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psnet.ahrq.gov/issue/assessing-evidence-base-context-sensitive-effectiveness-and-safety-patient-safety-practices
December 24, 2008 - In this RFP, clinical interventions are to be addressed within the context of organizations and systems … patient safety, research, and evaluation methodology to develop criteria that address the context (or … the Same Author(s)
Preventable Hospitalizations: A Window Into Primary and Preventive Care … Interest in Research About the Epidemiology of Patient Safety Risks and Harms in Ambulatory Health Care … November 25, 2013
Solicitation for written comments on draft National Action Plan for
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psnet.ahrq.gov/sites/default/files/2021-02/final_feb_2021_spotlight_delay_in_appropriate_dx.pdf
January 01, 2021 - plan
• That evening, she was transferred to the ICU after becoming
hemodynamically unstable with … instability, and
right heart strain was identified on bedside ultrasound, was the severity
of the patient’s condition … gestalt, clinical decision rules, D-
Dimer measurement, and/or diagnostic imaging such as
ultrasound … was
delayed despite obvious clinical deterioration … Acute Pulmonary Embolism: Focus on the Clinical Picture.
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psnet.ahrq.gov/issue/increased-risk-burnout-physicians-and-nurses-involved-patient-safety-incident
September 21, 2016 - Med Care. 2016;54(10):937-943. doi:10.1097/MLR.0000000000000582. … Med Care. 2016;54(10):937-943. doi:10.1097/MLR.0000000000000582. … January 31, 2013
In search of an international multidimensional action plan for second … June 1, 2012
Overall performance of a drug-drug interaction clinical decision support … April 13, 2022
Perioperative patient safety recommendations: systematic review of clinical
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psnet.ahrq.gov/web-mm/loss-trust-and-missed-diagnosis
October 31, 2023 - distributing health care goods or services consumed by, or used on patients” and relevant financial … considered first line treatment for degenerative disc disease because this is a chronic, slowly progressive condition … foundational to collaborating with patients to develop a safe and effective diagnosis and management plan … ‘Pain medication seeking’ or ‘drug seeking’ are labels that lack universal meaning and may distract care … Office
Health Care Providers
Anesthesiology
Primary Care
Clinical Misdiagnosis
View
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psnet.ahrq.gov/perspective/establishing-safety-culture-thinking-small
December 01, 2006 - includes all patients on the service, their diagnoses, hospital location, key lab results, and updated condition—its … Well, here's the operative plan and here's plan B. … A frontline nurse in Unit X doesn't really care what the hospital says, so much as how his or her actions … bedside and the clinical outcome. … You have to tackle the clinical issues?
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psnet.ahrq.gov/perspective/conversation-elizabeth-salisbury-afshar-about-harm-reduction-strategies-improve-safety
October 30, 2024 - My current clinical practice is predominantly in addiction medicine. … support them in their health the way we support all of our patients, including those who have a chronic condition … , the ED, or primary care, so we incorporated other services into our care model. … into all clinical environments. … emphasize social services and reduce stigma by recognizing substance use disorder as a chronic health condition
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psnet.ahrq.gov/issue/using-web-or-app-instead-seeing-doctor-caution-advised
December 16, 2015 - Newspaper/Magazine Article
Using the web or an app instead of seeing a doctor? … Citation Text:
Using the web or an app instead of seeing a doctor? Caution is advised. Frakt A. … Copy URL
Cite
Citation
Citation Text:
Using the web or … April 29, 2020
Clues to better health care from old malpractice lawsuits. … Patients
Medicine
Clinical Misdiagnosis
Epidemiology of Errors and Adverse Events
View
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psnet.ahrq.gov/primer/failure-rescue
September 15, 2024 - The monitoring and analysis functions involved in recognizing and responding to such a challenge - or … condition involving patient harm. … due to patient flow or turnover. … deterioration in acute care settings. … safety in the intensive care unit.
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psnet.ahrq.gov/node/84413/psn-pdf
February 23, 2022 - distributing health care goods or services consumed by, or used on patients” and relevant financial … considered first line
treatment for degenerative disc disease because this is a chronic, slowly progressive condition … foundational to collaborating
with patients to develop a safe and effective diagnosis and management plan … fresh eyes when the patient’s clinical course is not improving as expected. … Noninvasive treatments for acute, subacute, and chronic low
back pain: a clinical practice guideline
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psnet.ahrq.gov/perspective/conversation-withrichard-ricciardi-about-office-based-patient-safety
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.
