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psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.60_slideshow.ppt
May 01, 2004 - In-hospital death
Death in ICU (>5 days) Death in ICU (>5 days)
Conventional Treatment (%)
Intensive … 14 days ICU 15.7% 11.4%
> 14 days ventilator 11.9% 7.5%
Septicemia in ICU 7.8% 4.2%
In-hospital death … 10.9% 7.2%
Death in ICU (>5 days) 20.2% 10.6%
Sheet2
Sheet3
Chart2 (2)
> 14 days ICU > 14 … (all patients) In-hospital death (all patients)
Death in ICU (>5 days) Death in ICU (>5 days)
Conventional … Death in ICU
(>5 days)
Conventional Treatment (%)
Intensive Treatment (%)
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psnet.ahrq.gov/web-mm/when-vomit-gets-way-aspiration-resulting-death-during-endoscopy
March 18, 2020 - When Vomit Gets in the Way: Aspiration Resulting in Death During Endoscopy
Citation Text: … When Vomit Gets in the Way: Aspiration Resulting in Death During Endoscopy. PSNet [internet]. … When Vomit Gets in the Way: Aspiration Resulting in Death During Endoscopy. PSNet [internet]. … event, which most likely led to asphyxiation and severe hypoxia resulting in cardiopulmonary arrest and death … When Vomit Gets in the Way: Aspiration Resulting in Death During Endoscopy. PSNet [internet].
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psnet.ahrq.gov/issue/causes-their-death-appear-unto-our-shame-perpetual-why-root-cause-analysis-not-best-model
September 27, 2016 - Study
The causes of their death appear (unto our shame perpetual): why root cause … The Causes of Their Death Appear (Unto Our Shame Perpetual): Why Root Cause Analysis Is Not the Best … The Causes of Their Death Appear (Unto Our Shame Perpetual): Why Root Cause Analysis Is Not the Best … March 3, 2019
Death by suicide within 1 week of hospital discharge: a retrospective study
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psnet.ahrq.gov/node/36606/psn-pdf
January 31, 2007 - Cause of death: sloppy doctors.
January 31, 2007
Caplan J. Time. January 15, 2007. … https://psnet.ahrq.gov/issue/cause-death-sloppy-doctors
This article reports on an industry-supported … https://psnet.ahrq.gov/issue/cause-death-sloppy-doctors
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psnet.ahrq.gov/sites/default/files/2024-08/spotlight_case_a_fatal_twist_in_pseudohyperkalemia_slides.pptx
January 01, 2024 - misinterpretation of lab results led to the missed diagnosis of pseudohyperkalemia, incorrect treatment and death … Autopsy confirmed sudden cardiac arrest without myocardial infarction as the cause of death.
7
7 … Unfortunately, the patient deteriorated and suffered sudden cardiac death likely due to TdP (meaning … /HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac … death: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical
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psnet.ahrq.gov/issue/case-birth-and-death-high-reliability-healthcare-organisation
June 18, 2013 - Commentary
A case of the birth and death of a high reliability healthcare organisation … A case of the birth and death of a high reliability healthcare organisation. … A case of the birth and death of a high reliability healthcare organisation.
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psnet.ahrq.gov/perspective/measuring-and-responding-deaths-medical-errors
April 01, 2008 - the IOM report, multiple researchers and commentators have produced widely varying estimates of the death … If true, this would make medical error the third leading cause of death in the US. … The 2016 study—and earlier studies that also put the death toll from medical errors in the hundreds of … An electronic death review process that relied on input from frontline clinicians has been shown to … Identifying preventable harm through death reviews should be viewed as part of an overall strategy to
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psnet.ahrq.gov/issue/outreach-and-early-warning-systems-ews-prevention-intensive-care-admission-and-death
September 20, 2011 - Outreach and Early Warning Systems (EWS) for the prevention of Intensive Care admission and death … Outreach and Early Warning Systems (EWS) for the prevention of Intensive Care admission and death of … Outreach and Early Warning Systems (EWS) for the prevention of Intensive Care admission and death of … Settings Help Improve Management of Sepsis
May 31, 2023
Eliminating preventable death
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/qitoolkit/combined/c1_combo_prioritizationworksheet.xlsx
June 02, 2025 - Trauma-Vaginal Delivery With Instrument
PSI 19 Obstetric Trauma-Vaginal Delivery Without Instrument
Death … PSI 02 Death in Low-Mortality DRGs
PSI 04 Death Among Surgical Inpatients
Sentinel Events (Adults
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psnet.ahrq.gov/issue/liability-associated-obstetric-anesthesia-closed-claims-analysis
July 13, 2010 - Investigators found that while the proportion of maternal death and newborn death or brain damage claims … September 1, 2021
Frequency and type of situational awareness errors contributing to death
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psnet.ahrq.gov/node/41988/psn-pdf
January 23, 2013 - What a new doctor learned about medical mistakes from
her Mom's death.
