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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)

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21 - 40 of 867 Results
Shortliffe EH, Sepúlveda MJ. JAMA. 2018;320:2199-2200.
Clinical decision support on the front line of care harbors both potential benefits and barriers to effective care delivery. This commentary outlines system challenges such as complexity and poor communication that hinder reliable adoption and use of clinical decision support. The authors highlight the need for research and evaluation models to help bring clinical decision support safely and effectively into daily health care work.
Tubbs-Cooley HL, Mara CA, Carle AC, et al. JAMA Pediatr. 2019;173:44-51.
Excessive nursing workload is a known safety issue. This study examined whether nurse workload in the neonatal intensive care unit affected the quality of nursing care. Investigators measured workload using patient–nurse ratios, taking into account patient acuity, and a convenience sample of nurses also reported their perceived workload. Participating nurses were asked to report the care they provided, and missed care was defined as self-reported failure to provide any of 11 prespecified essential elements of nursing care. The authors identified a consistent association between perceived workload and missed care, suggesting that nurses' own assessments of their workload should be a safety consideration. A PSNet perspective explores how missed nursing care may explain the association between low nurse staffing levels and increased mortality in hospital patients.
Barr D, Epps QJ. J Thromb Thrombolysis. 2019;47:146-154.
Anticoagulants are commonly prescribed medications that have high potential for harm if administered incorrectly. This review summarizes common errors at the prescribing, dispensing, and administration phases of direct oral anticoagulant therapy. The authors suggest team-based strategies—such as process assessment, policy development, and medication reconciliation—to prevent adverse drug events associated with direct oral anticoagulants.
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.
Magill SS, O'Leary E, Janelle SJ, et al. N Engl J Med. 2018;379:1732-1744.
Health care–associated infections (HAIs) are a key cause of preventable harm in hospitals. Successful programs to avert HAIs include the comprehensive unit-based safety program to reduce catheter-related bloodstream infections and the AHRQ Safety Program for Surgery to prevent surgical site infections. This survey of 12,299 patients at 199 hospitals on a single day enabled researchers to estimate the prevalence of HAIs in the United States. In 2015, 3.2% of hospitalized patients experienced an HAI, a 16% decrease compared to a similarly derived estimate in 2011. The most common HAIs were pneumonia and Clostridium difficile infections, while the biggest reductions were in urinary tract and surgical site infections. This data emphasizes the importance of identifying strategies to combat pneumonia in nonventilated patients, which remains common and less well-studied than other HAIs. A past PSNet perspective discussed the history around efforts to address preventable HAIs, including federal initiatives.
Yu K-H, Kohane IS. BMJ Qual Saf. 2019;28:238-241.
Use of artificial intelligence (AI) and computer algorithms as tools to improve diagnosis have both risks and benefits. This commentary explores challenges to implementing AI systems at the front line of care in a safe manner and identifies weaknesses of advanced computing systems that influence their reliability.
Giardina TD, Haskell H, Menon S, et al. Health Aff (Millwood). 2018;37:1821-1827.
Reducing harm related to diagnostic error remains a major focus within patient safety. While significant effort has been made to engage patients in safety, such as encouraging them to report adverse events and errors, little is known about patient and family experiences related specifically to diagnostic error. Investigators examined adverse event reports from patients and families over a 6-year period and found 184 descriptions of diagnostic error. Contributing factors identified included several manifestations of unprofessional behavior on the part of providers, e.g., inadequate communication and a lack of respect toward patients. The authors suggest that incorporating the patient voice can enhance knowledge regarding why diagnostic errors occur and inform targeted interventions for improvement. An Annual Perspective discussed ongoing challenges associated with diagnostic error. The Moore Foundation provides free access to this article.
Bates DW, Singh H. Health Aff (Millwood). 2018;37:1736-1743.
