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psnet.ahrq.gov/web-mm/wrong-catheter-right-patient
May 16, 2022 - techniques, effective methods for safely using VOs are essential. 6 Approach to Improving Safety When analyzing
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psnet.ahrq.gov/node/33625/psn-pdf
January 01, 2006 - Aviation Safety Methods: Quickly Adopted but Questions
Remain
January 1, 2006
Thomas EJ. Aviation Safety Methods: Quickly Adopted but Questions Remain. PSNet [internet]. 2006.
https://psnet.ahrq.gov/perspective/aviation-safety-methods-quickly-adopted-questions-remain
Perspective
On August 2, 2005, Air France flig…
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psnet.ahrq.gov/node/33639/psn-pdf
September 01, 2006 - In Conversation with...James P. Bagian, MD
September 1, 2006
In Conversation with..James P. Bagian, MD. PSNet [internet]. 2006.
https://psnet.ahrq.gov/perspective/conversation-withjames-p-bagian-md
Dr. Robert Wachter, Editor, AHRQ WebM&M: Where did your interest in safety come from?
Dr. James Bagian: I don't know …
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psnet.ahrq.gov/node/865466/psn-pdf
March 27, 2024 - Equity in Patient Safety
March 27, 2024
Thomas A, Lee M, Mossburg S. Equity in Patient Safety. PSNet [internet]. 2024.
https://psnet.ahrq.gov/perspective/equity-patient-safety
Introduction
Safety and equity are among the central components that determine quality of care, according to nonprofit
advisory agencies l…
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psnet.ahrq.gov/perspective/equity-patient-safety
September 24, 2024 - Annual Perspective
Equity in Patient Safety
Angela D. Thomas, DrPH, MPH, MBA; Merton Lee, PhD, PharmD; Sarah Mossburg, RN, PhD
| March 27, 2024
View more articles from the same authors.
Citation Text:
Thomas A, Lee M, Mossburg S. Equity in Patient Safety. …
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psnet.ahrq.gov/node/33670/psn-pdf
July 01, 2008 - In Conversation with...Albert Wu, MD, MPH
July 1, 2008
In Conversation with..Albert Wu, MD, MPH. PSNet [internet]. 2008.
https://psnet.ahrq.gov/perspective/conversation-withalbert-wu-md-mph
Editor's note: Albert Wu, MD, MPH, is Professor of Health Policy and Management at the Johns Hopkins
School of Public Health…
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psnet.ahrq.gov/node/33642/psn-pdf
November 01, 2006 - In Conversation With...Donald A. Norman, PhD
November 1, 2006
In Conversation With..Donald A. Norman, PhD. PSNet [internet]. 2006.
https://psnet.ahrq.gov/perspective/conversation-withdonald-norman-phd
Dr. Robert Wachter, Editor, AHRQ WebM&M: Tell us a little bit about your background. How did you
become interested…
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psnet.ahrq.gov/perspective/diagnostic-errors-new-chapter-patient-safety-science-policy-and-practice
January 01, 2016 - learned is that IOM reports tend to stay at a very high level, and it's up to the stakeholders to start analyzing
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psnet.ahrq.gov/web-mm/diagnosing-diagnostic-mistakes
April 30, 2014 - care are considered, and that clinical practitioners rarely fully appreciate their own limitations in analyzing
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psnet.ahrq.gov/node/865411/psn-pdf
March 27, 2024 - and blood products, as needed.7
Reporting/Systems Learning
A growth mindset should prevail when analyzing
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psnet.ahrq.gov/perspective/conversation-withpatrick-s-romano-md-mph
July 10, 2024 - That might involve hospitals analyzing their own data, hospital associations, vendors working with hospitals
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psnet.ahrq.gov/innovation/algorithm-based-decision-support-system-guides-trauma-staff-during-initial-treatment
May 31, 2023 - Research: The team spent 9 months analyzing current practice and the medical literature on trauma reception
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psnet.ahrq.gov/perspective/conversation-withkaveh-g-shojania-md
September 01, 2011 - Shojania : The most plausible hope was that by analyzing certain types of incidents, that you could learn … there isn't a single great solution, so it's not clear what an institution is supposed to do after analyzing
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psnet.ahrq.gov/perspective/incident-reporting-more-attention-safety-action-feedback-loop-please
September 01, 2011 - Shojania : The most plausible hope was that by analyzing certain types of incidents, that you could learn … there isn't a single great solution, so it's not clear what an institution is supposed to do after analyzing
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psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.218_slideshow.ppt
May 01, 2010 - Spotlight Case [MONTH] 2003
Spotlight Case
Fatal Error in Neonate: Does ‘Just Culture’ Provide an Answer?
*
*
Source and Credits
This presentation is based on the May 2010
AHRQ WebM&M Spotlight Case
See the full article at http://webmm.ahrq.gov
CME credit is available
Commentary by: Sidney W.A. Dekker, Ph…
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psnet.ahrq.gov/
March 25, 2025 - This website is up to date as of March 24, 2025. You will not be able to register for an account and will no longer be able to obtain Continuing Medical Education (CME), Maintenance of Certification (MOC), or Continuing Pharmacy Education (CPE) credits. We are not taking submissions for WebM&M cases, Innovations, Train…
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psnet.ahrq.gov/node/33591/psn-pdf
March 15, 2025 - Triggers and Trigger Tools
March 15, 2025
Triggers and Trigger Tools. PSNet [internet]. 2019.
https://psnet.ahrq.gov/primer/triggers-and-trigger-tools
PSNet primers are regularly reviewed and updated by the UC Davis PSNet Editorial Team to ensure that
they reflect current research and practice in the patient safet…
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psnet.ahrq.gov/web-mm/moving-pains
August 17, 2017 - In analyzing this case, it is easy to shuffle all these issues to the bottom of the deck (after all,
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psnet.ahrq.gov/node/72563/psn-pdf
December 07, 2020 - We have completed over 70 interviews and are
currently analyzing that data.
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psnet.ahrq.gov/node/49588/psn-pdf
August 01, 2009 - Nursing resource management:
analyzing the relationship between costs and quality in staffing decisions