Special or Theme Issue Do HSMRs really measure patient safety? Citation Text: Leatt P; Wen E; Sandoval C; Zelmer J; Webster G; Jarman B; McKinley J; Gibson D; Ardal S; Zahn C; Baker M; MacNaughton J; Flemming C; Bell R; Figler S; Brien SE; Ghali WA; Sheps SB; Penfold RB; Dean S; Flemons W; Moffatt M. Copy Citation Save Save to your library Print Share Facebook Twitter Linkedin Copy URL August 13, 2008 Leatt P; Wen E; Sandoval C; Zelmer J; Webster G; Jarman B; McKinley J; Gibson D; Ardal S; Zahn C; Baker M; MacNaughton J; Flemming C; Bell R; Figler S; Brien SE; Ghali WA; Sheps SB; Penfold RB; Dean S; Flemons W; Moffatt M. View more articles from the same authors. This special issue discusses the pros and cons of the hospital standardized mortality ratio (HSMR) measurement tool for improving patient safety and quality in the Canadian health care system. Table of contents Introduction Save Save to your library Print Share Facebook Twitter Linkedin Copy URL Cite Citation Citation Text: Leatt P; Wen E; Sandoval C; Zelmer J; Webster G; Jarman B; McKinley J; Gibson D; Ardal S; Zahn C; Baker M; MacNaughton J; Flemming C; Bell R; Figler S; Brien SE; Ghali WA; Sheps SB; Penfold RB; Dean S; Flemons W; Moffatt M. Copy Citation Related Resources From the Same Author(s) Harm to Healing - Partnering with Patients Who Have Been Harmed. August 1, 2012 Safe healthcare. March 6, 2005 Report on the Burden of Endemic Health Care–Associated Infection Worldwide. July 20, 2011 Errors test openness at Beth Israel Deaconess. Disclosures will benefit hospital, president insists. November 5, 2008 Re-Engineered Discharge (RED) Toolkit. March 27, 2013 Hospital internet site content on patient safety and medical errors. September 27, 2006 A meta-review of methods of measuring and monitoring safety in primary care. September 15, 2021 Saving Lives, Saving Money: The Imperative for Computerized Physician Order Entry in Massachusetts Hospitals. February 27, 2008 Systems Approach in Healthcare. October 31, 2018 Preventable adverse events in obstetrics: systemic assessment of their incidence and linked risk factors. February 16, 2022 Medication safety in older adults: home-based practice patterns. June 22, 2005 With Safety in Mind: Mental Health Services and Patient Safety. September 6, 2006 Wall of Silence: The Untold Story of the Medical Mistakes That Kill and Injure Millions of Americans. March 6, 2005 When Doctors Don't Listen. January 23, 2013 The Francis Report: One Year On. February 26, 2014 Can we use incident reports to detect hospital adverse events? March 12, 2008 After the Error: Speaking Out About Patient Safety to Save Lives. May 1, 2013 Management of drug shortages in the perioperative setting. February 6, 2013 The devil is in the detail: how a closed-loop documentation system for IV infusion administration contributes to and compromises patient safety. July 22, 2020 Safer Clinical Systems: Evaluation Findings. February 18, 2015 The safety journal: lessons learned with an error reporting tool to stimulate systems thinking. September 12, 2007 Design of a safety dashboard for patients. December 18, 2019 Using health information technology in residential aged care homes: an integrative review to identify service and quality outcomes. August 17, 2022 Engineering a Learning Healthcare System: A Look at the Future: Workshop Summary. July 27, 2011 Risk, Safety and Reliability Special Issue. May 20, 2009 Use of dimensional analysis to reduce medication errors. March 15, 2006 The Expert Panel Report to Texas Health Resources Leadership on the 2014 Ebola Events. September 23, 2015 Medication administration in anesthesia: time for a paradigm shift. October 31, 2007 Measuring harm and informing quality improvement in the Welsh NHS: the longitudinal Welsh national adverse events study. April 19, 2017 Teamwork and communication in surgical teams: implications for patient safety. January 9, 2008 Safer Care for the Acutely Ill Patient: Learning from Serious Incidents. October 24, 2007 Patient Safety Papers. November 30, 2005 Reconciling medications at admission: safe practice recommendations and implementation strategies. January 11, 2006 Implementing and validating a comprehensive unit-based safety program. May 11, 2005 Structured override reasons for drug–drug interaction alerts in electronic health records. May 15, 2019 