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Showing results for "failure".

521. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/43912/psn-pdf
     February 25, 2015 - https://psnet.ahrq.gov/issue/patient-safety-dialysis-access Patients with chronic kidney failure are … safety in end-stage renal disease care, explores factors specific to this setting that contribute to failure

522. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/49675/psn-pdf
     February 01, 2013 - Delay in Treatment: Failure to Contact Patient Leads to Significant Complications February 1, 2013 … Delay in Treatment: Failure to Contact Patient Leads to Significant Complications. … https://psnet.ahrq.gov/web-mm/delay-treatment-failure-contact-patient-leads-significant-complications … Case Objectives Know that failure to properly act on abnormal test results is a significant patient … Describe some steps that might reduce the harm from failure to act on abnormal test results.

523. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/45724/psn-pdf
     July 21, 2017 - This commentary discusses learning from failure, or remembrance, in health care and suggests avenues … heart-darkness-impact-perceived-mistakes-physicians https://psnet.ahrq.gov/issue/not-again https://psnet.ahrq.gov/issue/strategies-learning-failure

524. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/34782/psn-pdf
     November 01, 2016 - psnet.ahrq.gov/issue/when-systems-fail This review provides a detailed account of managerial causes of failure … and managerial failure prevention strategies.

525. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/44152/psn-pdf
     November 06, 2015 - human-factors-engineering-its-place-and-potential-or-safety https://psnet.ahrq.gov/issue/applicability-healthcare-failure-mode-and-effects-analysis-healthcare-epidemiology-evaluation … https://psnet.ahrq.gov/issue/applicability-healthcare-failure-mode-and-effects-analysis-healthcare-epidemiology-evaluation

526. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/49641/psn-pdf
     November 01, 2011 - Liver Failure After Chemotherapy: Did We Forget Something? November 1, 2011 Lubel J. … Liver Failure After Chemotherapy: Did We Forget Something? PSNet [internet]. 2011. … https://psnet.ahrq.gov/web-mm/liver-failure-after-chemotherapy-did-we-forget-something The Case A 51 … Luckily, she has made a complete recovery from her liver failure and is receiving chronic therapy for … Antiviral therapy may have prevented the patient's progression to acute liver failure.

527. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/47921/psn-pdf
     June 18, 2019 - large-scale-implementation-i-pass-handover-system-academic-medical-centre https://psnet.ahrq.gov/web-mm/communication-failure-whos-charge

528. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/46943/psn-pdf
     November 16, 2018 - piece-my-mind-art-constructive-worrying Both organizational culture and individual accountability are key to admitting and learning from failure … piece-my-mind-art-constructive-worrying https://psnet.ahrq.gov/primer/culture-safety https://psnet.ahrq.gov/issue/strategies-learning-failure

529. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/47462/psn-pdf
     October 31, 2018 - emergency-department-checklist-innovation-improve-safety-emergency-care Enhancing information systems and team communication can reduce failure-to-rescue … emergency-department-checklist-innovation-improve-safety-emergency-care https://psnet.ahrq.gov/primer/failure-rescue

530. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/41763/psn-pdf
     October 10, 2012 - latency-ecg-displays-hospital-telemetry-systems-science-advisory-american-heart-association https://psnet.ahrq.gov/issue/alarm-interventions-during-medical-telemetry-monitoring-failure-mode-effects-analysis … https://psnet.ahrq.gov/issue/alarm-interventions-during-medical-telemetry-monitoring-failure-mode-effects-analysis

531. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/38727/psn-pdf
     November 25, 2009 - psnet.ahrq.gov/issue/fmea-team-performance-health-care-qualitative-analysis-team-member- perceptions Failure … https://psnet.ahrq.gov/issue/basics-fmea-2nd-edition https://psnet.ahrq.gov/issue/using-health-care-failure-mode-and-effect-analysis-va-national-center-patient-safetys

532. Rapid response systems. | PSNet
     psnet.ahrq.gov/issue/rapid-response-systems-0
     April 07, 2010 - September 7, 2022 Failure to rescue deteriorating patients: a systematic review of root … May 29, 2019 A review of current and emerging approaches to address failure-to-rescue … See More About The Topic Hospitals Health Care Executives and Administrators Medicine Failure

533. Evaluation of a preoperative checklist and team briefing among surgeons, nurses, and anesthesiologists to reduce failures in communication. | PSNet
     psnet.ahrq.gov/issue/evaluation-preoperative-checklist-and-team-briefing-among-surgeons-nurses-and
     August 28, 2013 - Using trainee failures to enhance learning: a qualitative study of pediatric hospitalists on allowing failure … 'Whatever you cut, I can fix it': clinical supervisors' interview accounts of allowing trainee failure … November 21, 2018 Allowing failure for educational purposes in postgraduate clinical

534. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/43158/psn-pdf
     May 07, 2014 - rates of cardiac arrests or intensive care unit transfers, this study advocates for using the AHRQ failure … Failure to rescue rates declined in the second year after implementation of the rapid response team

535. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/45028/psn-pdf
     May 25, 2016 - approaches should address to build trust for blame-free response to error and enable learning from failure … psnet.ahrq.gov/perspective/accountability-patient-safety https://psnet.ahrq.gov/issue/strategies-learning-failure

536. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/43692/psn-pdf
     April 22, 2015 - found that most perioperative deaths were not due to surgical error and advocates for focusing on failure … The authors believe that emphasizing failure to rescue can promote a systems approach to reduce surgical

537. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/39618/psn-pdf
     August 03, 2010 - This study found that preventable delays in lung cancer diagnosis were largely attributable to either failure … in recognizing documented abnormal imaging results or failure to complete diagnostic procedures in

538. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/41541/psn-pdf
     September 26, 2012 - failures-communication-and-information-transfer-across-surgical-care-pathway-interview-study https://psnet.ahrq.gov/issue/communication-failure-operating-room

539. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/40068/psn-pdf
     January 19, 2011 - application-root-cause-analysis-malpractice-claim-files-related-diagnostic- failures This study applied root cause analysis to cases of diagnostic failure

540. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/42501/psn-pdf
     January 07, 2015 - epidemics—can be applied to monitor health information technologies for early signs of unreliability or failure