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Total Results: 7,834 records

Showing results for "failures".

  1. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/867429/psn-pdf
    December 18, 2024 - Management of CSF Leaks After Elective Spine Surgery: Routine Laminectomy Leads to Fatal Discitis and Sepsis December 18, 2024 Castillo JA, Price R, Kim KD. Management of CSF Leaks After Elective Spine Surgery: Routine Laminectomy Leads to Fatal Discitis and Sepsis. PSNet [internet]. 2024. https://psnet.ahrq.gov/w…

  2. Interpreting the Patient Safety Literature | PSNet

    psnet.ahrq.gov/perspective/interpreting-patient-safety-literature
    June 01, 2005 - Interpreting the Patient Safety Literature Kaveh G. Shojania, MD | June 1, 2005  Also Read a Conversation View more articles from the same authors. Citation Text: Shojania KG. Interpreting the Patient Safety Literature. PSNet [internet]. Rockville (MD): Agency f…

  3. Patient and Family Roles in Safety | PSNet

    psnet.ahrq.gov/perspective/patient-and-family-roles-safety
    June 14, 2023 - healthcare and the Safety-II framework , which seeks to define safety by understanding successes rather than failures

  4. In Conversation with... Beverley H. Johnson about The Role of Patient's Family In Reducing Harm | PSNet

    psnet.ahrq.gov/perspective/conversation-beverley-h-johnson-about-role-patients-family-reducing-harm
    June 14, 2023 - healthcare and the Safety-II framework , which seeks to define safety by understanding successes rather than failures

  5. A Sweet Case of Hidden Hydrogen Ions | PSNet

    psnet.ahrq.gov/web-mm/sweet-case-hidden-hydrogen-ions
    November 30, 2023 - A Sweet Case of Hidden Hydrogen Ions Citation Text: Plante D, Falero A. A Sweet Case of Hidden Hydrogen Ions. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2021. Copy Citation Format: Google Scholar BibTeX EndNote X3 X…

  6. Dropping to New Lows | PSNet

    psnet.ahrq.gov/web-mm/dropping-new-lows
    December 18, 2024 - SPOTLIGHT CASE Dropping to New Lows Citation Text: Juang PC, Kulasa K. Dropping to New Lows. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2016. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML End…

  7. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/865884/psn-pdf
    May 29, 2024 - Managing Complexity in Diagnosis: Life-threatening Complications after Gastric Bypass Surgery. May 29, 2024 Olson APJ. Managing Complexity in Diagnosis: Life-threatening Complications after Gastric Bypass Surgery. PSNet [internet]. 2024. https://psnet.ahrq.gov/web-mm/managing-complexity-diagnosis-life-threatening-…

  8. "The Ultrasound Looked Fine": Point-of-Care Ultrasound and Patient Safety | PSNet

    psnet.ahrq.gov/web-mm/ultrasound-looked-fine-point-care-ultrasound-and-patient-safety
    December 01, 2012 - SPOTLIGHT CASE "The Ultrasound Looked Fine": Point-of-Care Ultrasound and Patient Safety Citation Text: Lewiss RE. "The Ultrasound Looked Fine": Point-of-Care Ultrasound and Patient Safety. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and H…

  9. E-prescribing: E for error? | PSNet

    psnet.ahrq.gov/web-mm/e-prescribing-e-error
    February 03, 2021 - SPOTLIGHT CASE E-prescribing: E for error? Citation Text: Ashton EW. E-prescribing: E for error?. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2012. Copy Citation Format: Google Scholar BibTeX EndNote X3 XM…

  10. Privacy or Safety? | PSNet

    psnet.ahrq.gov/web-mm/privacy-or-safety
    December 01, 2011 - SPOTLIGHT CASE Privacy or Safety? Citation Text: Halamka JD, McGraw D. Privacy or Safety?. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2015. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML EndNo…

  11. In Conversation With… Kaveh Shojania, MD | PSNet

    psnet.ahrq.gov/perspective/conversation-kaveh-shojania-md
    February 26, 2025 - In Conversation With… Kaveh Shojania, MD November 1, 2015  Citation Text: In Conversation With… Kaveh Shojania, MD. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2015. Copy Citation For…

