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Patient Safety Network

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 - 5 of 5 Results
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    • Evaluation of near-miss wrong-patient events in radiology reports.
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    • Sadigh G, Loehfelm T, Applegate KE, et al. AJR Am J Roentgenol. 2015;205:337-43.
    Despite The Joint Commission requirement to use at least two patient identifiers when obtaining an imaging study, wrong-patient events still occur. This retrospective case review study determined the prevalence of reported near-miss wrong-patient events in radiology at two large academic hospitals. The overall event rate was 4 per 100,000 radiology studies.
    Improvement in detection of wrong-patient errors when radiologists include patient photographs in their interpretation of portable chest radiographs.
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    • Tridandapani S, Olsen K, Bhatti P. J Digit Imaging. 2015;28:664-70.
    This innovative pilot study found significant improvement in radiologists' ability to detect wrong-patient errors when patient photographs were provided with radiographs. The authors advocate for including photographs with portable radiographs to prevent patient mislabeling errors and augment safety.
    A multiobserver study of the effects of including point-of-care patient photographs with portable radiography: a means to detect wrong-patient errors.
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    • Tridandapani S, Ramamurthy S, Provenzale J, et al. Acad Radiol. 2014;21:1038-47.
    Similar to a prior smaller study, this study found the inclusion of point-of-care facial photographs obtained with portable chest radiographs increased the identification of wrong-patient errors among a group of 90 academic radiologists.
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