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psnet.ahrq.gov/issue/misdiagnosis-acute-myocardial-infarction-systematic-review-literature
July 28, 2021 - approximately 1-2% of cases, and AMI is commonly diagnosed as other heart conditions, musculoskeletal pain, or … Evaluating the relationship between health information technology and safer-prescribing in the long-term care … May 12, 2021
Bracing for the storm: one health care system's planning for the COVID-19 … October 14, 2009
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Hospitals
Health Care … Providers
Educators
Cardiology
Clinical Misdiagnosis
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psnet.ahrq.gov/node/867429/psn-pdf
December 18, 2024 - The patient was discharged, but
his condition worsened over the following week, with increasing back … intradural tumors, the dura
is opened intentionally, and reapproximating via suturing is the intended plan … fluid (CSF) leaks through the
dural tear into the surrounding tissue, forming a fibrous capsule, the condition … Approaches to Improving Patient Safety
Avoidance of a durotomy, if not in the plan of the operation, … Take-Home Points
The best offense is a good defense and avoidance of a durotomy, if not in the plan
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psnet.ahrq.gov/issue/distractions-cardiac-catheterisation-laboratory-impact-cardiologists-and-patient-safety
June 07, 2023 - hospital, the authors found that fewer than half of all procedures were completed without interruption or … June 7, 2023
A clinical pharmacist-led transitions of care program for veterans with … two planned care transitions (hospital to skilled care and skilled care to home) amid the COVID-19 pandemic … core processes of care at Johns Hopkins Medicine. … Improved prophylaxis and decreased rates of preventable harm with the use of a mandatory computerized clinical
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psnet.ahrq.gov/issue/entangled-complexity-ethnographic-study-organizational-adaptability-and-safe-care-transitions
August 21, 2024 - for patients with complex care needs. … care needs. … March 12, 2025
A clinical pharmacist-led transitions of care program for veterans with … two planned care transitions (hospital to skilled care and skilled care to home) amid the COVID-19 pandemic … June 15, 2016
Developing a medical emergency team running sheet to improve clinical handoff
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psnet.ahrq.gov/perspective/patient-engagement-and-patient-safety
February 01, 2013 - at the bedside, where engaged patients, armed with information about their condition and available services … or the care of loved ones. … chronic condition. … planning and clinical teaching for trainees. … views about what happened and what didn't happen in the last 24 hours, and their perceptions about the plan
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psnet.ahrq.gov/innovation/university-michigan-emergency-critical-care-center-ec3-provides-timely-intensive-care
October 30, 2024 - -square-foot unit with five resuscitation or trauma bays and nine critical care patient rooms immediately … ED team in resuscitation bays or regular ED rooms until an inpatient ICU bed became available or the … team is comprised of emergency medicine (EM) physicians (with or without critical care fellowship training … Staffing of the EC3 includes one EM attending physician and one or two residents, fellows, or physician … In addition to providing clinical care, EC3 serves as a training site for medical students, residents
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psnet.ahrq.gov/node/73526/psn-pdf
July 28, 2021 - , treatment, or
services. … The implementation of first-fill counseling reinforces
understanding of the patient’s treatment plan … This would have provided an opportunity for the
patient to inform the pharmacist of their actual condition … , treatment or services? … An overview of clinical
decision support systems: benefits, risks, and strategies for success.
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psnet.ahrq.gov/issue/warning-health-it-may-be-hazardous-your-healthcare
July 30, 2008 - The author describes a plan to integrate the tool into the Patient Safety Organization reporting … Changes in hospital-acquired conditions and mortality associated with the hospital-acquired condition … December 16, 2015
More than a feeling: the role of empathetic care in promoting safety … in health care. … May 22, 2015
Clinical ICT Systems in the Victorian Public Health Sector.
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psnet.ahrq.gov/issue/interprofessionalinterdisciplinary-teamwork-during-early-covid-19-pandemic-experience
September 23, 2020 - J Interprof Care. 2020;34(5):682-686. doi:10.1080/13561820.2020.1791809. … J Interprof Care . 2020; 34 (5) :682-686 .
