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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;368:2255-2265.

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... Read More

All Classics and Emerging Classics (970)

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Displaying 961 - 970 of 970 Results
Woods D, Thomas E, Holl J, et al. Pediatrics. 2005;115:155-60.
Adverse events in hospitalized children are largely preventable. This study analyzed records of 3,719 patients under 21 years of age in Utah and Colorado. Adverse event and preventable adverse event rates (1% and 0.6%, respectively) were similar to those seen in adult populations, with most occurring in the context of birth.
Ash JS, Berg M, Coiera E. J Am Med Inform Assoc. 2004;11:104-12.
The authors draw from their aggregated experience in qualitative assessment of clinical information systems in the United States, Europe, and Australia to propose a framework for understanding unexpected adverse consequences of patient care information systems (PCIS) on clinical work. The adverse effects are broadly divided into errors in the process of entering and retrieving information in or from the system and errors in the communication and coordination processes that the PCIS is intended to support. The authors highlight the mismatch between the linear, rigid design of software and the cognitive, social, and organizational realities of health care delivery. The article was among the first and most influential in a wave of papers highlighting potential drawbacks in clinical information technology, and tempering the impression of computerized provider order entry systems as a universal good.
Bates DW, Gawande AA. N Engl J Med. 2003;348:2526-34.
The authors provide a broad overview of the goals, approaches, and limitations of information technology in patient safety, and discuss barriers to increased adoption and proposals to overcome them.
Berger RG, Kichak JP. J Am Med Inform Assoc. 2004;11:100-3.
The authors critically review the published data that traditionally support computerized physician order entry (CPOE) as means to improve patient safety and reduce costs. Through reanalysis of the work of Bates, Classen, and others, the authors challenge the accepted premise of CPOE's benefits, suggesting that CPOE is an unproven technology and that the broad policy enthusiasm for its adoption is premature.
Eccles M, Grimshaw J, Campbell M, et al. Qual Saf Health Care. 2003;12:47-52.
This review discusses the wide range of available methods to study quality improvement projects. The authors provide a framework for evaluating work of this nature and focus specifically on quantitative designs. They discuss the nuances of selecting randomized versus non-randomized approaches and the tradeoffs of each approach for evaluating a given intervention. Numerous examples are included that offer insight into the challenges of measuring effectiveness in quality improvement efforts. The authors advocate for selecting an evaluation strategy that meets the needs and available resources of a given project while minimizing bias and maximizing generalizability. The review and accompanying discussion apply directly to work in patient safety, which shares the same challenges in evaluation design.
Samore MH, Evans S, Lassen A, et al. JAMA. 2004;291:325-34.
This study evaluated methods for medical device event surveillance to help identify and classify an important source of adverse events. Investigators used a number of different strategies to capture device-related events, which included a computer-based system, discharge codes (ICD-9), work logs, and patient survey results. They analyzed more than 7000 identified problems and discovered that very few events were captured by more than one surveillance strategy. Their findings suggest that voluntary reporting alone vastly underestimates the rate of medical device-related errors. Furthermore, future investigation to better understand the incidence and nature of such events must occur to frame necessary prevention efforts.
Cullen DJ, Sweitzer BJ, Bates DW, et al. Crit Care Med. 1997;25:1289-1297.
This prospective cohort study examined more than 4000 adult admissions to compare the frequency and preventability of adverse drug events (ADEs) in intensive care units (ICUs) and non-ICUs. Investigators report the rate of preventable and potential ADEs, the combined event rates by unit type, and characteristics of the hospitalizations. The authors also present data on the stage at which an ADE occurred, consequences of the preventable and potential ADEs, and the respective drug categories implicated. They suggest that, after adjustment for the number of drugs administered, ICUs and non-ICUs share comparable rates of ADEs. Based on structured interviews conducted with those persons involved in each ADE, system-level differences in the respective units failed to provide a clear association.
March JG, Sproull LS, Tamuz M. Org Sci.1991;2:1-13. (reprinted in: Qual Saf Health Care 2003;12:465-472.)
Organizations learn from experience. However, learning from rare events is challenging because experience is limited. The authors cite examples of rare events and outline the strategies that organizations use to learn from these. The authors review two strategies for learning from rare events: one that focuses on experiencing the event more richly and another that attempts to simulate the experience. The authors assess the reliability and validity of these approaches.
Rogers AE, Hwang W-T, Scott LD, et al. Health Aff (Millwood). 2004;23:202-212.
This AHRQ-funded study demonstrated that the risk of error increased in association with extended work shifts, overtime, or longer than 40-hour work weeks. Using logbooks from nearly 400 nurses sampled out of a larger group from the American Nurses Association, investigators determined that an alarmingly high percentage of nurses report working extended hours. For those shifts longer than 12.5 hours, the error rate increased notably. The authors advocate for continued attention to relationships between nursing work hours and patient safety, building on past research that linked staffing to poor patient outcomes.
Howard S K, Gaba D M, Smith B E, et al. Anesthesiology. 2003;98:1345-1355.
This study of anesthesiology residents demonstrated that fatigue negatively impairs psychomotor functioning and mood but not measures of clinical performance. Investigators examined, scored, and analyzed the observed behaviors of 12 residents in differing states of prior sleep. The findings support the notion that fatigue can lead to errors as a result of impaired cognitive abilities even if the more difficult to measure clinical performance outcomes were less affected. These findings are the first from a comprehensive simulation study addressing the effects of provider fatigue.