Fatal Solutions: How a Healthcare System Used Tragedy to Transform Itself and Redefine Just Culture. October 5, 2022 Incidence of nosocomial COVID-19 in patients hospitalized at a large US academic medical center. October 21, 2020 Report on the Safe Use of Pick Lists in Ambulatory Care Settings. December 7, 2016 Partnering with Patients and Families to Design a Patient- and Family-Centered Health Care System: Recommendations and Promising Practices. June 4, 2008 Preventing Falls in Hospitals: A Toolkit for Improving Quality of Care. February 20, 2013 The role of teamwork in the professional education of physicians: current status and assessment recommendations. March 6, 2005 Effect of cognitive aids on adherence to best practice in the treatment of deteriorating surgical patients: a randomized clinical trial in a simulation setting. January 8, 2020 A lost voice. March 1, 2017 Challenges and opportunities from the Agency for Healthcare Research and Quality (AHRQ) research summit on improving diagnosis: a proceedings review. June 14, 2017 Impact of the unit-based patient safety officer. September 19, 2012 No excuses: the reality that demands action. September 1, 2005 Patient safety implications of wearing a face mask for prevention in the era of COVID-19 pandemic: a systematic review and consensus recommendations. February 15, 2023 Difficult diagnosis in the ICU: making the right call but beware uncertainty and bias. March 22, 2023 Hospital Survey on Patient Safety Culture: 2016 User Comparative Database Report. May 11, 2016 Understanding care transitions as a patient safety issue. June 29, 2011 Analysis of the interprofessional clinical learning environment for quality improvement and patient safety from perspectives of interprofessional teams. March 16, 2022 Using Six Sigma to improve patient safety in the perioperative process. August 28, 2013 Procuring Interoperability: Achieving High-Quality, Connected, and Person-Centered Care. October 24, 2018 Patient Safety Papers 6. May 2, 2012 Engagement of leadership in quality improvement initiatives: executive quality improvement survey results. July 11, 2007 Human costs of training doctors. August 11, 2010 Health IT-Enabled Quality Measurement: Perspectives, Pathways, and Practical Guidance. October 2, 2013 Patient Safety Papers 5. November 10, 2010 Hospitals, medical groups start to worry about skills of older doctors. September 2, 2015 Nurses' role in detecting deterioration in ward patients: systematic literature review. September 30, 2009 Chemotherapy dose limits set by users of a computer order entry system. March 8, 2006 For some troops, powerful drug cocktails have deadly results. February 23, 2011 Patient Safety and Adverse Events. September 23, 2009 Near-miss event analysis enhances the barcode medication administration process. January 17, 2018 Barriers to implementation of patient safety systems in healthcare institutions: leadership and policy implications. May 11, 2005 Emotion and coping in the aftermath of medical error: a cross-country exploration. March 4, 2015 IHI Framework for Improving Joy in Work. August 9, 2017 Patient Safety Papers 3. April 23, 2008 Hospital Medication Errors Commonplace. August 23, 2006 National and institutional trends in adverse events over time: a systematic review and meta-analysis of longitudinal retrospective patient record review studies. March 3, 2021 Patient-Centered Care Improvement Guide. November 12, 2008 Patient safety, systems design and ergonomics. June 21, 2006 Measuring shared mental models in healthcare. November 7, 2018 The Feasibility of Determining the Effectiveness and Cost-effectiveness of Medication Organisation Devices Compared with Usual Care for Older People in a Community Setting: Systematic Review, Stakeholder Focus Groups and Feasibility RCT. August 10, 2016 Incidence, nature and causes of avoidable significant harm in primary care in England: retrospective case note review. December 16, 2020 Fatigue and safety in paramedicine. December 18, 2019 Patient Safety Papers 4. September 2, 2009 Bipartisan Consensus: The Public Wants Well-Rested Medical Residents to Help Ensure Safe Patient Care. October 5, 2016 AHRQ Nursing Home Survey on Patient Safety Culture: 2014 User Comparative Database Report. November 19, 2014 The July effect: an analysis of never events in the nationwide