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Promoting Patient Safety.

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AHRQ’s Patient Safety Network (PSNet) features a collection of the latest news and resources on patient safety, innovations and toolkits, opportunities for free CME and trainings. The platform provides powerful searching and browsing capability, as well as the ability for users to customize the site around their interests (My Profile).

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November 13, 2024 Weekly Issue

PSNet highlights the latest patient safety literature, news, and expert commentary, including Weekly Updates, WebM&M, and Perspectives on Safety.

Study
Goh E, Gallo R, Hom J, et al. JAMA Netw Open. 2024;7:e2440969.
Large language models (LLM) offer a promising approach to improving diagnostic accuracy. In this study, internal medicine physicians were randomized to use conventional (eg, UpToDate) or conventional plus LLM diagnostic resources to provide a differential and final diagnosis on 4 to 6 clinical vignettes. There was no significant difference in diagnostic performance or time spent per case between...
Commentary
Juhl MH, Soerensen AL, Vardinghus-Nielsen H, et al. JMIR Form Res. 2024;8:e54977.
Residents of nursing homes (NH) often require multiple medications to treat their chronic conditions. This article describes the co-creation of an intervention to improve medication safety in Danish nursing homes. Unlicensed healthcare personnel who administer the medication (social and healthcare assistants and helpers) and relatives representing NH residents contributed to the design of the...
Review
Shalviri G, Mohebbi N, Mirbaha F, et al. Cochrane Database Syst Rev. 2024;2024:CD012594.
Adverse drug events (ADE) are common medical errors that can lead to additional healthcare utilization and patient harm. This Cochrane review, including 15 studies with over 62,000 participants, evaluated the effectiveness of interventions to improve ADE reporting. The review found low-certainty evidence that education sessions paired with reminder cards and ADE report forms can significantly improve...
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Training and Education

Update Date: October 30, 2024

WebM&M Case Studies & Spotlight Cases

WebM&M (Morbidity & Mortality Rounds on the Web) features expert analysis of medical errors reported anonymously by our readers. Spotlight Cases include interactive learning modules available for CME. Commentaries are written by patient safety experts and published monthly. Contribute by Submitting a Case anonymously.

Victoria Jackson, DNP, RN, PHN, FNP-C, PA-C and Anna Satake, PhD, MSN, GCNS, RN | October 30, 2024

These cases involve two elderly patients presenting to the emergency department (ED) who suffered falls during their care, despite recognition of risk factors including previous... Read More

Have you encountered medical errors or patient safety issues?
Have you encountered medical errors or patient safety issues? Submit your case below to help the medical community and to prevent similar errors in the future.

Upcoming Events

United States Meeting/Conference

Institute for Healthcare Improvement. Orlando World Center Marriott, Orlando, FL, December 9-11, 2024.

Improvement Resources
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Innovations

The Patient Safety Innovations Exchange highlights important innovations that can lead to improvements in patient safety.

Toolkit
Toolkits

Toolkits provide practical applications of PSNet research and concepts for front line providers to use in their day to day work.

Create Your Own Library

Create your own library to save and manage content on any topic of interest. You can start by searching for articles or by creating your library right here.