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Health Services Research & Development

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Research Topics

Patient Safety

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.

Search results were generated based on the search term "Patient Safety". Results are updated weekly, as new data are available.

VIEW: Citations | Publication Briefs | Studies | HSR&D Briefs, Reports, Newsletters | Topic Spotlight | Cyberseminars | Videos | Podcasts | Other Resources


(5 of more than 256 PATIENT SAFETY focused publications)

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Publication Briefs

(5 of more than 35 PATIENT SAFETY focused publication briefs)

  • 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
  • Eight Organizational Target Areas for Improving Access to Primary Care
    This study sought to identify priorities for improving healthcare organization management of patient access to primary care based on prior evidence and a stakeholder panel. Findings showed that optimal access to primary care for enrolled patient populations requires active ongoing management of at least eight diverse target areas (two organizational structure targets, four process improvements, an...
    Date: February 1, 2020
  • Excess Medication Supply Potentially High among Veterans Using VA Healthcare
    This study sought to determine the prevalence of potential medication excess in the VA healthcare system – and to identify associated medication-, patient-, and system-level factors. Findings showed that medication excess was high among VA healthcare users in this study, with nearly two-thirds of patients (64%) experiencing at least one duplicative medication. Medication excess was more likely for...
    Date: November 1, 2019
  • Unintentional Consequences of FDA Warnings: Varenicline
    This study examined the association between FDA drug safety communications and the use of varenicline (Chantix) – a prescription drug used to treat addiction to smoking. Investigators tracked varenicline and nicotine replacement therapy (NRT) prescribing and evaluated the potential consequences of decreased varenicline use on lost opportunities to assist patients with quitting smoking and health o...
    Date: September 4, 2019

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( 5 of more than 27 PATIENT SAFETY focused projects )

Project No.  Title  PI  Funding Start   
PPO 20-148 Promoting Antimicrobial Stewardship and Patient Safety by Implementing Interventions to Evaluate and Delabel Penicillin Allergy Kakumanu, Sujani 2021-02-01
RRP 11-379 Off-Label Use of Antipsychotics: Determinants and Impact on Patient Safety Hudson, Teresa 2012-07-01
RRP 11-022 How to Interpret and Use Patient Safety Indicator (PSI) Reports Shin, Marlena 2011-10-01
NRI 10-124 Improving Patient Safety: Context and Nurses' Work Processes for Pressure Ulcers Soban, Lynn 2011-06-01
CDA 09-024 Circumventing Health IT: Identifying Patient Safety Risks Saleem, Jason 2009-10-01

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HSR&D Briefs, Reports, Newsletters

5 sample "Patient Safety" publications displayed.

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Topic Spotlight

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The most recent "Patient Safety" seminars are displayed.

Date Title Presenter(s)
2/25/2021 Leveraging VA Text Note Data for Quality Measurement: A Case Study of a Novel Measurement Tool for Cardiac Device Procedures Branch-Elliman, Westyn  
Mull, Hillary  
4/12/2018 HSR&D Health System Impact Award: Enhancing Patient Safety by Preventing Catheter-Associated Urinary Tract Infection (CAUTI): The Journey Continues Saint, Sanjay  
Krein, Sarah  
12/20/2017 The ED-PACT Tool: Communicating Veterans’ Care Needs After ED Visits Cordasco, Kristina  
12/7/2017 De-implementing inhaled corticosteroids to improve quality and safety for patients with mild-to-moderate COPD: Mixed-methods findings of primary-care providers’ perspectives Helfrich, Christian  
Stryczek, Krysttel  
8/30/2017 Integrating Pattern Matching and Active Thinking Support in Information Displays for Clinicians Weir, Charlene  
Nebeker, Jonathan  
Slager, Stacey  
Del Fiol, Guilherme  

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There are currently no podcasts for this topic.

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Other Resources

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