inpatient sample. April 15, 2015 A system-based approach to managing patient safety in ambulatory care (and beyond). January 10, 2018 Considering human factors and developing systems-thinking behaviours to ensure patient safety. February 21, 2018 Diagnostic delays in infectious diseases. September 28, 2022 Reporting and Learning Systems for Medication Errors: The Role of Pharmacovigilance Centres. November 19, 2014 The Texas Health Presbyterian Hospital Ebola Crisis: A Perfect Storm of Human Errors, System Failures and Lack of Mindfulness. February 10, 2016 Why do healthcare professionals fail to escalate as per the early warning system (EWS) protocol? A qualitative evidence synthesis of the barriers and facilitators of escalation. February 17, 2021 Leading Health Care Transformation: A Primer for Clinical Leaders. August 12, 2015 Disclosing unanticipated outcomes to patients: the art and practice. September 12, 2007 Characteristics of morbidity and mortality conferences associated with the implementation of patient safety improvement initiatives, an observational study. March 16, 2016 Safe Patients, Smart Hospitals: How One Doctor's Checklist Can Help Us Change Health Care from the Inside Out. March 10, 2010 Cognitive Factors in Health Care. October 12, 2011 Concordance with urgent referral guidelines in patients presenting with any of six ‘alarm’ features of possible cancer: a retrospective cohort study using linked primary care records. August 10, 2022 How a change in hospital policy saved thousands of lives. November 8, 2017 Complications and Errors in Periodontal and Implant Therapy. September 13, 2023 Patient Safety. January 12, 2022 Analysis of errors in dictated clinical documents assisted by speech recognition software and professional transcriptionists. July 25, 2018 Impact of a pharmacist-directed pain management service on inpatient opioid use, pain control, and patient safety. February 27, 2019 Incorporating Health Information Technology Into Workflow Redesign: Request for Information Summary Report. November 17, 2010 Patient perceptions of hospital experiences: implications for innovations in patient safety. March 16, 2022 Hemodialysis bleeding events and deaths: an 18-year retrospective analysis of patient safety and root cause analysis reports in the Veterans Health Administration. November 24, 2021 View More Related Resources Patient Safety Authority Annual Reports. April 30, 2024 Interview In Conversation With... Dr. Michelle Schreiber on Measuring Patient Safety December 14, 2022 Perspective Measuring Patient Safety December 14, 2022 The impact of meaningful use and electronic health records on hospital patient safety. November 2, 2022 Hospital Performance Report. October 28, 2021 Hospital Compare. May 13, 2021 Culture as a Cure: Assessments of Patient Safety Culture in OECD Countries. July 15, 2020 Q3 Health Innovation Partners. January 8, 2020 HANYS' Report on Report Cards. November 20, 2019 Perceived patient safety culture in nursing homes associated with "Nursing Home Compare" performance indicators. July 24, 2019 Patient safety climate strength: a concept that requires more attention. August 31, 2016 A reduced duty hours model for senior internal medicine residents: a qualitative analysis of residents' experiences and perceptions. August 24, 2016 A systematic review of patient safety measures in adult primary care. May 18, 2016 Understanding the Role of Facility Design in the Acquisition and Prevention of Healthcare-Associated Infections. February 5, 2014 Exploring Alternatives To Malpractice Litigation. January 15, 2014 The Orthopaedic Error Index: development and application of a novel national indicator for assessing the relative safety of hospital care using a cross-sectional approach. December 18, 2013 Demonstrating high reliability on accountability measures at The Johns Hopkins Hospital. December 4, 2013 Improving America's Hospitals: The Joint Commission's Annual Report on Quality and Safety 2013. November 13, 2013 Validity of AHRQ patient safety indicators derived from ICD-10 hospital discharge abstract data (chart review study). November 6, 2013 Safety in numbers: the development of Leapfrog's composite patient safety score for US hospitals. October 16, 2013 Using AHRQ Patient Safety Indicators to detect postdischarge adverse events in the Veterans