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Showing results for "failure".

281. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/40690/psn-pdf
     August 17, 2011 - Designing a safer process to prevent retained surgical sponges: a healthcare failure mode and effect … Designing a safer process to prevent retained surgical sponges: a healthcare failure mode and effect … https://psnet.ahrq.gov/issue/designing-safer-process-prevent-retained-surgical-sponges-healthcare-failure … - mode-and-effect A prospective failure mode and effect analysis identified 57 potential failures that … https://psnet.ahrq.gov/issue/designing-safer-process-prevent-retained-surgical-sponges-healthcare-failure-mode-and-effect

282. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/42329/psn-pdf
     December 18, 2014 - Health care failure mode and effect analysis to reduce NICU line–associated bloodstream infections. … Health care failure mode and effect analysis to reduce NICU line-associated bloodstream infections. … https://psnet.ahrq.gov/issue/health-care-failure-mode-and-effect-analysis-reduce-nicu-line-associated … - bloodstream Successful application of a failure mode and effect analysis approach resulted in a marked … https://psnet.ahrq.gov/issue/health-care-failure-mode-and-effect-analysis-reduce-nicu-line-associated-bloodstream

283. System failure versus personal accountability--the case for clean hands. | PSNet
     psnet.ahrq.gov/issue/system-failure-versus-personal-accountability-case-clean-hands
     February 16, 2011 - Commentary System failure versus personal accountability--the case for clean hands … System failure versus personal accountability--the case for clean hands. … System failure versus personal accountability--the case for clean hands.

284. Automation failures and patient safety. | PSNet
     psnet.ahrq.gov/issue/automation-failures-and-patient-safety
     November 21, 2012 - Review Automation failures and patient safety. Citation Text: Ruskin KJ, Ruskin AC, O’Connor M. Automation failures and patient safety. Curr Opin Anaesthesiol. 2020;33(6):788-792. doi:10.1097/aco.0000000000000935. Copy Citation Format: DOI Google Scholar BibTeX EndNote X3 X…

285. Deconstructing intraoperative communication failures. | PSNet
     psnet.ahrq.gov/issue/deconstructing-intraoperative-communication-failures
     July 25, 2012 - Study Deconstructing intraoperative communication failures. Citation Text: Hu Y-Y, Arriaga AF, Peyre S, et al. Deconstructing intraoperative communication failures. J Surg Res. 2012;177(1):37-42. doi:10.1016/j.jss.2012.04.029. Copy Citation Format: DOI Google Scholar PubM…

286. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/43988/psn-pdf
     February 22, 2018 - High rate of implementation of proposed actions for improvement with the Healthcare Failure Mode Effect … High Rate of Implementation of Proposed Actions for Improvement With the Healthcare Failure Mode Effect … https://psnet.ahrq.gov/issue/high-rate-implementation-proposed-actions-improvement-healthcare-failure … - mode-effect-analysis Failure mode effect analysis is a widely used method of prospectively detecting … https://psnet.ahrq.gov/issue/high-rate-implementation-proposed-actions-improvement-healthcare-failure-mode-effect-analysis

287. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/42674/psn-pdf
     September 12, 2016 - Using crew resource management and a 'read-and-do checklist' to reduce failure-to-rescue events on a … Using crew resource management and a 'read-and-do checklist' to reduce failure-to-rescue events on a … https://psnet.ahrq.gov/issue/using-crew-resource-management-and-read-and-do-checklist-reduce-failure- … an intermediate care unit increased appropriate utilization of the rapid response team and reduced failure-to-rescue … https://psnet.ahrq.gov/issue/using-crew-resource-management-and-read-and-do-checklist-reduce-failure-rescue-events-step

288. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/39064/psn-pdf
     October 28, 2009 - Use of failure mode and effects analysis for proactive identification of communication and handoff failures … Use of failure mode and effects analysis for proactive identification of communication and handoff failures … https://psnet.ahrq.gov/issue/use-failure-mode-and-effects-analysis-proactive-identification-communication … - and-handoff Failure mode and effects analysis was used to identify vulnerable handoff and communication … https://psnet.ahrq.gov/issue/use-failure-mode-and-effects-analysis-proactive-identification-communication-and-handoff

289. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/40657/psn-pdf
     August 03, 2011 - Effectiveness and cost of a transitional care program for heart failure: a prospective study with concurrent … Effectiveness and cost of a transitional care program for heart failure: a prospective study with concurrent … https://psnet.ahrq.gov/issue/effectiveness-and-cost-transitional-care-program-heart-failure-prospective … transitional care program produced a 48% reduction in readmission rates for elderly patients with heart failure … https://psnet.ahrq.gov/issue/effectiveness-and-cost-transitional-care-program-heart-failure-prospective-study-concurrent

290. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/41724/psn-pdf
     January 01, 2013 - Using Healthcare Failure Mode and Effect Analysis to reduce medication errors in the process of drug … Using Healthcare Failure Mode and Effect Analysis to reduce medication errors in the process of drug … https://psnet.ahrq.gov/issue/using-healthcare-failure-mode-and-effect-analysis-reduce-medication-errors … - process-drug In this study, failure mode and effect analysis—a prospective risk assessment tool—successfully … https://psnet.ahrq.gov/issue/using-healthcare-failure-mode-and-effect-analysis-reduce-medication-errors-process-drug

291. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/45609/psn-pdf
     November 16, 2016 - A review of healthcare failure mode and effects analysis (HFMEA) in radiotherapy. … A Review of Healthcare Failure Mode and Effects Analysis (HFMEA) in Radiotherapy. … https://psnet.ahrq.gov/issue/review-healthcare-failure-mode-and-effects-analysis-hfmea-radiotherapy … Health care failure mode and effect analysis (HFMEA) was developed by the Veterans Affairs health system … https://psnet.ahrq.gov/issue/review-healthcare-failure-mode-and-effects-analysis-hfmea-radiotherapy https

292. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/40348/psn-pdf
     June 28, 2011 - The Failure Issue. June 28, 2011 Harv Bus Rev. April 2011;89(4);1-140. …   https://psnet.ahrq.gov/issue/failure-issue This special issue explores business executives' … experiences with recognizing, learning from, and avoiding failure. … https://psnet.ahrq.gov/issue/failure-issue https://psnet.ahrq.gov/issue/strategies-learning-failure

293. Failed Interpretation of Screening Tool: Delayed Treatment | PSNet
     psnet.ahrq.gov/web-mm/failed-interpretation-screening-tool-delayed-treatment
     August 20, 2018 - The emergency physician assessed the patient as having either new onset congestive heart failure or an … Two diagnostic tests were ordered: an echocardiogram for heart failure and both blood and sputum cultures … He received diuretics for the potential diagnosis of heart failure, but he was not empirically treated … Defined as a mistake or failure in the process leading to a misdiagnosis, a missed diagnosis, or delay … exam findings evident of fluid overload or prior history of heart failure.

294. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/73335/psn-pdf
     May 26, 2021 - Management of intestinal failure involves slowly increasing nutrition enterally, reducing parenteral … Pediatric Intestinal Failure. N Engl J Med. 2017;377(7):666-675. Go to PubMed 2. … Long-term outcomes of pediatric intestinal failure.  … Coordinated interdisciplinary management of pediatric intestinal failure: a 2-year review. … Clinical outcomes in pediatric intestinal failure: a meta- analysis and meta-regression. 

295. A systematic proactive risk assessment of hazards in surgical wards: a quantitative study. | PSNet
     psnet.ahrq.gov/issue/systematic-proactive-risk-assessment-hazards-surgical-wards-quantitative-study
     August 15, 2013 - This study reports on a failure mode and effect analysis used to detect and prioritize potential patient … Related Resources Reducing failures in daily medical practice: healthcare failure … June 22, 2016 Applicability of Healthcare Failure Mode and Effects Analysis to healthcare … April 28, 2010 Use of failure mode and effects analysis for proactive identification

296. Where are my instruments? Hazards in delivery of surgical instruments. | PSNet
     psnet.ahrq.gov/issue/where-are-my-instruments-hazards-delivery-surgical-instruments
     September 25, 2008 - This study used failure mode and effect analysis to characterize instrument delivery to operating rooms … March 29, 2023 Reducing failures in daily medical practice: healthcare failure mode … August 2, 2015 Applicability of Healthcare Failure Mode and Effects Analysis to healthcare … March 28, 2011 Use of failure mode and effects analysis for proactive identification

297. Using prospective risk analysis tools to improve safety in pharmacy settings: a systematic review and critical appraisal. | PSNet
     psnet.ahrq.gov/issue/using-prospective-risk-analysis-tools-improve-safety-pharmacy-settings-systematic-review-and
     January 24, 2018 - This narrative review found that failure mode and effect analysis and sociotechnical probabilistic … Download Citation Related Resources From the Same Author(s) Using failure … May 29, 2019 Using failure mode and effects analysis to reduce patient safety risks related … January 22, 2017 Using Failure Mode and Effects Analysis for safe administration of chemotherapy

298. Value of improving patient safety: health economic considerations for rapid response systems-a rapid review of the literature and expert round table. | PSNet
     psnet.ahrq.gov/issue/value-improving-patient-safety-health-economic-considerations-rapid-response-systems-rapid
     January 07, 2015 - Failure to rescue refers to delayed or missed recognition of clinical deterioration, which can lead … the authors used health economics methods to understand the health economic impacts associated with failure … March 5, 2025 Patient Safety Primers Failure to Rescue … April 20, 2022 Rapid response teams as a patient safety practice for failure to rescue

299. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/43516/psn-pdf
     June 15, 2017 - Application of failure mode effect analysis to improve the care of septic patients admitted through … Application of Failure Mode Effect Analysis to Improve the Care of Septic Patients Admitted Through … https://psnet.ahrq.gov/issue/application-failure-mode-effect-analysis-improve-care-septic-patients-admitted … - through A multidisciplinary team employed failure mode and effect analysis methodology to detect … https://psnet.ahrq.gov/issue/application-failure-mode-effect-analysis-improve-care-septic-patients-admitted-through

300. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/41504/psn-pdf
     July 11, 2012 - Failure and rescue. July 11, 2012 Gawande A. The New Yorker: News Desk. June 4, 2012. … https://psnet.ahrq.gov/issue/failure-and-rescue This piece, originally delivered as a commencement speech … , discusses the importance of recognizing failure and understanding how to plan for and respond to it … https://psnet.ahrq.gov/issue/failure-and-rescue https://psnet.ahrq.gov/issue/failure-issue