessment.

August 4, 2010

Diagnostic Error: Is Overconfidence the Problem.

May 14, 2008

2008 John M. Eisenberg Patient Safety and Quality Awards.

October 8, 2008

Journal of Patient Safety.

May 11, 2005

2010 John M. Eisenberg Patient Safety and Quality Awards.

May 4, 2011

The 2013 John M. Eisenberg Patient Safety and Quality Awards.

April 30, 2014

2011 John M. Eisenberg Patient Safety and Quality Awards.

June 27, 2012

Improving the Health Care Work Environment.

November 28, 2007

Proceedings from the European Handover Research Collaborative.

December 5, 2012

Patient Safety.

May 24, 2017

Burnout and Resilience and Quality and Safety Programs in Obstetrics and Gynecology.

August 21, 2019

Monitoring the harm associated with use of anticoagulants in pediatric populations through trigger-based automated adverse-event detection.

March 11, 2015

Diagnostic Error in Medicine.

September 25, 2013

Disclosing unanticipated outcomes to patients: the art and practice.

September 12, 2007

Preventing medical injury.

March 27, 2005

Standardized orders for titrating vasopressors: do efforts to improve safety slow delivery of care?

September 11, 2019

Barriers to implementation of patient safety systems in healthcare institutions: leadership and policy implications.

May 11, 2005

2022 John M. Eisenberg Patient Safety and Quality Awards.

August 30, 2023

Child-specific risk factors and patient safety.

May 11, 2005

Development and usability testing of the Agency for Healthcare Research and Quality Common Formats to capture diagnostic safety events.

May 25, 2022

Getting Results: Reliably Communicating and Acting on Critical Test Results.

July 12, 2006

Special Issue on Teamwork.

May 1, 2013

Delivering the right diet to the right patient every time.

June 24, 2015

Cardiovascular drugs: linked to many errors.

July 27, 2005

ASPEN Parenteral Nutrition Safety Summit.

March 21, 2012

Improving Health Care.

March 6, 2005

The 2020 John M. Eisenberg Patient Safety and Quality Awards.

August 4, 2021

A practical guide to Failure Mode and Effects Analysis in health care: making the most of the team and its meetings.

August 4, 2010

The effect of blue-enriched lighting on medical error rate in a university hospital ICU.

January 27, 2021

Spreading a medication administration intervention organizationwide in six hospitals.

February 15, 2012

Development of the ICU safety reporting system.

May 11, 2005

Quality and Safety Education.

August 12, 2009

Pediatric Quality.

September 9, 2009

The Joint Commission's new and revised workplace violence prevention standards for hospitals: a major step forward toward improved quality and safety.

May 4, 2022

Using Human Factors Engineering to Improve Patient Safety, Second edition.

June 29, 2005

Second Annual Nursing Leadership Congress: "Building the Foundation for a Culture of Safety" conference proceedings.

June 20, 2007

Patient and family engagement in catheter-associated urinary tract infection (CAUTI) prevention: a systematic review.

July 14, 2021

Lessons learned implementing a complex and innovative patient safety learning laboratory project in a large academic medical center

January 15, 2020

Diagnostic Error in Medicine.

October 7, 2009

Implementing and validating a comprehensive unit-based safety program.

May 11, 2005

Reducing the Risk by Designing a Safer, Shame-free Health Care Environment.

September 26, 2007

Lessons learned from implementing a principled approach to resolution following patient harm.

January 9, 2019

Adverse events present on arrival to the emergency department: the ED as a dual safety net.

March 11, 2020

Pharmacy Education and Practice.

January 26, 2022

Encouraging patients to speak up about problems in cancer care.

January 12, 2022

Health Literacy Research: Current Status and Future Directions.

November 24, 2010

Quality of Anesthesia Care.

February 23, 2011

Characteristics of disease-specific and generic diagnostic pitfalls: a qualitative study.

February 9, 2022

Emergency department crowding: the canary in the health care system.

November 3, 2021

The potential of artificial intelligence to improve patient safety: a scoping review.

March 31, 2021

Human Factors in Anaesthesia and Critical Care.

July 14, 2010

Simulation in Surgical Training and Practice.

August 19, 2015

Medical Error: What Do We Know? What Do We Do?

August 10, 2005

Perceptions of institutional support for “second victims” are associated with safety culture and workforce well-being.

February 24, 2021

Patient Safety.

December 13, 2006

Improving Diagnosis.

November 28, 2018

Patient Safety in Obstetrics and Gynecology: Improving Outcomes, Reducing Risks.

March 19, 2008

Special Issue: Progress at the Intersection of Patient Safety and Medical Liability.

December 14, 2016

Don't go to the hospital alone: ensuring safe, highly reliable patient visitation.

January 12, 2022

Health system leaders' role in addressing racism: time to prioritize eliminating health care disparities.

February 10, 2021

Perfect is possible.

October 25, 2006

Scalia's death and the value of autopsy: a teachable moment.

April 6, 2016

The persistent problem of diagnostic error.

December 16, 2015

Eighth Annual National Patient Safety Foundation Congress: Conference Proceedings.