Health Administration. September 18, 2013 Validity of Agency for Healthcare Research and Quality Patient Safety Indicators at an academic medical center. August 21, 2013 National trends in hospital-acquired preventable adverse events after major cancer surgery in the USA. July 17, 2013 Resident Projects for Improvement. June 19, 2013 Using inpatient hospital discharge data to monitor patient safety events. May 8, 2013 Front-Line Ownership: Generating a Cure Mindset for Patient Safety. May 8, 2013 Prospects for comparing European hospitals in terms of quality and safety: lessons from a comparative study in five countries. March 27, 2013 Handoff Communication Tools. January 16, 2013 What is the NHS Safety Thermometer? November 28, 2012 Thirty-day, all-cause readmissions for elderly patients who have an injury-related inpatient stay. November 28, 2012 View More See More About The Topic Hospitals Health Care Executives and Administrators General Internal Medicine Hospital Medicine Epidemiology of Errors and Adverse Events View More
Errors test openness at Beth Israel Deaconess. Disclosures will benefit hospital, president insists. November 5, 2008
Saving Lives, Saving Money: The Imperative for Computerized Physician Order Entry in Massachusetts Hospitals. February 27, 2008
Preventable adverse events in obstetrics: systemic assessment of their incidence and linked risk factors. February 16, 2022
Wall of Silence: The Untold Story of the Medical Mistakes That Kill and Injure Millions of Americans. March 6, 2005
The devil is in the detail: how a closed-loop documentation system for IV infusion administration contributes to and compromises patient safety. July 22, 2020
The safety journal: lessons learned with an error reporting tool to stimulate systems thinking. September 12, 2007
Using health information technology in residential aged care homes: an integrative review to identify service and quality outcomes. August 17, 2022
The Expert Panel Report to Texas Health Resources Leadership on the 2014 Ebola Events. September 23, 2015
Measuring harm and informing quality improvement in the Welsh NHS: the longitudinal Welsh national adverse events study. April 19, 2017
Reconciling medications at admission: safe practice recommendations and implementation strategies. January 11, 2006
Structured override reasons for drug–drug interaction alerts in electronic health records. May 15, 2019
Fatal Solutions: How a Healthcare System Used Tragedy to Transform Itself and Redefine Just Culture. October 5, 2022
Incidence of nosocomial COVID-19 in patients hospitalized at a large US academic medical center. October 21, 2020
Partnering with Patients and Families to Design a Patient- and Family-Centered Health Care System: Recommendations and Promising Practices. June 4, 2008
The role of teamwork in the professional education of physicians: current status and assessment recommendations. March 6, 2005
Effect of cognitive aids on adherence to best practice in the treatment of deteriorating surgical patients: a randomized clinical trial in a simulation setting. January 8, 2020
Challenges and opportunities from the Agency for Healthcare Research and Quality (AHRQ) research summit on improving diagnosis: a proceedings review. June 14, 2017
Patient safety implications of wearing a face mask for prevention in the era of COVID-19 pandemic: a systematic review and consensus recommendations. February 15, 2023
Difficult diagnosis in the ICU: making the right call but beware uncertainty and bias. March 22, 2023
Analysis of the interprofessional clinical learning environment for quality improvement and patient safety from perspectives of interprofessional teams. March 16, 2022
Procuring Interoperability: Achieving High-Quality, Connected, and Person-Centered Care. October 24, 2018
Engagement of leadership in quality improvement initiatives: executive quality improvement survey results. July 11, 2007
Health IT-Enabled Quality Measurement: Perspectives, Pathways, and Practical Guidance. October 2, 2013
Nurses' role in detecting deterioration in ward patients: systematic literature review. September 30, 2009
Barriers to implementation of patient safety systems in healthcare institutions: leadership and policy implications. May 11, 2005
National and institutional trends in adverse events over time: a systematic review and meta-analysis of longitudinal retrospective patient record review studies. March 3, 2021
