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Classics and Emerging Classics

To help our readers navigate the tremendous breadth of the PSNet Collection, AHRQ PSNet editors and advisors have given the designation of “Classic” to review articles, empirical studies, government and stakeholder reports, commentaries, and books of lasting importance to the patient safety field. These items have the potential to impact how providers approach care practice and are regularly referenced in the literature. More information on the selection process.

 

The “Emerging Classics” designation identifies those resources that may not have met the level of a “Classic” yet due to limited citation in the published literature or in the level of impact/contribution to the environment, but these are resources which our patient safety subject matter experts believe have the potential to drive change in the field.

Popular Classics

Huang SS, Septimus E, Kleinman K, et al. N Engl J Med. 2013;368.

Healthcare associated infection is a leading cause of preventable illness and death. Methicillin-resistant Staphylococcus aureus (MRSA) is a virulent, multi-drug resistant infection increasingly seen across healthcare settings. This pragmatic,... Read More

All Classics and Emerging Classics (867)

1 - 20 of 111 Results
Carayon P, Wooldridge A, Hose B-Z, et al. Health Aff (Millwood). 2018;37:1862-1869.
System and process weaknesses can hinder safe patient care. This commentary raises awareness of human factors engineering as a key opportunity for enhancing patient safety. The authors provide recommendations to drive adoption and spread of human factors strategies through targeted education, clinician–engineer partnerships, and coordinated improvement efforts.
Nickel WK, Weinberger SE, Guze PA, et al. Ann Intern Med. 2018;169:796-799.
Patient and family engagement can enhance both individual safety and organizational improvement efforts. This position paper advocates for patients and families to be active partners in all aspects of their care, treated with respect and dignity, engaged in improving health care systems, and directly involved in education of health care professionals. The piece also provides strategies to employ these recommendations in the daily practice.
Sloane DM, Smith HL, McHugh MD, et al. Med Care. 2018;56:1001-1008.
Prior research suggests that improved nursing resources may be associated with decreased mortality and adverse events. However, less is known about how changes to nursing resources in the inpatient setting may affect quality and safety over time. In this study involving 737 hospitals and survey data from nurses obtained in 2006 and 2016, researchers found that after adjusting for numerous factors, better nursing resources in terms of work environment, staffing, and education was associated with improvement in quality and patient safety outcomes. A PSNet perspective discussed the impact of nursing resources on patient safety.
Martin P, Tamblyn R, Benedetti A, et al. JAMA. 2018;320:1889-1898.
This randomized controlled trial tested a pharmacist-led educational intervention at community pharmacies. Intervention patients received a brochure about potentially inappropriate medications. Discontinuation of potentially harmful medications increased among older adults compared to usual pharmacy care, suggesting that community pharmacies can play a significant role in medication safety.
Mann S, Hollier LM, McKay K, et al. New Engl J Med. 2018;379:1689-1691.
Maternal morbidity has received increasing attention as a patient safety issue. This commentary recommends four strategies for improving obstetrics safety: focusing on prevention of complications, using multidisciplinary huddles to enhance communication, employing simulation as a teamwork training model, and developing partnerships between hospitals to ensure the best care is available.
O'Sullivan ED, Schofield SJ. J R Coll Physicians Edinb. 2018;48:225-232.
Cognitive biases can lead to unnecessary treatment and delays in diagnosis. This commentary reviews examples of bias that commonly occur in medical practice and describes debiasing tactics to help improve decision-making.
Boet S, Etherington N, Larrigan S, et al. BMJ Qual Saf. 2019;28:327-337.
Teamwork training enhances health care team performance, especially in crisis situations. This systematic review identified 13 tools for assessing teamwork in high-stress settings, most of which were designed for the emergency department. A past PSNet perspective explored insights learned from experience with the AHRQ-supported teamwork training program, TeamSTEPPS.
Meisenberg BR, Grover J, Campbell C, et al. JAMA Netw Open. 2018;1:e182908.
Opioid deaths are a major public health and patient safety hazard. This multimodal, health care system-level intervention to reduce opioid overprescribing consisted of changes to the electronic health record, patient education, and provider education and oversight. Opioid prescribing decreased substantially (58%) systemwide with no discernible decrement in patient satisfaction.
Mianda S, Voce A. BMC Health Serv Res. 2018;18:747.
Clinical leadership training and teamwork training both augment the safety of maternity care. This systematic review found that most leadership training in maternity settings used a work-based learning approach rather than simulation or classroom interventions. The authors emphasize the importance of tailoring leadership interventions to low- and middle-income countries, where this training is less common.
Bates DW, Landman A, Levine DM. JAMA. 2018;320:1975-1976.
Mobile health care applications are increasingly being developed and marketed to patients for self-care and diagnosis, with little oversight as to their effectiveness or safety. This commentary outlines four key issues that must be addressed to improve the safety of medical applications.
Croskerry P. Med Teach. 2018;40:803-808.
Clinical reasoning is a complex process that can be influenced by numerous factors. This commentary reviews major factors that affect clinical reasoning such as teamwork, decision-maker characteristics, and environmental conditions. The author suggests that an adaptive rather than linear decision-making approach would support reasoning improvements to reduce diagnostic error.
Fønhus MS, Dalsbø TK, Johansen M, et al. Cochrane Database Syst Rev. 2018;9:CD012472.
Engaging patients in their care can enhance safety, quality, and satisfaction. The Joint Commission and Centers for Medicare and Medicaid Services both call for health care organizations to encourage patient engagement in their care. This review and meta-analysis assessed which patient engagement strategies improve clinician adherence to recommended clinical practice. Two strategies had moderate impact: enhancing the information elicited from patients and educating patients about best clinical practice. Patient decision aids did not affect clinician performance, and the authors were unable to determine how interventions impacted health outcomes. A PSNet perspective explored novel avenues for patient engagement that leverage health information technology.
Ramani S, Könings KD, Mann K, et al. Acad Med. 2018;93:1348-1358.
Constructive feedback is a pillar of strong safety culture. Through resident and attending physicians focus groups at a single institution, investigators found that cultural emphasis on politeness and excellence hindered all parties' ability to provide honest feedback. The authors advocate for transitioning to a culture of growth, which would shift their institution toward a more just culture.
Dyrbye LN, Burke SE, Hardeman RR, et al. JAMA. 2018;320:1114-1130.
Physician burnout threatens the well-being and sustainability of the health care workforce. This large prospective cohort study found that 45% of resident physicians experienced burnout. Higher burnout rates were detected in urology, general surgery, emergency medicine, and neurology residents (relative to internal medicine residents). The overall prevalence of burnout was similar to studies of practicing physicians, and significantly higher than studies of the general population. Although most residents were satisfied with their career choice, those who were burned out were more likely to regret their decision to become a physician. An Annual Perspective explored how burnout impacts patient safety.
Weiner SG, Price CN, Atalay AJ, et al. Jt Comm J Qual Patient Saf. 2019;45:3-13.
Multidisciplinary organizational efforts are necessary to reduce inappropriate prescribing of opioids. This commentary describes the design and implementation of an opioid stewardship program that combined the use of technology, education, and clinical strategies under strong leadership guidance as a cross-disciplinary strategy to address opioid misuse.
Ma C, Park SH, Shang J. Int J Nurs Stud. 2018;85:1-6.
Teamwork training interventions enhance both clinical outcomes and safety culture. This cross-sectional survey found hospital units that nurses rated as more collaborative had lower rates of both hospital-acquired pressure ulcers and falls. A PSNet Interview discusses how the nursing work environment affects patient safety.

