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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 - 20 of 52 Results

Marsch A, Khodosh R, Porter M, et al. J Am Acad Dermatol. 2023;89(4):641-54; 57-67.

Patient safety in dermatology has received increasing attention over the past ten years. Part 1 of this series provides examples of patient safety concerns in dermatology (e.g., medication errors, teledermatology) and how key patient safety concepts such as safety culture and root cause analysis can be applied in dermatology settings. Part 2 of this series applies three quality improvement frameworks (LEAN, Six Sigma, and IHI-QI) can be used to improve the quality and safety of dermatology practice.
Harrison J. Br Paramed J. 2023;8:18-28.
Patients with dark skin tones are not well represented in health education, particularly dermatology, which can result in delayed diagnosis. In this scoping review, thirteen articles were identified assessing the confidence of students and healthcare providers in assessing patients with dark skin tones.  Overall, confidence was low but tailored training somewhat improved confidence. The author asserts more research and education is needed outside dermatology, for example, when assessments use terms such as pale, redness, or blue.
Bourkas AN, Barone N, Bourkas MEC, et al. BMJ Open. 2023;13:e068207.
Telemedicine can improve access to specialist care and reduce time to treatment. This systematic review including 44 articles examined the diagnostic agreement between teledermatology and face-to-face consults. The overall average diagnostic agreement was 68.9%, but subgroup analyses identified significantly higher agreement when dermatologists conducted face-to-face and teledermatology consults, rather than non-specialists (i.e., primary care or emergency medicine physicians).
Pagani K, Lukac D, Olbricht SM, et al. Arch Dermatol Res. 2022;315:1397-1400.
Delayed referrals from primary care providers to specialty care can lead to delayed diagnoses and patient harm. This retrospective analysis examined differences in timely versus delayed referrals for urgent skin cancer evaluations at one institution. Among 320 referrals occurring in 2018, 38% of evaluations occurred 31 days or more after the referral and nearly 11% of referrals were never completed. Delayed referrals were more common among patients who did not speak English and racial/ethnic minorities.
Howe LC, Hardebeck EJ, Eberhardt JL, et al. Proc Natl Acad Sci USA. 2022;119:e2007717119.
Providers’ gender, racial, and ethnic bias can adversely affect patient safety and lead to poor outcomes. This study investigated white patients’ physiological responses to treatment provided by either a woman or Black physician. Despite patients’ positive overt attitudes to Black or woman physicians, they were less physiologically responsive to placebo treatment provided by women or Black physicians, suggesting additional implications for health inequities.
Nehls N, Yap TS, Salant T, et al. BMJ Open Qual. 2021;10:e001603.
Incomplete or delayed referrals from primary care providers to specialty care can cause diagnostic delays and patient harm. A systems engineering analysis was conducted to identify vulnerabilities in the referral process and develop a framework to close the loop between primary and specialty care. Low reliability processes, such as workarounds, were identified and human factors approaches were recommended to improve successful referral rates.
Rajan SS, Baldwin J, Giardina TD, et al. J Patient Saf. 2022;18:e262-e266.
Radiofrequency identification (RFID) technology has been most commonly used in perioperative settings to improve patient safety. This study explored whether RFID technology can improve process measures in laboratory settings, such as order tracking, specimen processing, and test result communication. Findings indicate that RFID-tracked orders were more likely to have completed testing process milestones and were completed more quickly.

Patel J, Otto E, Taylor JS, et al. Dermatol Online J. 2021;27(3).

In an update to their 2010 article, this review’s authors summarized the patient safety literature in dermatology from 2009 to 2020. In addition to topics covered in the 2010 article, this article also includes diagnostic errors related to telemedicine, laser safety, scope of practice, and infections such as COVID-19. The authors recommend further studies, and reports are needed to reduce errors and improve patient safety.
Reynolds KA, Hellquist K, Ibrahim SA, et al. Arch Dermatol Res. 2022;314:363-367.
Adverse events associated with pharmacy compounding (e.g., parenteral nutrition, sterile compounding) are well-documented. This survey of state medical and osteopathic boards gathered information about compounding-associated adverse events in physician offices and use of compounding standards. Findings indicate that the incidence of in-office compounding-related adverse events is low and that the majority of respondents had not incorporated compounding standards into their regulations.

