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Showing results for "example".

2501. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/33741/psn-pdf
      November 01, 2012 - In patients with suspected pneumonia, for example, one evidence-based approach filters through scores … Pneumonia is far from the only example of situations in which physical findings have stunning accuracy … For example, the interobserver agreement for most physical examination findings is no different than

2502. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49520/psn-pdf
      September 01, 2006 - achieved.(4) Similar issues arise when a patient with a DNR order undergoes conscious sedation, for example … For example, a patient might require mechanical ventilation or vasopressors for longer than anticipated … For example, drugs to support blood pressure and measures to maintain breathing are used in the operating

2503. Clinician-directed performance improvement: moving beyond externally mandated metrics. | PSNet
      psnet.ahrq.gov/issue/clinician-directed-performance-improvement-moving-beyond-externally-mandated-metrics
      July 10, 2008 - rapid assessment procedures for implementation research using a team-based approach to analysis: a case example

2504. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/34729/psn-pdf
      October 31, 2016 - Set Phasers on Stun: And Other True Tales of Design, Technology, and Human Error, Second Edition. October 31, 2016 Casey SM. Santa Barbara, CA: Aegean; 1998. ISBN 9780963617880. https://psnet.ahrq.gov/issue/set-phasers-stun-and-other-true-tales-design-technology-and-human-error- second-edition This book introduce…

2505. Spotlight Case [MONTH] 2003 (ppt file)
      psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.122_slideshow.ppt
      April 01, 2006 - procedures require complex teamwork among anesthesiologists, nurses, and a variety of specialists For example … that operate in hazardous conditions but have fewer than their fair share of adverse events Example

2506. In Conversation with… Edward Tenner, PhD | PSNet
      psnet.ahrq.gov/perspective/conversation-edward-tenner-phd
      June 01, 2011 - RW : Can you give us your favorite example or two from outside of health care? … universal law: automobile seat belts actually do reduce deaths and injuries, although the record of, for example … patient safety and health care issues, and it's one that also appears in many other safety contexts, for example … This seems to have been the case, for example, in the federal Minerals Management Service. … For example, software malfunction prevented a defibrillator from delivering shocks when needed.

2507. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/45083/psn-pdf
      July 18, 2016 - commentary emphasizes the need for valid patient safety measures and mentions the Surgeon Scorecard as an example

2508. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/42748/psn-pdf
      November 20, 2013 - However, the utility of the written signout varied widely despite use of a template—for example, the

2509. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/43263/psn-pdf
      July 16, 2014 - For example, the official investigation of the Mid-Staffordshire NHS Foundation Trust in the United

2510. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/42711/psn-pdf
      October 31, 2014 - For example, incorrect transcription of an order could then lead to a medication administration error

2511. In Conversation With… Richard Hoppmann, MD | PSNet
      psnet.ahrq.gov/perspective/conversation-richard-hoppmann-md
      June 01, 2018 - Take for example pediatric safety and quality around appendicitis—if a patient comes in with physical … Let me give you an example of how that might be beneficial. … For example, if you are scanning the heart and capturing an apical four-chamber view, the ultrasound … For example, if they cannot get a good image, they should not try to interpret the image. … For example, emergency physicians may use POCUS for examinations ranging from trauma and pregnancy to

2512. Diagnostic Errors: A New Chapter in Patient Safety Science, Policy, and Practice | PSNet
      psnet.ahrq.gov/perspective/diagnostic-errors-new-chapter-patient-safety-science-policy-and-practice
      January 01, 2016 - For example, diagnoses can be completely missed (cancer missed despite alarming symptoms), wrong (patients … For example, the Department of Veterans Affairs has successfully implemented initiatives where researchers … For example, diagnosis of lung cancer cases that should have been made in 3 or 4 months but stretched … There is some data; for example, optometrists looking at diabetic eyes don't all agree on what grade … For example, the report includes very little about what laboratories could do or what radiology could

2513. In Conversation With… Mark L. Graber, MD | PSNet
      psnet.ahrq.gov/perspective/conversation-mark-l-graber-md
      January 01, 2016 - For example, diagnosis of lung cancer cases that should have been made in 3 or 4 months but stretched … For example, if I don't diagnose something correctly in clinic, that patient may go on into the hospital … For example the 40,000 to 80,000 deaths a year was just a back-of-the-envelope calculation based on autopsy … There is some data; for example, optometrists looking at diabetic eyes don't all agree on what grade … For example, the report includes very little about what laboratories could do or what radiology could

2514. Our Maturing Understanding of Safety Culture: How to Change It and How It Changes Safety | PSNet
      psnet.ahrq.gov/perspective/our-maturing-understanding-safety-culture-how-change-it-and-how-it-changes-safety
      March 01, 2017 - First, to deepen their understanding, they would need additional detail to understand, for example, residents … RW : Can you give an example of a piece of forbidden knowledge? … For example, junior doctors are supposed to be given quiet time to complete their notes, but they never … What I'm seeing, for example, is the notion of error increasingly receding and increasingly a focus on … For example, with the use of routine beta-blockers in surgery, where that technical intervention just

2515. In Conversation with…Barbara A. Blakeney, MS, RN | PSNet
      psnet.ahrq.gov/perspective/conversation-withbarbara-blakeney-ms-rn
      August 01, 2005 - For example, I met a nurse recently who said, "What I need is a really good nursing assistant who can … For example, the ANA has kicked off a major program in ergonomics, and I have had ergonomics people say … As one example, the evidence linking nurse staffing to patient outcomes is considerably more extensive … The Magnet Recognition Program of the American Nurses Credentialing Center is the best example of a successful

2516. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/33876/psn-pdf
      August 01, 2018 - encouraging staff to intervene or speak up when they feel a patient's safety may be compromised.(8) For example … For example, at UPMC our system team hosts several speakers series on quality and patient safety topics … For example, at UPMC we package the data from our culture of safety surveys to include the local hospital

2517. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/33659/psn-pdf
      October 01, 2007 - Policies that require punishment for errors, for example, won't work. … For example, if you have policies that authorize punishment (e.g., written reprimand or dismissal) after … If your organization's priority is reducing harm related to misidentification of patients, for example

2518. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/38981/psn-pdf
      September 30, 2009 - alerts were accepted nearly half the time, and alerts were generally rejected for valid reasons (for example

2519. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/37873/psn-pdf
      June 16, 2009 - Dropping the baton: a qualitative analysis of failures during the transition from emergency department to inpatient care. June 16, 2009 Horwitz LI, Meredith T, Schuur JD, et al. Dropping the baton: a qualitative analysis of failures during the transition from emergency department to inpatient care. Ann Emerg Med. …

2520. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/36044/psn-pdf
      April 27, 2010 - Expected and unanticipated consequences of the quality and information technology revolutions. April 27, 2010 Wachter R. Expected and unanticipated consequences of the quality and information technology revolutions. JAMA. 2006;295(23):2780-3. https://psnet.ahrq.gov/issue/expected-and-unanticipated-consequences-qua…