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psnet.ahrq.gov/node/846125/psn-pdf
March 15, 2023 - Addressed
The COVID-19 pandemic resulted in a time of unprecedented patient volume, rapidly changing or … Funding Sources
No outside funding sources contributed to the creation or implementation of the innovation … A retrospective study of endotracheal or tracheostomy tube
blockage and their impact on the patients … in an intensive care unit. … Am J Respir Crit Care Med. 1998;158(2):489-493.
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psnet.ahrq.gov/perspective/operationalizing-patient-safety-academic-medical-centers
August 01, 2010 - fostering small, iterative, measurable changes to fix, assess, and re-assess problems (often called the plan-do-study-act … errors due to poor or absent teamwork. … Improving safety on the front lines: the role of clinical microsystems. … We do this by asking housestaff and nurses to observe the current condition. … Decoding the data, developing observations in the current condition, and then applying these principles
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psnet.ahrq.gov/issue/patient-safety-what-how-and-when
June 23, 2021 - incident reporting, and various approaches to detect and analyze errors, within the context of the Clinical … July 19, 2023
Optimizing Pediatric Patient Safety in the Emergency Care Setting. … Safety Framework: Strong Communications Channels and Effective Practices to Rapidly Update and Implement Clinical … July 24, 2019
Improving diagnosis in health care—the next imperative for patient safety … September 30, 2015
Advancing medication safety: establishing a National Action Plan for
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psnet.ahrq.gov/issue/physician-ehr-adoption-and-potentially-preventable-hospital-admissions-among-medicare
February 14, 2024 - October 18, 2023
The quality of pharmacologic care for vulnerable older patients. … September 20, 2011
Implementation of the I-PASS handoff program in diverse clinical environments … November 16, 2022
Clinical communities at Johns Hopkins Medicine: an emerging approach … bridge to quality: an urgent call to integrate quality improvement and patient safety education with clinical … September 7, 2016
Evaluating alert fatigue over time to EHR-based clinical trial alerts
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psnet.ahrq.gov/web-mm/updates-management-high-risk-pulmonary-embolism
December 02, 2020 - The ICU resident provided the accepting medicine team with signout but did not explicitly discuss the plan … care unit for close monitoring. … anticoagulation, though there was substantial variation in practice.( 18 ) Regardless of the approach, a plan … performing CDT, intensivists, and hematologists were on a single team that discussed the overall treatment plan … and Poor Communication at Discharge Leads to a PICC without a Plan.
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psnet.ahrq.gov/issue/evaluation-older-persons-medications-critical-incident-technique-study-exploring-healthcare
July 14, 2021 - They also identified two main areas of action: working with a plan and collaborative problem-solving. … communication-related factors on medication errors in public and private hospitals: a retrospective clinical … May 4, 2022
How do patients respond to safety problems in ambulatory care? … July 29, 2020
Use of an electronic clinical decision support system in primary care to … November 6, 2019
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See More About The Topic
Ambulatory Clinic or
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psnet.ahrq.gov/node/74226/psn-pdf
February 01, 2019 - Case reviews are conducted by an interdisciplinary team and include follow-up to ensure a treatment plan … CARA-mandated point-of-
care reviews are intended to be done by the prescriber or someone closely involved … , or patient advocacy. … These teams work together in clinical case reviews to coordinate and
improve the patient’s care. … providers, focusing on the patient’s treatment plan, using risk mitigation interventions, considering
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psnet.ahrq.gov/web-mm/good-catch-operating-room
August 27, 2017 - 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/after-mid-staffordshire-acknowledgement-through-learning-improvement
August 28, 2024 - Special or Theme Issue
After Mid Staffordshire: from acknowledgement, through learning … a series of seven peer-reviewed commentaries that explore the ethical, sociolegal , academic, and clinical … June 16, 2021
Uncovering, creating or constructing problems? … 21, 2011
The problem of engaging hospital doctors in promoting safety and quality in clinical … care.
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psnet.ahrq.gov/issue/role-nursing-surveillance-keeping-patients-safe
July 14, 2009 - it can help enhance monitoring of patient conditions to address failure to rescue as well as other care … Citation
Related Resources From the Same Author(s)
Medication error in the care … July 7, 2021
Description and factors associated with missed nursing care in an acute … care community hospital. … November 7, 2012
A performance improvement plan to increase nurse adherence to use of