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.
Kisely S, Warren N, McMahon L, et al. BMJ. 2020;369:m1642.
This meta-analysis examined the psychological effects of viral outbreaks on clinicians and effective strategies to manage stress and psychological distress. The review included 59 studies involving severe acute respiratory syndrome (SARS), COVID-19, Middle East respiratory syndrome (MERS), Ebola and influence. Compared with clinicians at lower risk, those in contact with affected patients had greater levels of both acute and post-traumatic stress, as well as psychological distress. Clinicians were at increased risk for psychological distress if they were younger, more junior, had dependent children, or had an infected family member. Identified interventions to mitigate stress and psychological distress included clear communication, infectious disease training and education, enforcement of infection control procedures, adequate supply of personal protective equipment (PPE) and access to psychological support.
Nowotny BM, Davies-Tuck M, Scott B, et al. BMJ Qual Saf. 2021;30:186-194.
After a cluster of perinatal deaths was identified in 2015, the authors assessed 15-years of routinely collected observational data from 7 different sources (administrative, patient complaint and legal data) preceding the cluster to determine whether the incidents could have been predicted and prevented. The extent of clinical activity along with direct-to-service patient complaints were found to be the more promising for purposes of potential predictive signals. The authors suggest that use of some routinely collected data of these types show promise; however, further work needs to be done on specificity and sensitivity of the data and to gain access to comparator data is needed.
Ameratunga R, Klonin H, Vaughan J, et al. BMJ. 2019;364:l706.
Recent high-profile incidents in the United States and the United Kingdom have fueled debate on the impact of criminalizing medical mistakes that result in patient harm. This article compares how the United Kingdom and New Zealand respond when patients experience unintentional health care–related harm. The authors emphasize the importance of focusing on resolution and learning to improve patient safety.
Cleary M, Lees D, Lopez V. Issues Ment Health Nurs. 2018;39:980-982.
Effective apology behaviors improve opportunities for error resolution for clinicians, patients, and families. This commentary highlights the importance of expressing empathy, considering legal implications, and demonstrating individual, leadership, and organizational support of open disclosure.
Scott IA, Soon J, Elshaug AG, et al. Med J Aust. 2017;206:407-411.
Heuristics and cognitive biases can contribute to uninformed decision making. This review explores how biases affect overuse and suggests patient stories, huddles, and shared decision making as strategies to mitigate cognitive biases in health care.
The Quality Improvement Committee. Wellington, New Zealand; 2006-2013.
Considered a starting point for a national reporting initiative, this series of annual reports provides statistics on serious and sentinel events in New Zealand's 21 District Health Boards. The reports aim to encourage transparency in New Zealand medical practice and bolster knowledge to prevent future errors.