The American Society for Dermatologic Surgery Association and the Northwestern University Department of Dermatology.

Voluntary reporting systems collect adverse event data to inform improvement and education efforts. This site provides a platform for physicians and their staff to submit adverse experiences associated with dermatologic surgery equipment, medications or biologics.

Oglethorpe A. Women's Health. November 4, 2020.

Skin condition diagnosis is a visual activity that is vulnerable to error. This article highlights how conditions such as psoriasis and skin cancer can be misdiagnosed. The piece shares recommendations for patients to obtain an accurate diagnosis such as seeking a second opinion and preparing for appointments with notes and questions.

McFarling UL. Stat. July 21, 2020.

Dermatologists rely on visualization techniques to enhance diagnosis in their practice. This article highlights the unavailability of appropriate tools for assessment of disease on black and brown skin as a problem that reduces the safety and effectiveness of care for this patient population. 
Tschandl P, Rinner C, Apalla Z, et al. Nat Med. 2020;26:1229-1234.
This study explored the use of artificial intelligence (AI)-based support in clinical decision-making in dermatology. The authors propose a framework for future research on image-based diagnostics to improve AI use in clinical practice.
Nelson CA, Pérez-Chada LM, Creadore A, et al. JAMA Dermatol. 2020;156:501-512.
Researchers in this study used semi-structured interviews to explore how patients perceive the use of direct-to-patient and clinician decision-support artificial intelligence (AI) tools for skin cancer screening. Common perceived benefits included increased diagnostic speed and health care access, while increased anxiety was a common risk. Patients perceived more accurate diagnoses (69%) and less accurate diagnoses (85%) to be both the greatest strength and weakness of these tools. The vast majority of patients (94%) expressed the importance of a symbiotic relationship between patients, physicians and AI tools. The related commentary discusses the importance of including the patient perspective in the development and implementation of AI tools in healthcare.
Freeman K, Dinnes J, Chuchu N, et al. BMJ. 2020;368:m127.
Delays in cancer diagnosis can lead to adverse patient outcomes. This systematic review examined whether smartphone-based apps can assist patients in assessing skin cancer risk and whether they should seek medical attention for suspicious lesions. The review included nine studies evaluating six different smartphone apps; reported sensitivity and specificity varied widely across studies. The authors note limitations of the included studies, such as failure to recruit a population representative of the general population. Findings are consistent with earlier studies reporting poor performance of smartphone apps for melanoma detection. Although these apps are intended to reduce delays in diagnosis, the authors conclude they can’t be relied upon for detection of all cases of skin cancer.
Dick V, Sinz C, Mittlböck M, et al. JAMA Dermatol. 2019;155:1291-1299.
Advanced computing holds promise for reducing missed diagnoses of cancer. This metanalysis found that computer-aided diagnosis effectively detects melanoma; however, studies were low in quality. The authors suggest that these systems may help assist dermatologists in overcoming the limitations of human cognition for performing repetitive tasks.
Tschandl P, Codella N, Akay BN, et al. Lancet Oncol. 2019;20:938-947.
Machine learning may have the potential to improve clinical decision-making and diagnosis. In this study, machine-learning algorithms generally performed better than human experts in accurately diagnosing 7 types of pigmented skin lesions and the top 3 algorithms performed better than the 27 physicians.
Lowenstein EJ, Sidlow R. J Dermatol. 2018;179:1263-1276.
Cognitive shortcuts, or heuristics, are often used by experts to make decisions. This two-part review examines how heuristics affect diagnosis in dermatology. The first article discusses the strengths and weaknesses in visual diagnosis behaviors. The second recommends techniques for improving decision making and self-awareness of thought processes to avoid diagnostic error in dermatology practice.
Cossman JP, Wang M, Fischer AA. J Am Acad Dermatol. 2018;79:981-983.
A key component of resident education is learning from mistakes in real time to improve practice. An open and psychologically safe clinical learning environment enables residents and the health care workforce to develop the skills required to manage such situations appropriately.