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Marshall M, Cruickshank L, Shand J, et al. BMJ Qual Saf. 2017;26:751-759.
Marshall M ; Cruickshank L ; Shand J; et al. Assessing the safety culture of care homes: a multimethod evaluation of the adaptation, face validity and feasibility of the Manchester Patient Safety Framework. BMJ Qual Saf. 2017; 26: 751-759
This study adapted a patient safety framework for use by frontline staff in long-term care facilities. Researchers reported that the simplified tool, which they named "Culture is Key," was feasible and acceptable for measuring safety culture.
Serious misdiagnosis-related harms in malpractice claims: the "Big Three"—vascular events, infections, and cancers.
Newman-Toker DE, Schaffer AC, Yu-Moe CW, et al. Diagnosis (Berl). 2019;227-240.
Analysis of human performance deficiencies associated with surgical adverse events.
Suliburk JW, Buck QM, Pirko CJ, et al. JAMA Netw Open. 2019;2:e198067.
Investigating for improvement? Five strategies to ensure national patient safety investigations improve patient safety.
Macrae C. J R Soc Med. 2019 May 22; [Epub ahead of print].
What US hospitals are currently doing to prevent common device-associated infections: results from a national survey.
Saint S, Greene MT, Fowler KE, et al. BMJ Qual Saf. 2019;28:741-749.
What quality and safety of care for patients admitted to clinically inappropriate wards: a systematic review.
La Regina M, Guarneri F, Romano E, et al. J Gen Intern Med. 2019;34:1314-1321.
Type 1 diabetes defined by severe insulin deficiency occurs after 30 years of age and is commonly treated as type 2 diabetes.
Thomas NJ, Lynam AL, Hill AV, et al. Diabetologia. 2019;62:1167-1172.
Association between long-term opioid use in family members and persistent opioid use after surgery among adolescents and young adults.
Harbaugh CM, Lee JS, Chua KP, et al. JAMA Surg. 2019;154:e185838.
Prevalence, underlying causes, and preventability of sepsis-associated mortality in US acute care hospitals.
Rhee C, Jones TM, Hamad Y, et al; Centers for Disease Control and Prevention (CDC) Prevention Epicenters Program. JAMA Netw Open. 2019;2:e187571.
Decisions and repercussions of second victim experiences for mothers in medicine (SAVE DR MoM).
Gupta K, Lisker S, Rivadeneira NA, et al. BMJ Qual Saf. 2019;28:564-573.
Appropriateness of outpatient antibiotic prescribing among privately insured US patients: ICD-10-CM based cross sectional study.
Chua KP, Fischer MA, Linder JA. BMJ. 2019;364:k5092.
Association of adverse effects of medical treatment with mortality in the United States: a secondary analysis of the Global Burden of Diseases, Injuries, and Risk Factors study.
Sunshine JE, Meo N, Kassebaum NJ, Collison ML, Mokdad AH, Naghavi M. JAMA Netw Open. 2019;2:e187041.
Medicine Safety: Take Care.
Lim R, Semple S, Ellett LK, Roughead L. Canberra, Australia: Pharmaceutical Society of Australia; 2019.
Race differences in reported harmful patient safety events in healthcare system high reliability organizations.
Thomas AD, Pandit C, Krevat SA. J Patient Saf. 2018 Dec 21; [Epub ahead of print].
Lessons learned from implementing a principled approach to resolution following patient harm.
Smith KM, Smith LL, Gentry JC, Mayer DB. J Patient Saf Risk Manag. 2019;24:83–89.
Quality improvement priorities for safer out-of-hours palliative care: lessons from a mixed-methods analysis of a national incident-reporting database.
Williams H, Donaldson LJ, Noble S, et al. Palliat Med. 2019;33:346-356.
Adverse Events in Long-Term-Care Hospitals: National Incidence Among Medicare Beneficiaries.
Levinson DR. Washington, DC: US Department of Health and Human Services, Office of the Inspector General; November 2018. Report No. OEI-06-14-00530.
Fatal flaws in clinical decision making.
Davis SS, Babidge WJ, McCulloch GAJ, Maddern GJ. ANZ J Surg. 2019;89:764-768.
Learning from tragedy: the Julia Berg story.
Graber ML, Berg D, Jerde W, Kibort P, Olson APJ, Parkash V. Diagnosis (Berl). 2018;5:257-266.
Dissecting communication barriers in healthcare: a path to enhancing communication resiliency, reliability, and patient safety.
Guttman OT, Lazzara EH, Keebler JR, Webster KLW, Gisick LM, Baker AL. J Patient Saf. 2018 Nov 9; [Epub ahead of print].
Unintentionally retained foreign objects: a descriptive study of 308 sentinel events and contributing factors.
Steelman VM, Shaw C, Shine L, Hardy-Fairbanks AJ. Jt Comm J Qual Patient Saf. 2019;45:249–258.
Association of cataract surgical outcomes with late surgeon career stages: a population-based cohort study.
Campbell RJ, El-Defrawy SR, Gill SS, et al. JAMA Ophthalmol. 2019;137:58-64.
Predictors of adverse events and medical errors among adult inpatients of psychiatric units of acute care general hospitals.
Vermeulen JM, Doedens P, Cullen SW, et al. Psychiatr Serv. 2018;69:1087-1094.
Trends in anesthesia-related liability and lessons learned.
Mora JC, Kaye AD, Romankowski ML, Delahoussaye PJ, Urman RD, Przkora R. Adv Anesth. 2018;36:231-249.
Social disparities in patient safety in primary care: a systematic review.
Piccardi C, Detollenaere J, Vanden Bussche P, Willems S. Int J Equity Health. 2018;17:114.
Characteristics of healthcare organisations struggling to improve quality: results from a systematic review of qualitative studies.
Vaughn VM, Saint S, Krein SL, et al. BMJ Qual Saf. 2019;28:74-84.
PSNET: Patient Safety Network
PSNet is produced for the Agency for Healthcare Research and Quality by a team of editors at the University of California, San Francisco with guidance from a prominent Technical Expert/Advisory Panel. The AHRQ PSNet site was designed and implemented by Silverchair.
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