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.
McMullen S, Panagioti M, Planner C, et al. Health Expect. 2023;26:2064-2074.
Caregivers and family members offer a unique perspective on patient safety. In this study, patient and caregiver stakeholders outlined the safety threats affecting patients discharged from mental health services and the well-being of caregivers as well as potential solutions. Participants highlighted approaches to improve caregiver involvement, patient and caregiver wellness and education, and the policy and system environments.
Morris RL, Giles SJ, Campbell S. Health Expect. 2023;Jan 16.
Patient and caregiver engagement is an important strategy for improving the quality and safety of care. This qualitative study with 18 patients and/or caregivers explored perspectives on engagement in primary care. While participants were supportive of engagement in their care and safety, some expressed concerns regarding additional workload for patients. Participants also provided feedback on a patient safety guide for primary care (PSG-PC) and identified areas to embed the PSG-PC into routine interactions with primary care, particularly for individuals caring for a family member with complex or chronic health conditions.
Williams R, Jenkins DA, Ashcroft DM, et al. The Lancet Pub Health. 2020;5:e543-e550.
The COVID-19 pandemic has led to patients delaying or forgoing necessary health care, which can contribute to diagnostic and treatment delays. This retrospective cohort study used primary care data to investigate the indirect effect of the COVID-19 pandemic on primary care health care use and subsequent diagnoses among residents in a poor, urban area in the United Kingdom. Between March and May 2020, there was a 50% reduction in expected diagnoses for mental health conditions, as well as substantial decreases in diagnoses and associated medication prescriptions for circulatory system diseases and type 2 diabetes.
Cheraghi-Sohi S, Panagioti M, Daker-White G, et al. Int J Equity Health. 2020;19:26.
To better understand patient safety issues of marginalized groups, this scoping review assessed 67 articles primarily focusing on four patient groups: ethnic minorities, frail elderly, care home residents and those with low socioeconomic status. A variety of patient safety issues were identified, and half of the included studies looked at either medication safety, adverse outcomes, and near misses. This review highlights the need for additional research to understand the intersection between marginalization and the multi-dimensional nature of patient safety issues.
Giles SJ, Parveen S, Hernan AL. BMJ Qual Saf. 2019;28:389-396.
This measure validation study examined the reliability and validity of a patient-reported measure of safety in primary care. The analysis established concurrent validity and reliability, paving the way for measuring patients' perceptions of ambulatory safety.
Medically complex patients experience more safety hazards than their healthier peers. This ethnographic study described the safety experience of 26 medically complex British adults. Physicians and patients alike struggled to achieve a balance between underinvestigating health concerns and risking diagnostic delays and overinvestigating health concerns and exposing patients to unnecessary testing.
Hays R, Daker-White G, Esmail A, et al. BMC Health Serv Res. 2017;17:754.
Patient safety in ambulatory care is receiving increased attention. In this qualitative study, researchers interviewed 26 patients over the age of 65 with multiple comorbid medical conditions to better understand perceived threats to patient safety in primary care among this population.
Lydon S, Power M, McSharry J, et al. Crit Care Med. 2017;45.
This systematic review examined efforts to improve hand hygiene in critical care settings. Although many interventions were effective, poor methodological rigor and bundled interventions limited identification of best practices. A previous PSNet perspective discussed approaches to measuring and improving hand hygiene, including human factors engineering.
Alam R, Cheraghi-Sohi S, Panagioti M, et al. BMC Fam Pract. 2017;18:79.
A recent commentary described fear of uncertainty as a contributor to diagnostic error. This systematic review developed a framework for how primary care clinicians manage uncertainty, consisting of cognitive, emotional, and ethical domains. However, the review identified little data on best ways to support clinicians in handling uncertainty.
Riches N, Panagioti M, Alam R, et al. PLoS One. 2016;11:e0148991.
Despite increasing focus on diagnostic error, it remains a controversial patient safety issue. The Institute of Medicine recently suggested that further research is needed regarding electronic tools to improve diagnosis. Differential diagnosis generators provide a list of possible diagnoses for a problem. The investigators conducted a systematic review and found that differential diagnosis generators have been shown to improve diagnostic accuracy when a clinician has an opportunity to re-review the case using the software in pre-post studies. The degree of improvement varied between studies. The effect on actual clinician behaviors—such as test ordering, clinical outcomes, and cost—is unclear. Clinicians need prospective studies in order to determine whether such tools enhance diagnosis in actual practice. A recent PSNet perspective discussed future research avenues to ensure progress in diagnostic safety.
Rhodes P, McDonald R, Campbell S, et al. Sociol Health Illn. 2016;38:270-285.
This sociology study used qualitative interviews with primary care patients to explore their conceptualization of patient safety. The patients provided multiple insights that suggested they might feel more equipped to be proactive about ensuring their safety in primary care compared to the less predictable hospital setting.
Panagioti M, Stokes J, Esmail A, et al. PLoS One. 2015;10:e0135947.
This systematic review assessed the potential link between multimorbidity and patient safety incidents in the ambulatory setting. Patients that had multiple medical conditions and a mental health component, such as depression, were at particularly high risk for errors and patient safety incidents.
This study interpreted the results of 48 qualitative studies of patient safety in primary care. The conceptual model that emerged highlights the central role of effective communication between patients and health care staff and the risks electronic systems may introduce by interrupting opportunities for face-to-face communication.
Hernan AL, Giles SJ, O'Hara JK, et al. BMJ Qual Saf. 2016;25:273-80.
Patients may provide valuable insights into potential safety problems. This study describes the development and initial validation of a survey tool for capturing patient feedback about safety in the ambulatory setting. This tool expanded the previously developed patient measure of safety questionnaire to include four primary care–specific domains: continuity of care, external policy context, primary–secondary interface, and referrals. The survey was developed by an expert panel through a modified Delphi process and was well received by patients and staff during face validity testing. This tool aims to provide patient perspectives to primary care organizations to focus improvement efforts in these settings. A prior AHRQ WebM&M interview discussed the emerging field of ambulatory patient safety.
Hernan AL, Giles SJ, Fuller J, et al. BMJ Qual Saf. 2015;24:583-93.
The patient safety field's understanding of safety issues in ambulatory care continues to evolve. Recent studies have helped quantify the incidence of diagnostic errors and medication errors in primary care, indicating that serious safety concerns exist in this arena. This Australian study used qualitative methodology to examine patient and caregiver perceptions of factors affecting safety in ambulatory care. The investigators identified several unique themes related to safety, including difficulties in accessing care, insufficient continuity of care, and poor communication between primary care physicians and specialists. Some of these themes were also found in a prior study of primary care patients in the United Kingdom. The emerging area of ambulatory patient safety was explored in a previous AHRQ WebM&M perspective.
Rhodes P, Campbell S, Sanders C. Health Expect. 2016;19:253-263.
Although the field of patient safety was largely built around a systems approach, this interview-based qualitative study in England sought to understand how patients perceive safety in primary care. Researchers determined that ambulatory patients focus on individual trust and relationships when thinking about safety. Patients were not able to clearly differentiate dimensions of safety from quality, suggesting that in real-world experiences these domains are considered similar. Some of the important markers of safe care, according to patients, were prompt investigations and referrals to specialists. The authors note that none of the patients interviewed in this study mentioned unnecessary care as a cause of concern. Patient safety researcher Dr. Urmimala Sarkar discussed patient safety in the ambulatory setting in a recent AHRQ WebM&M interview.