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.
Lane-Fall MB, Pascual JL, Massa S, et al. Jt Comm J Qual Saf. 2018;44:514-525.
Standardizing handoffs has been shown to improve patient safety. The authors describe provider perspectives regarding handoffs from the operating room to intensive care unit as well as the development of a standardized OR-to-ICU handoff protocol.
Vioque SM, Kim PK, McMaster J, et al. Am J Surg. 2014;208:187-194.
Approximately 1 in 13 deaths of patients with major trauma were considered preventable or potentially preventable in this retrospective review from an urban trauma center. Diagnostic errors during the initial trauma assessment were a frequent contributor to preventable harm.
Morris DS, Schweickert W, Holena DN, et al. Resuscitation. 2012;83:1434-7.
Rapid response events led by senior residents resulted in similar patient outcomes compared with those run by intensive care unit attending physicians, in this retrospective study at a large academic medical center.
Sarani B, Sonnad SS, Bergey MR, et al. Crit Care Med. 2009;37:3091-6.
Rapid response systems serve an important patient safety function in hospitals by helping detect systematic problems in care, and emerging evidence indicates that such teams may improve some clinical outcomes. This study evaluated the views of frontline providers—bedside nurses and resident physicians—toward a rapid response team (RRT). Both groups agreed that the presence of the RRT improved patient safety, and both also felt that the RRT did not adversely affect their educational experience or patient care skills. These findings have been previously demonstrated for nurses. Interestingly, both nurses and residents who had more experience with the RRT felt more positively about its effects. The RRT in this study consisted of a critical care nurse, a respiratory therapist, and a pharmacist with physician backup.