Journal Article
The purpose of this updated review is to reassess the benefits and harms of fall prevention programs in acute care settings and to identify factors associated with successful implementation of these programs.
Journal Article
This paper describes the first phase of a three-phase effort to conduct an evidence-based assessment of patient safety strategies. The paper describes a framework for reviewing existing studies and prospectively evaluating new studies of the implementation of patient safety practices.
Journal Article
A small percentage of patients die during hospitalization or shortly thereafter, and it is widely believed that more or better nursing care could prevent some of these deaths.
Journal Article
The authors redesigned an electronic clinical reminder to improve identification and management of Veterans at high risk for falls, and piloted the reminder in 3 Veterans Health Administration community-based outpatient clinics.
Journal Article
The Agency for Healthcare Research and Quality commissioned a team to reexamine the evidence behind key patient safety strategies (PSSs).
Journal Article
Better reporting of outcomes, implementation, adherence, intervention components, and comparison group information is necessary to establish evidence on how hospitals can successfully prevent falls.
Commentary
The problem is that on any given day, disaster preparedness takes a back seat to ongoing operations. The tyranny of the urgent prevents hospital administrators from making investments in preparedness, writes Art Kellermann.
Research Brief
Providers can dramatically improve American health care by focusing on value instead of volume, eliminating wasteful and inappropriate care, applying the best available evidence to their practices, and enhancing patient safety.
Content
In its second term, the Obama Administration can restrain further health care spending growth—without compromising quality—by employing four broad strategies: fostering efficient and accountable providers, engaging and empowering consumers, promoting population health, and facilitating high-value innovation.
Research Brief
Analyses indicated that although physicians uniformly felt responsible for assessing and promoting adherence to prescriptions, only a minority of them asked detailed questions about adherence.
Blog
Computerized clinical decision support (CDS) systems have been developed to enhance physician decisionmaking and reduce the incidence of avoidable medical errors. Drug-drug interaction warnings are a mainstay of CDS systems, but they give rise to a fundamental problem that limits the utility of the systems to date.
Blog
A patient safety event is any event or action that could lead to a worse outcome for a patient, from bedsores to post-operative respiratory failure.
Journal Article
New electronic clinical decision support (CDS) systems are intended to reduce medical errors but sometimes have the unexpected and perverse effect of overwhelming physicians with potential warnings about trivial events, particularly regarding drug-drug interactions.
Journal Article
This article explores provider opinions about responsibility for medication adherence and examine physician--patient interactions to illustrate how adherence discussions are initiated.
Report
For nearly a decade, RAND researchers have studied how health information technology (HIT) stands to change health care.
Commentary
Hospitals that perform better on the survey tend to do better on clinical measures, have fewer readmissions within 30 days and have lower risk-adjusted mortality, write Marc Elliott and Alan Zaslavsky.
Journal Article
Examines net costs to teaching hospitals and cost-effectiveness to society across a range of hypothetical changes in preventable adverse events (PAEs).
Journal Article
Pediatric residents who support further reductions in work-hours believe reductions have positive effects on patient care, education, and quality of life.
Journal Article
Quality of prescribing for older vets -- measured by high-risk medications and drug--disease interactions -- varies across VA facilities. Prescribing is better at facilities that care for a larger number of older veterans and have formal geriatric education.
Journal Article
Examines co-occurrence of iatrogenic events in US hospitals. Using Agency for Healthcare Research and Quality patient safety indicators (PSIs), the authors defined multiple patient safety events (MPSEs) as the occurrence of multiple PSIs during a single hospitalization.
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