Free Webinar for Hospitals – PSO: What You Should Know

pso-whatyoushouldknowThursday, April 28th from noon-1pm Central Time

The Center for Patient Safety is hosting a webinar to share information and answer questions on how joining a PSO can help you meet the requirements of the new CMS regulation for requirements under the Affordable Care Act by January 2017:

  1.     Learn the benefits of joining a Patient Safety Organization (PSO)
  2.     Learn how joining a PSO can support your patient safety efforts
  3.     Learn how the PSO protections can apply to your organization

This webinar is open to healthcare professionals in hospitals with a desire to improve patient safety and reduce patient risk, including professionals working in quality, risk, patient safety, quality improvement, and legal staff, executive leaders, and outside counsel and consultants for hospitals or health systems. Download flyer.

PSO 101: Introduction to PSOs

November 17 @ 12pm CST   – Free webinar

Questions and Answers signpostConfused about Patient Safety Organizations (PSOs)?   You’re not alone!

Join the experts at the Center for Patient Safety as they describe the basics of the Patient Safety and Quality Improvement Act (PSQIA) and provide an introduction to the terminology and concepts of PSO participation.  Applications to EMS, LTC, medical offices, and hospitals will be presented.   Q&A available during webinar.   Register

Pilot program launched for EMS behavior health data

The Center for Patient Safety works closely with many EMS services around the United States to improve patient safety and reduce preventable harm. Over the past year EMS leaders have expressed interest to better serve the needs of the mental health population. In the process many of these leaders have discovered there is little data around these encounters and transports. This includes emergency calls or scene encounters as well as inter facility transfers between hospitals.

Therefore, approximately six months ago the Center’s EMS data committee started to explore the opportunity to collect data around these patient encounters. This includes understanding what happens on an emergency scene but also during an inter facility transfer. Recently the committee finalized the data collection formats for this project. Starting this month a pilot program was initiated to collect data and so far participation has been strong.

Why a PSO? Participating with a federally listed PSO (Patient Safety Organization) that works with EMS offers many important benefits. PSO’s were created to support shared learning under the Patient Safety Quality Improvement Act of 2005. A PSO does this with federal safeguards to protect discoverability of event analysis and deliberations. Event information is aggregated and de- identified then shared with participants in various learning opportunities. Many EMS services are hesitant to share data out of the fear of litigation and concern about their public image

The behavior health pilot will collect data around several key areas including provider and patient safety as well as resource utilization. In addition, many leaders would like to understand the frequency and dynamics of specific high risk events such as patient elopement from an ambulance.  Data will also support understanding community’s mental health resources as this often determines the destination for this patient population.

EMS leaders are hopeful that this new area of data collection will help everyone understand the current state more clearly. The Center and its many PSO participants are excited to be involved with this project. Ultimately we hope it drives greater patient and provider safety while we also learn how to save healthcare dollars.

Center’s Executive Director Comments on Recent Health Leaders Media on Event Reporting

Read below Becky Miller’s comment to the recent Health Leaders Media Article, Never Event Frequency Troubling, Standards Lacking

This is such an important topic for discussion in healthcare. Here at the Center for Patient Safety, we offer another perspective. How can we learn as much as possible about what errors occur, why they occur and how to prevent them?  This can be accomplished by reporting not just sentinel or “never events” by a few types of providers, but reporting all errors plus near misses and unsafe conditions by all types of licensed providers.  (more…)

CPS March 13th Conference! Continuing Education Available! Early Bird Registration Ends 2/2!

The Center’s 9th Annual Conference on March 13, offers Continuing Education for physicians, risk managers and is pending for nursing and quality professionals.   Conference information, registration and information about continuing education is available at

A Message from the CPS Executive Director
Becky Miller, Executive Director

Becky Miller, MHA, CPHQ, FACHE, CPPS
Executive Director
Center for Patient Safety

We are excited about the Center for Patient Safety’s 10th year as a part of the solution to address the multitude of issues surrounding patient safety.   Safety culture is the KEY!   Medical error prevention and reduced patient harm occurs in organizations with a strong safety culture, supporting and encouraging the reporting of adverse events, near misses and unsafe conditions; reporting that leads to learning what and why errors occur and to sharing of solutions.

We hope you will join us as the celebration continues throughout 2015, including our March patient safety conference and available resources during Patient Safety Awareness Week!

Find out more about Patient Safety Awareness Week.

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2014 EMS Patient Safety Conference Success!

The Center for Patient Safety’s Annual EMS Patient Safety Conference was a success!   We had great speakers who brought new ideas and concepts that helped stretch the imagination of those attending.

  • David Williams from the Institute for Healthcare Improvement shared the Plan-Do-Study-Act method for organizational change and success.
  • Tom Judge, Executive Director of Lifeflight of Maine having years of EMS experience, offered practical advice regarding the changes that he has witnessed in EMS.   He also discussed how organizations can utilize a culture of safety to help manage risk.
  • Michael Bachman from Wake County EMS in Raleigh, NC shared his insights and experience regarding the coordination of patient safety using mobile integrated healthcare, focusing on “For the patient, not to the patient”.


Center releases Fall 2014 EMS PSO Newsletter

Fall EMS 2014The latest newsletter from the Center for Patient Safety has been released. The Fall 2014 EMS PSONews contains information on the recently released PSO Safety Alert and EMS Safety Watch, articles on the legal environment to help maximize federal protections from the PSO, patient safety culture topics, and much more!   Download the newsletter or view on Issuu.

CPS Safety Watch/Alert: EMS Stretchers

Safety WatchMultiple stretcher-related incidents have been reported to the Center’s Patient Safety Organization.   The areas of concern are from real events.

Released 08.11.2014.

MEMSA EMS Expo & Conference

Don’t miss Dr. Scott Shappell presenting…

  • Fatigue Management
  • Managing Human Error in Complex Systems

It’s not too late to register for the MEMSA EMS Expo & Conference!   Can’t come for the entire conference, that’s okay, come one or two days but don’t miss out…

The conference planners have successfully found leaders in their field to share details about what’s new and happening in EMS.   Join over 35 vendors to see the latest and   greatest in equipment, technology and services.


PSO Case Law: Ungurian v. Beyzman, et al., 2020 PA Super 105:

A recent Pennsylvania case shows how courts narrowly interpret the PSQIA, ignoring the D & A pathway and the clear language of the Final Rule. (Ungurian v. Beyzman, et al., 2020 PA Super 105). The cour

Joint Commission New Sentinel Event Alert 61: Managing the Risks of Direct Oral Anticoagulants:

The Center for Patient Safety wants to share this important harm-prevention advice from The Joint Commission and its Sentinel Event Alert: Managing the Risks of Direct Oral Anticoagulants. The Joint Commis

CPS Safety Watch/Alert – Culture Can Improve the Control of Multi-Drug Resistant Organisms:

Issue: A number of events reported co CPS’ Patient Safety Organization (PSO) demonstrate poor handoff communication about the patients’ infectious disease status Examples include: Patient with

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The Center for Patient Safety believes that collaboration and sharing are the best ways to drive improvement. We strive to provide the right solutions and resources to improve healthcare safety and quality.