The role of patient safety research is to understand how best to ensure that patients, their clinical environments, and their clinical processes and systems are safe—and not vulnerable to causing inadvertent harm. VA health services investigators conduct research into patient safety that encompasses everything from appropriate patient identification processes to preventing hospital-acquired infections to assessing clinical and organizational leadership attitudes.
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(5 of more than 262 PATIENT SAFETY focused publications)
- Cordasco KM, Watson T, Glassman P. When Lightning Hits Your Spaceship: the Power and Peril of Habits in Aerospace and Patient Safety. Journal of general internal medicine. 2022 May 1; 37(7):1777-1779.
- Manojlovich M, Hofer TP, Krein SL. Advancing Patient Safety Through the Clinical Application of a Framework Focused on Communication. Journal of Patient Safety. 2021 Dec 1; 17(8):e732-e737.
- Murphy DR, Savoy A, Satterly T, Sittig DF, Singh H. Dashboards for visual display of patient safety data: a systematic review. BMJ health & care informatics. 2021 Oct 1; 28(1).
- Preston-Suni K, Celedon MA, Cordasco KM. Patient Safety and Ethical Implications of Health Care Sick Leave Policies in the Pandemic Era. Joint Commission Journal on Quality and Patient Safety. 2021 Oct 1; 47(10):673-676.
- Fauer A, Wright N, Lafferty M, Harrod M, Manojlovich M, Friese CR. Influences of Physical Layout and Space on Patient Safety and Communication in Ambulatory Oncology Practices: A Multisite, Mixed Method Investigation. HERD. 2021 Oct 1; 14(4):270-286.
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(5 of more than 38 PATIENT SAFETY focused publication briefs)
- High Acute Inpatient Psychiatric Bed Occupancy Associated with Increased Rates of Suicide among Veterans
This study examined the relationship between the incidence of suicide among Veterans and acute inpatient psychiatric bed availability using occupancy as a measure of hospital strain and access. Findings showed that high acute VA psychiatric bed occupancy (>95%), not beds per capita, was associated with a 10% higher incidence of death by suicide. Extrapolated over the 6-year study across 145 hospit...
Date: August 16, 2021
- Need for Systemic, Multi-Level Interventions for Patient-Perpetrated Sexual Harassment in VA Healthcare Settings
This study sought to identify challenges and stakeholder recommendations for addressing patient-perpetrated sexual harassment of women staff and patients at VA facilities. Findings highlight the complexity of addressing patient-perpetrated harassment and underscore the need for systemic, multi-level interventions. Perceived organizational-level challenges included a climate of tolerance for harass...
Date: February 25, 2021
- Veterans Open to Discussing Firearms Storage Safety in Primary Care Setting
This quality improvement project – part of a larger study to develop a training program on firearms storage safety (FSS) for VA primary care teams – describes Veterans’ perspectives on discussing FSS during primary care visits. Most Veterans in the study agreed that primary care is an acceptable setting for FSS discussions, but staff need to build rapport and trust by using a personal, caring, and...
Date: January 26, 2021
- JAMA Features Reflections on “Crossing the Quality Chasm” 20 Years Later
This issue of JAMA includes two articles that reflect on the recommendations of the Institute of Medicine’s 2001 Crossing the Quality Chasm report that, 20 years ago, asked healthcare stakeholders to collaborate in order to provide care that is safe, effective, patient-centered, timely, efficient, and equitable. Both articles discuss how to make more progress toward these goals, while a third arti...
Date: December 22, 2020
- VA HIT-Related Outpatient Diagnostic Delays
This study evaluated the role of health information technology (HIT) in the root cause analyses (RCAs) of outpatient diagnostic delays submitted to the VA National Center for Patient Safety, which leads patient safety initiatives and uses RCAs of adverse events and close calls to promote learning across the VA healthcare system. Findings showed that of the 214 RCAs included in this study, 88 invol...
Date: June 25, 2020
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( 5 of more than 27 PATIENT SAFETY focused projects
|| Promoting Antimicrobial Stewardship and Patient Safety by Implementing Interventions to Evaluate and Delabel Penicillin Allergy
|| Off-Label Use of Antipsychotics: Determinants and Impact on Patient Safety
|| How to Interpret and Use Patient Safety Indicator (PSI) Reports
|| Improving Patient Safety: Context and Nurses' Work Processes for Pressure Ulcers
|| Circumventing Health IT: Identifying Patient Safety Risks
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Read more on this topic and related topics
The most recent "Patient Safety" seminars are displayed.
Electronic Triggers to Monitor Patient Safety in Primary Care
|| Hagan, Scott
Speaking Up for Patient Safety: It’s Complicated
|| Gilmartin, Heather
Using PowerBI to Accelerate National Implementation of Evidence-based Practices
|| Dhruva, Sanket
Leveraging VA Text Note Data for Quality Measurement: A Case Study of a Novel Measurement Tool for Cardiac Device Procedures
|| Branch-Elliman, Westyn
HSR&D Health System Impact Award: Enhancing Patient Safety by Preventing Catheter-Associated Urinary Tract Infection (CAUTI): The Journey Continues
|| Krein, Sarah
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