Ibrahim M; Gyuchan S; Jun GT; Robinson S. Safety Sci. 2018;106:104-120.

This literature review examined the application of system dynamics, a simulation method that incorporates qualitative and quantitative data to characterize and predict how complex systems will perform over time, to patient safety. The authors applied a human factors framework to this literature and identified several influences on safety, including supervision, external factors, and organizational culture. The authors conclude that the field of system dynamics can be applied to health care in order to improve patient safety.
Young M, Thomas A, Lubarsky S, et al. Acad Med. 2018;93:990-995.
Enhancing clinical reasoning skill is emerging as a strategy to reduce diagnostic error. This review spotlights the need for a uniform definition of clinical reasoning and a robust literature base to augment efforts to improve reasoning and decision making. The authors suggest these refinements will identify cognitive biases and other contextual influences on clinical reasoning and improve education and professional development.
Clark BW, Derakhshan A, Desai S. Med Clin North Am. 2018;102:453-464.
Diagnostic errors have garnered increasing attention as a contributor to patient harm. This review explores reasons for underrecognition of diagnostic errors, including cognitive biases and large-scale system weaknesses. The authors suggest emphasis on education to enhance clinical knowledge, physical examination practice, and medical history-taking skills to improve diagnosis.
Fiscella K, McDaniel SH. Amer Psychol. 2018;73:451-467.
Teamwork is an important element of safe care delivery. This review explores the evidence on the role of teams in ambulatory care, innovations in primary care teamwork models, and barriers to success. The authors offer recommendations to encourage team development in primary care, including defining team competencies, providing team training opportunities specific to ambulatory care, and adjusting care payment mechanisms.