January 23, 2013
Allen M. …
https://psnet.ahrq.gov/issue/what-new-doctor-learned-about-medical-mistakes-her-moms-death
This … https://psnet.ahrq.gov/issue/what-new-doctor-learned-about-medical-mistakes-her-moms-death
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psnet.ahrq.gov/issue/medical-negligence-drug-associated-deaths
September 02, 2009 - Study
Medical negligence in drug associated deaths.
Citation Text:
Madea B, Musshoff F, Preuss J. Medical negligence in drug associated deaths. Forensic Sci Int. 2009;190(1-3):67-73. doi:10.1016/j.forsciint.2009.05.014.
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DOI Google Scholar PubMed BibT…
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psnet.ahrq.gov/issue/absence-drug-disease-interaction-alert-leads-childs-death
July 08, 2015 - Magazine Article
The absence of a drug–disease interaction alert leads to a child's death … Citation Text:
The absence of a drug–disease interaction alert leads to a child's death. … Citation
Citation Text:
The absence of a drug–disease interaction alert leads to a child's death
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psnet.ahrq.gov/node/40523/psn-pdf
August 31, 2011 - A Hospital Accident: Lessons Learned – A Death, A
Conviction, and A Healing. … https://psnet.ahrq.gov/issue/hospital-accident-lessons-learned-death-conviction-and-healing
This webinar … https://psnet.ahrq.gov/issue/hospital-accident-lessons-learned-death-conviction-and-healing
https://psnet.ahrq.gov
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psnet.ahrq.gov/node/33652/psn-pdf
June 01, 2007 - in an ASA Class I patient
Product or Device Events
Patient death or serious disability associated … the use of contaminated drugs, devices, or
biologics provided by the health care facility
Patient death … a device in patient care in
which the device is used or functions other than as intended
Patient death … labor or delivery in a low-risk pregnancy while
being cared for in a health care facility
Patient death … neonates
Stage 3 or 4 pressure ulcers acquired after admission to a health care facility
Patient death
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www.ahrq.gov/sites/default/files/2024-04/naughton-report.pdf
January 01, 2024 - Death in a hospital has been associated with unrelieved symptoms and unmet needs for
physician communication … Transfer within 3 days of death and late transfer to hospice
have been defined as markers for poor quality … Between 2000 and 2009, the use of intensive care units
within 30 days prior to death increased for the … improve outcomes for them as well as their family, particularly if the adverse outcomes
associated with death … older with an
emergency department admission with pneumonia and hospital discharge (or in-hospital death
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hcup-us.ahrq.gov/datainnovations/clinicalcontentenhancementtoolkit/mn22.jsp
September 01, 2014 - Center for the SCIENCE of HEALTH CARE DELIVERY logo
Slide 16
Proposed Algorithms: 30-Day Death … Process diagram showing 30 day death matches going through three of the four algorithms described on … algorithm missed
Specificity
# falsely identified visits with a death
Algorithm 1
DOB, … algorithm missed
Specificity
# falsely identified visits with a death
Algorithm 1
DOB, … algorithm missed
Specificity
# falsely identified visits with a death
Algorithm 1
DOB,
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psnet.ahrq.gov/issue/death-due-pharmacy-compounding-error-reinforces-need-safety-focus
May 31, 2017 - Newspaper/Magazine Article
Death due to pharmacy compounding error reinforces need … Citation Text:
Death due to pharmacy compounding error reinforces need for safety focus. … Linkedin
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Citation Text:
Death
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psnet.ahrq.gov/node/33835/psn-pdf
June 01, 2017 - Overall, a nearly
30% increase in the risk of death if you were admitted on the weekend compared to … After looking at these 4 million admissions, we found that the odds of death was about
10% higher in … a
40% higher odds of death compared to patients who had had their operation on a Monday. … The risk of death in elective surgery is thankfully pretty low,
a fraction of a percent. … You have a higher risk of
death.
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psnet.ahrq.gov/issue/national-cross-sectional-cohort-study-relationship-between-quality-mental-healthcare-and
May 04, 2022 - National cross-sectional cohort study of the relationship between quality of mental healthcare and death … National cross-sectional cohort study of the relationship between quality of mental healthcare and death … National cross-sectional cohort study of the relationship between quality of mental healthcare and death