  12. Steroids and Safety: Preventing Medication Adverse Events During Transitions of Care | PSNet

    psnet.ahrq.gov/web-mm/steroids-and-safety-preventing-medication-adverse-events-during-transitions-care
    September 09, 2013 - SPOTLIGHT CASE Steroids and Safety: Preventing Medication Adverse Events During Transitions of Care Citation Text: Lucier DJ, Greenwald JL. Steroids and Safety: Preventing Medication Adverse Events During Transitions of Care. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Qu…

  13. Microsoft PowerPoint - FINAL CME Reviewed Spotlight_Loss of Trust and a Missed Diagnosis_02.14.20221 - clean - REVISED.pptx (pdf file)

    psnet.ahrq.gov/sites/default/files/2022-02/final_cme_reviewed_spotlight_loss_of_trust_and_a_missed_diagnosis_02.14.20221_-_clean_-_revised.pdf
    January 01, 2022 - Microsoft PowerPoint - FINAL CME Reviewed Spotlight_Loss of Trust and a Missed Diagnosis_02.14.20221 - clean - REVISED.pptx Spotlight A Loss of Trust and a Missed Diagnosis Source and Credits • This presentation is based on the February 2022 AHRQ WebM&M Spotlight Case o See the full article at https://psnet.ahrq.…

  14. In Conversation With… Paul Aylin, MBChB | PSNet

    psnet.ahrq.gov/perspective/conversation-paul-aylin-mbchb
    June 01, 2017 - In Conversation With… Paul Aylin, MBChB June 1, 2017  Also Read an Essay Citation Text: In Conversation With… Paul Aylin, MBChB. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2017. Copy …

  15. The Wet Read | PSNet

    psnet.ahrq.gov/web-mm/wet-read
    October 01, 2017 - SPOTLIGHT CASE The Wet Read Citation Text: Arenson RL. The Wet Read. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2006. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML EndNote 7 XML Endnote tagge…

  16. Spotlight (pdf file)

    psnet.ahrq.gov/sites/default/files/2022-10/trocar_injury_final.pdf
    January 01, 2022 - Spotlight Spotlight Fecal Contamination of the Peritoneum from Laparoscopic Trocar Injury: A Routine Operation Goes Wrong Source and Credits • This presentation is based on the October 2022 AHRQ WebM&M Spotlight Case o See the full article at https://psnet.ahrq.gov/webmm o CME credit is available o Commentary…

  17. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/838900/psn-pdf
    October 27, 2022 - Fecal Contamination of the Peritoneum from Laparoscopic Trocar Injury: A Routine Operation Goes Wrong. October 27, 2022 Ahmed SM, Ali M. Fecal Contamination of the Peritoneum from Laparoscopic Trocar Injury: A Routine Operation Goes Wrong. PSNet [internet]. 2022. https://psnet.ahrq.gov/web-mm/fecal-contamination-…

  18. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49657/psn-pdf
    July 01, 2012 - Not-So-Therapeutic Tap July 1, 2012 Barsuk JH. Not-So-Therapeutic Tap. PSNet [internet]. 2012. https://psnet.ahrq.gov/web-mm/not-so-therapeutic-tap Case Objectives Describe current issues with training clinicians to perform procedures. Understand how simulation can be used to ensure trainees are competent in proc…

  19. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/33750/psn-pdf
    May 01, 2013 - In Conversation With… Ashish K. Jha, MD, MPH May 1, 2013 In Conversation With… Ashish K. Jha, MD, MPH. PSNet [internet]. 2013. https://psnet.ahrq.gov/perspective/conversation-ashish-k-jha-md-mph Editor's note: Ashish K. Jha, MD, MPH, is professor of health policy and management at the Harvard School of Public Hea…

  20. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/61083/psn-pdf
    October 28, 2020 - In Conversation With... Charles A Crecelius, MD, PhD, CMD and Lori L Popejoy, PhD, RN, FAAN October 28, 2020 In Conversation With.. Charles A Crecelius, MD, PhD, CMD and Lori L Popejoy, PhD, RN, FAAN. PSNet [internet]. 2020. https://psnet.ahrq.gov/perspective/conversation-charles-crecelius-md-phd-cmd-and-lori-l-po…
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