View more articles from the same authors. … J Interprof Care. 2020;34(5):682-686. doi:10.1080/13561820.2020.1791809. … August 18, 2021
Implementation of the I-PASS handoff program in diverse clinical environments … Resources
Team debriefing in the COVID-19 pandemic: a qualitative study of a hospital-wide clinical
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psnet.ahrq.gov/perspective/conversation-susan-mcgrath-phd-and-george-blike-md-about-surveillance-monitoring
April 26, 2023 - , or in the intermediate care setting, versus the general care setting. … So, if you use the condition-specific monitoring approach in the general care setting where the prevalence … Our research shows if you set up alerts at traditional ICU levels, or even a more condition-specific … We always find things we didn’t expect—you can’t plan it all. … Providers
Clinical Technologists
Health Care Executives and Administrators
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psnet.ahrq.gov/node/866622/psn-pdf
August 28, 2024 - By clinical
background, I am an internal medicine hospitalist. … Instead of a causal factor, we'll say condition/contributing factor. … but instead maybe did some immediate mitigation and a learning team that resulted in a robust action
plan … I think there are a lot of ways to do that, with the National Action Plan
being one of them. … organizations feel they are from an
intra-organizational learning perspective, which is on the National Action Plan
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psnet.ahrq.gov/issue/cleveland-clinic-health-system-comprehensive-framework-health-system-patient-safety
January 04, 2017 - May 12, 2010
The impact of power on health care team performance and patient safety: … 2023
Measurement matters: changing penalty calculations under the hospital acquired condition … December 4, 2016
Building a highway to quality health care. … power of collaboration with patient safety programs: building safe passage for patients, nurses, and clinical … and Administrators
Institutional Patient Safety Plan
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psnet.ahrq.gov/issue/retrospective-review-emergency-response-activations-during-13-year-period-tertiary-care
August 26, 2020 - October 19, 2022
Complexity and challenges of the clinical diagnosis and management of … 2015
Team debriefing in the COVID-19 pandemic: a qualitative study of a hospital-wide clinical … November 16, 2022
Clinical practice guideline: safe medication use in the ICU. … January 3, 2017
Implementation of Condition Help: family teaching and evaluation of family … February 1, 2011
A reduction in cardiac arrests and duration of clinical instability
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psnet.ahrq.gov/node/49407/psn-pdf
July 01, 2003 - to a skilled nursing facility (SNF) for physical therapy on low-
molecular-weight heparin, with a plan … patient self-monitoring with point-of-care INR testing, increases the time in the therapeutic
range … These systems are also likely to detect changes in the patient’s clinical condition
or medication regimen … frequency of
excessively prolonged INR values, there has been little research into the frequency, clinical … Treatment of warfarin-associated coagulopathy with oral
vitamin K: a randomized clinical trial.
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psnet.ahrq.gov/perspective/conversation-withrobert-m-wachter-md
October 01, 2008 - or more specialized care for those disorders. … to push the check box in front of the providers and make it very hard to move to the next stage of clinical … How do you plan to prepare your service and hospitalists or other physicians for the implications of … patient safety revolution was to get patient safety on the radar screen and to have it be part of the clinical … To me the fundamental reason that care is not nearly as safe as it should be is that up until 7 or 8
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psnet.ahrq.gov/innovation/care-managers-use-software-aided-medication-review-protocol-frail-community-dwelling
September 13, 2023 - , or other clinical staff) use software-based protocols to screen older clients' medications and collaborate … and hospital readmissions through an individual client service plan based on medical risk, psychosocial … Plan logistics: Plan for program implementation at a detailed level. … Start small: Consider starting with only new clients or with only one or two care managers, social workers … A Collaboration Among Primary Care-Based Clinical Pharmacists and Community-Based Health Coaches.
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psnet.ahrq.gov/node/49863/psn-pdf
May 01, 2019 - The procedure initially started well and the surgeon followed his
expected operative plan. … The patient required care
in the intensive care unit postoperatively, but she recovered and was discharged … home in good condition
several days later. … communication
among members of the clinical care team. … Paige, MD
Professor of Clinical Surgery
Director of Wound Care
LSU Health New Orleans Health Sciences
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psnet.ahrq.gov/issue/policies-and-practices-related-role-board-certification-and-recertification-pediatricians
February 03, 2011 - wide range of policies and practices with respect to requirements for board certification in obtaining or … for greater collaboration among hospitals, health plans, and physicians to improve quality by using clinical … Same Author(s)
Use of board certification and recertification of pediatricians in health plan … September 23, 2015
Errors in administration of parenteral drugs in intensive care units … 17, 2011
Use of board certification and recertification of pediatricians in health plan
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psnet.ahrq.gov/issue/bid-better-care-surgery-warranty
August 05, 2008 - Newspaper/Magazine Article
In bid for better care, surgery with a warranty. … Citation Text:
In bid for better care, surgery with a warranty. Abelson R. … April 27, 2016
Clash in the name of care. … August 8, 2012
Patient Safety: Investigating and Reporting Serious Clinical Incidents … April 29, 2009
Geisinger Health System's plan to fix America's health care.
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psnet.ahrq.gov/perspective/patient-safety-office-based-care-settings
January 31, 2024 - plan. … Care to me or care delivered in the acute care setting, in which healthcare professionals are primarily … a care plan that is tailored for that individual patient. … So how you integrate those determinants of care and the patient’s health habits in a plan is very much … up on the care and treatment plan.