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The PSNet Collection: All Content

The AHRQ PSNet Collection comprises an extensive selection of resources relevant to the patient safety community. These resources come in a variety of formats, including literature, research, tools, and Web sites. Resources are identified using the National Library of Medicine’s Medline database, various news and content aggregators, and the expertise of the AHRQ PSNet editorial and technical teams.

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Displaying 1 - 15 of 15 Results
Rao A, Pang M, Kim J, et al. J Med Internet Res. 2023;25:e48659.
Interest in testing ChatGPT as a clinical tool is increasing. This study asked ChatGPT to provide a differential diagnosis, diagnostic testing, final diagnosis, and care management for 36 previously published clinical vignettes. ChatGPT had an overall accuracy of 72%, with the highest level of accuracy at the final diagnosis stage (77%).
Alsabri M, Boudi Z, Zoubeidi T, et al. J Patient Saf. 2022;18:e124-e135.
In this retrospective study, researchers used electronic health record and quality assurance issue (QAI) data to analyze risk factors associated with patient safety events in the emergency department (ED). Multivariable analyses showed several potential risk factors for safety events – including length of time in the ED, which increased the odds of a safety event by 4.5% for each hour spent in the ED.
Dubosh NM, Edlow JA, Goto T, et al. Ann Emerg Med. 2019;74:549-561.
… of emergency medicine … Ann Emerg Med … Misdiagnosis of a neurologic emergency such as stroke can lead to serious morbidity or mortality. Using a large multi-state database, this study examined the … neurological event after ED discharge. Extrapolated to a national level, this translates to over 55,000 patients …
Lee MO, Arthofer R, Callagy P, et al. Am J Emerg Med. 2019;38:272-277.
This retrospective cohort study of 16,801 patients examined whether patients in alternative care areas like hallways experienced more safety problems, such as intensive care unit transfer, readmission, and hospital-acquired infections. Investigators found that patients in alternative care areas were younger, had fewer comorbid health conditions, and no increase in risk for adverse safety outcomes. The results suggest that bed management takes into account patient acuity when assigning location to mitigate potential safety concerns.
Adelman JS, Applebaum JR, Schechter CB, et al. JAMA. 2019;321:1780-1787.
Having multiple patient records open in the electronic health record increases the potential risk of wrong-patient actions. This randomized trial tested two different electronic health record configurations: one allowed up to four patient records to be open at a time, and the other allowed only one to be open. Among the 3356 clinicians with nearly 4.5 million order sessions, there were no significant differences in wrong-patient orders. However, the investigators noted that clinicians in the multiple records group placed most orders with just one record open. A post hoc analysis determined that the rate of errors increased when orders were placed with multiple records open. A related editorial highlights the tradeoffs between safety and efficiency and argues for examining the context of the two configurations, including throughput and clinician satisfaction. A previous PSNet perspective discussed assessing and improving the safety of electronic health records.
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.
Le RD, Melanson SEF, Petrides AK, et al. Am J Clin Pathol. 2016;146:456-61.
Laboratory errors, such as mislabeling, improper collection, or specimen loss, can lead to delays in diagnosis and the need for repeat procedures or blood draws. In this single institution study, implementing a custom-built specimen collection module led to a significant decrease in the rate of lab specimen collection and handling errors for blood samples drawn by nurses in both the emergency department and inpatient settings.
Magid DJ, Sullivan AF, Cleary PD, et al. Ann Emerg Med. 2009;53:715-723.e1.
… consultations in emergency departments. … Magid DJ, Sullivan AF, Cleary PD, et al. The safety of emergency care systems: Results of a survey of clinicians in 65 US emergency departments.  Ann Emerg Med . 2009;53(6):715-23.e1. doi:10.1016/j.annemergmed.2008.10.007 …
Sullivan AF, Camargo CA, Cleary PD, et al. Acad Emerg Med. 2007;14:1182-1189.
… Med … The authors describe the process used to implement a national epidemiological study of medical error in emergency departments. … Sullivan AF, Camargo CA Jr, Cleary PD, et al. The National … design. Acad Emerg Med. 2007;14(12):1182-1189. doi:10.1197/j.aem.2007.07.014 …