The release of the Institute of Medicine's To Err Is Human in 1999 represented a seminal moment in patient safety and is considered by many to have launched the modern patient safety movement. The report highlighted the incidence of medical errors and preventable deaths in the United States and catalyzed research to identify interventions for improvement. The authors reflect on progress since its publication and suggest that while many effective interventions have been developed for addressing safety challenges such as hospital-acquired infections and medication errors, successful implementation of these solutions remains difficult, and improvement in other areas has been less consistent. In addition, new safety challenges have emerged in the last 20 years including those related to ambulatory care and diagnostic error. The authors conclude that preventable harm remains significant and advocate for enhanced use of widely available electronic data to develop improved interventions for what they foresee may be a Golden Era of swift progress in patient safety. A PSNet perspective reflected on patient safety progress in surgery. The Moore Foundation provides free access to this article.
Bombard Y, Baker R, Orlando E, et al. Implement Sci. 2018;13:98.
Engaging patients and their families in quality and safety is considered central to providing truly patient-centered care. This systematic review included 48 studies involving the input of patients, family members, or caregivers on health care quality improvement initiatives to identify factors that facilitate successful engagement, patients' perceptions regarding their involvement, and patient engagement outcomes.
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.
Vento S, Cainelli F, Vallone A. World J Clin Cases. 2018;6:406-409.
Malpractice concerns can influence treatment decisions as clinicians seek to avoid errors of omission. This commentary reviews factors that contribute to defensive medicine, underscores the role the blame culture has in perpetuating this behavior, and discusses the costs to patients, physicians, and health systems.
Chrouser KL, Xu J, Hallbeck S, et al. Am J Surg. 2018;216:573-584.
Stressful clinician interactions can diminish the teamwork required to support safe care. This review describes a framework for guiding understanding of how behavioral and emotional responses can affect team behavior, performance, and patient outcomes in the surgical setting. The authors recommend areas of research required to fully understand the phenomenon.
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.
Lam MB, Figueroa JF, Feyman Y, et al. BMJ. 2018;363:k4011.
Accreditation is a widely accepted strategy for ensuring hospital quality and safety. Hospitals accredited by The Joint Commission have been found to have improved performance on care quality metrics. However, few researchers have investigated whether or how accreditation affects patient outcomes. Investigators used Medicare data to assess the relationship between Joint Commission accreditation, other independent accreditation, or state survey review only (no independent accreditation) on patient outcomes and experience. Surgical mortality and readmissions did not differ between hospitals with and without accreditation. For medical conditions, accredited hospitals had a lower readmission rate but no statistically significant difference in mortality rate. Patient experience was modestly better at hospitals without accreditation. These findings may reflect how state survey and independent accreditation have converged in terms of methods and efficacy. A PSNet interview with The Joint Commission's CEO discussed the organization's efforts to use accreditation as one of many tools to promote high reliability in health care.
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.
Schwartz SP, Adair KC, Bae J, et al. BMJ Qual Saf. 2019;28:142-150.
Burnout is a highly prevalent patient safety issue. This survey study examined work–life balance and burnout. Researchers validated a novel survey measure for work–life balance by asking participants to report behaviors like skipping meals and working without breaks. Residents, fellows, and attending physicians reported the lowest work–life balance, and psychologists, nutritionists, and environmental services workers reported the highest work–life balance. Time of day and shift length also influenced work–life balance: day shift had better scores compared to night shift, and shorter shifts had better scores than longer shifts. The work–life balance score also clustered by the work setting: individuals with different roles within a given setting (such as the intensive care unit, the emergency department, or the clinical laboratory) had more similar work–life balance. Those with higher work–life balance reported better safety culture and less burnout. The authors suggest that burnout interventions target work settings rather than individuals, because work–life balance seems to function as a shared experience within health care settings.
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.
Powers EM, Shiffman RN, Melnick ER, et al. J Am Med Inform Assoc. 2018;25:1556-1566.
Although hard-stop alerts can improve safety, they have been shown to result in unintended consequences such as delays in care. This systematic review suggests that while implementing hard stops can lead to improved health and process outcomes, end-user involvement is essential to inform design and appropriate workflow integration.
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.