The Feasibility of Determining the Effectiveness and Cost-effectiveness of Medication Organisation Devices Compared with Usual Care for Older People in a Community Setting: Systematic Review, Stakeholder Focus Groups and Feasibility RCT. August 10, 2016
Incidence, nature and causes of avoidable significant harm in primary care in England: retrospective case note review. December 16, 2020
Bipartisan Consensus: The Public Wants Well-Rested Medical Residents to Help Ensure Safe Patient Care. October 5, 2016
AHRQ Nursing Home Survey on Patient Safety Culture: 2014 User Comparative Database Report. November 19, 2014
Considering human factors and developing systems-thinking behaviours to ensure patient safety. February 21, 2018
Reporting and Learning Systems for Medication Errors: The Role of Pharmacovigilance Centres. November 19, 2014
The Texas Health Presbyterian Hospital Ebola Crisis: A Perfect Storm of Human Errors, System Failures and Lack of Mindfulness. February 10, 2016
Why do healthcare professionals fail to escalate as per the early warning system (EWS) protocol? A qualitative evidence synthesis of the barriers and facilitators of escalation. February 17, 2021
Characteristics of morbidity and mortality conferences associated with the implementation of patient safety improvement initiatives, an observational study. March 16, 2016
Safe Patients, Smart Hospitals: How One Doctor's Checklist Can Help Us Change Health Care from the Inside Out. March 10, 2010
Concordance with urgent referral guidelines in patients presenting with any of six ‘alarm’ features of possible cancer: a retrospective cohort study using linked primary care records. August 10, 2022
Analysis of errors in dictated clinical documents assisted by speech recognition software and professional transcriptionists. July 25, 2018
Impact of a pharmacist-directed pain management service on inpatient opioid use, pain control, and patient safety. February 27, 2019
Incorporating Health Information Technology Into Workflow Redesign: Request for Information Summary Report. November 17, 2010
Patient perceptions of hospital experiences: implications for innovations in patient safety. March 16, 2022
Hemodialysis bleeding events and deaths: an 18-year retrospective analysis of patient safety and root cause analysis reports in the Veterans Health Administration. November 24, 2021
Interview In Conversation With... Dr. Michelle Schreiber on Measuring Patient Safety December 14, 2022
The impact of meaningful use and electronic health records on hospital patient safety. November 2, 2022
Perceived patient safety culture in nursing homes associated with "Nursing Home Compare" performance indicators. July 24, 2019
A reduced duty hours model for senior internal medicine residents: a qualitative analysis of residents' experiences and perceptions. August 24, 2016
Understanding the Role of Facility Design in the Acquisition and Prevention of Healthcare-Associated Infections. February 5, 2014
The Orthopaedic Error Index: development and application of a novel national indicator for assessing the relative safety of hospital care using a cross-sectional approach. December 18, 2013
Demonstrating high reliability on accountability measures at The Johns Hopkins Hospital. December 4, 2013
Improving America's Hospitals: The Joint Commission's Annual Report on Quality and Safety 2013. November 13, 2013
Validity of AHRQ patient safety indicators derived from ICD-10 hospital discharge abstract data (chart review study). November 6, 2013
Safety in numbers: the development of Leapfrog's composite patient safety score for US hospitals. October 16, 2013
Using AHRQ Patient Safety Indicators to detect postdischarge adverse events in the Veterans Health Administration. September 18, 2013
Validity of Agency for Healthcare Research and Quality Patient Safety Indicators at an academic medical center. August 21, 2013
National trends in hospital-acquired preventable adverse events after major cancer surgery in the USA. July 17, 2013
Prospects for comparing European hospitals in terms of quality and safety: lessons from a comparative study in five countries. March 27, 2013
Thirty-day, all-cause readmissions for elderly patients who have an injury-related inpatient stay. November 28, 2012