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.
Kaufmnan J, Twite M, Barrett C, et al. Jt Comm J Qual Patient Saf. 2013;39:306-311.
A standardized handoff protocol for cardiac surgery patients between the operating room and intensive care unit led to decreases in unplanned extubations and the amount of time spent on ventilators.
McCoy AB, Wright A, Kahn MG, et al. BMJ Qual Saf. 2013;22:219-24.
The presence of duplicate records (a single patient having multiple medical records within the same system) is a risk factor for preventable errors. This study at five academic medical centers found that duplicate records were common, with the incidence varying widely across centers.
Kahn MG, Ranade D. J Am Med Inform Assoc. 2010;17:185-91.
Trigger tools are used to screen for patient safety events and are also used to calculate rates of certain safety problems (such as adverse drug events). This study found that the rate of a trigger tool–based drug safety quality measure varied widely depending on the specific data source used to calculate the rate.