October 4, 2006

Patient Safety and Quality.

March 3, 2010

Resident Duty Hours Across Borders: An International Perspective.

January 21, 2015

The Science of Simulation in Healthcare: Defining and Developing Clinical Expertise.

November 19, 2008

Salzburg Global Seminar Session 565—Better Health Care: How Do We Learn About Improvement?

May 16, 2018

Considering the safety and quality of artificial intelligence in health care.

September 16, 2020

An infrastructure to provide safer, higher quality, and more equitable telehealth.

March 1, 2023

Obstetric Quality and Safety.

October 28, 2009

Ensuring primary care diagnostic quality in the era of telemedicine.

October 27, 2021

Safety and Human Performance in the Operating Room and Other Extreme Environments.

March 27, 2024

Patient Safety in Pediatric Emergency Medicine.

January 3, 2007

Incidence of adverse events and negligence in hospitalized patients. Results of the Harvard Medical Practice Study I.

March 27, 2005

Maximizing the Use of State Adverse Event Data to Improve Patient Safety.

December 14, 2005

Will medicine ever become safer?

December 11, 2013

Related Resources

Exploring the causes of COPD misdiagnosis in primary care: a mixed methods study.

April 10, 2024

WebM&M Cases

Delayed Diagnosis and Treatment of Systemic Lupus Erythematosus with a Psychiatric Presentation

March 27, 2024

Why is safety in intrapartum electronic fetal monitoring so hard? A qualitative study combining human factors/ergonomics and social science analysis.

February 7, 2024

Low rate of completion of recommended tests and referrals in an academic primary care practice with resident trainees.

January 31, 2024

Deficiencies in Quality Management Processes and Delays in the Communication of Test Results and Follow-Up Care at the Phoenix VA Health Care System in Arizona.

November 29, 2023

On Patient Safety.

November 7, 2023

WebM&M Cases

Delay in Malignancy Diagnosis Reflects Systemic Failures

October 31, 2023

Intraoperative communications between pathologists and surgeons: do we understand each other?

September 6, 2023

Clinical pathway adherence and missed diagnostic opportunities among children with musculoskeletal infections.

September 6, 2023

WebM&M Cases

Critical Echocardiogram Result Lost to Follow-up.

June 14, 2023

Delays in care during the COVID-19 pandemic in the Veterans Health Administration.

May 3, 2023

Annual Perspective

Improving Diagnostic Safety and Quality

April 26, 2023

A perfect storm averted: flawed systems, a dropped ball, and cognitive biases delay a critical diagnosis.

November 2, 2022

WebM&M Cases

False Assumptions Result in a Missed Pneumothorax after Bronchoscopy with Transbronchial Biopsy.

October 27, 2022

Are pathologists self-aware of their diagnostic accuracy? Metacognition and the diagnostic process in pathology.

October 5, 2022

WebM&M Cases

Delayed Diagnosis of Mesenteric Ischemia

August 31, 2022

Multiple Failures in Test Results Follow-up for a Patient Diagnosed with Prostate Cancer at the Hampton VA Medical Center in Virginia.

July 13, 2022

Machine learning models outperform manual result review for the identification of wrong blood in tube errors in complete blood count results.

June 29, 2022

Collaborative case review: a systems-based approach to patient safety event investigation and analysis.

March 30, 2022

Patient Safety Primers

Coronavirus Disease 2019 (COVID-19) and Diagnostic Error

January 11, 2022

Communicating certainty in pathology reports: interpretation differences among staff pathologists, clinicians, and residents in a multicenter study.

December 22, 2021

Bringing the clinical laboratory into the strategy to advance diagnostic excellence.

September 22, 2021

Unlocking Solutions in Imaging: Working Together to Learn from Failings in the NHS.

August 4, 2021

The perfect storm: exam of a medical error and factors contributing to its possible escalation.

June 23, 2021

What are the implications for patient safety and experience of a major healthcare IT breakdown? A qualitative study.

May 26, 2021

WebM&M Cases

A Postpartum Woman with an Erroneous SARS-CoV-2 Test

April 28, 2021

High-Performance Work Systems in Health Care Management: Parts 1-5.

October 4, 2020

Special Issue on Prescription Drug Misuse.

September 25, 2019

Error Reduction and Prevention in Surgical Pathology, Second Edition.

August 28, 2019

Building an ambulatory safety program at an academic health system.

May 15, 2019

See More About The Topic

Physicians

Diagnostic Test Interpretation Error

Missed or Critical Lab Results

Communication between Providers

Communicating Critical Test Results.

Coronavirus Disease 2019 (COVID-19) and Diagnostic Error

Connect With Us

Sign up for Email Updates

Agency for Healthcare Research and Quality

Communicating Critical Test Results.

Coronavirus Disease 2019 (COVID-19) and Diagnostic Error

Connect With Us

Sign up for Email Updates

Agency for Healthcare Research and Quality

Submit Your Innovations

Continue as a Guest

Continue Logged In

Submit Your Innovations

Continue as a Guest

Continue logged in

New Users to the PSNet site