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Showing results for "fall prevention".
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3481. Lost in Transition | PSNet
      psnet.ahrq.gov/web-mm/lost-transition
      November 17, 2010 - Catastrophe requires multiple failures—a single point failure is not enough.”( 14 ) Communication failures fall

3482. Navigating Chaos: Fatal Iatrogenic Liver Injury in a Patient Admitted for Leg Fractures | PSNet
      psnet.ahrq.gov/web-mm/navigating-chaos-fatal-iatrogenic-liver-injury-patient-admitted-leg-fractures
      November 27, 2019 - Navigating Chaos: Fatal Iatrogenic Liver Injury in a Patient Admitted for Leg Fractures Citation Text: Loseth C. Navigating Chaos: Fatal Iatrogenic Liver Injury in a Patient Admitted for Leg Fractures. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and …

3483. Out of Sight, Out of Mind: Out-of-Office Test Result Management | PSNet
      psnet.ahrq.gov/web-mm/out-sight-out-mind-out-office-test-result-management
      September 01, 2007 - provider is unavailable or distracted, creating opportunities for critical pieces of information to fall

3484. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/72689/psn-pdf
      January 29, 2021 - ) activation of a code or rapid response, 3) a significant change in clinical status, 4) a patient fall

3485. In Conversation With... Cindy Brach | PSNet
      psnet.ahrq.gov/perspective/conversation-cindy-brach
      December 27, 2019 - In Conversation With... Cindy Brach December 27, 2019  Also Read the Essay Citation Text: In Conversation With.. Cindy Brach. PSNet [internet]. 2019.In Conversation With... Cindy Brach. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, …

3486. In Conversation With… Michelle Mello, MPhil, JD, PhD | PSNet
      psnet.ahrq.gov/perspective/conversation-michelle-mello-mphil-jd-phd
      July 01, 2017 - If the insurer is not on board, it's very easy for things to fall off the rails. … institutions off the sidelines of the quality improvement movement and cast them in a more central role in prevention

3487. Doctors With Multiple Malpractice Claims, Disciplinary Actions, and Complaints: What Do We Know? | PSNet
      psnet.ahrq.gov/perspective/doctors-multiple-malpractice-claims-disciplinary-actions-and-complaints-what-do-we-know
      July 01, 2017 - institutions off the sidelines of the quality improvement movement and cast them in a more central role in prevention … If the insurer is not on board, it's very easy for things to fall off the rails.

3488. In Conversation With… Eduardo Salas, PhD | PSNet
      psnet.ahrq.gov/perspective/conversation-eduardo-salas-phd
      November 01, 2011 - Reducing falls and fall-related injuries in the VA system. J Healthc Saf Q. 2003;1:25-33. 8.

3489. In Conversation With… Sigall K. Bell, MD | PSNet
      psnet.ahrq.gov/perspective/conversation-sigall-k-bell-md
      February 26, 2025 - But we still fall short.

3490. Spotlight Case Hindsight Is 2020 Slides Final Revised 05.03.2024 (pdf file)
      psnet.ahrq.gov/sites/default/files/2024-05/spotlight_case_hindsight_is_2020_slides_final_revised_05.03.2024.pdf
      January 01, 2024 - – Clinicians in these high risk, high reward situations may also fall prey to commission bias, which

3491. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/33866/psn-pdf
      September 01, 2018 - But we still fall short.

3492. In Conversation with...James P. Bagian, MD | PSNet
      psnet.ahrq.gov/perspective/conversation-withjames-p-bagian-md
      September 01, 2006 - In Conversation with...James P. Bagian, MD September 1, 2006  Also Read an Essay Also Read an Essay Citation Text: In Conversation with..James P. Bagian, MD. PSNet [internet]. 2006.In Conversation with...James P. Bagian, MD. PSNet [internet]. Rockville (MD): Ag…

3493. Implementing a Patient Safety Program at a Large National Health System | PSNet
      psnet.ahrq.gov/perspective/implementing-patient-safety-program-large-national-health-system
      January 01, 2008 - April 1, 2014 Perspective How Does Infection Prevention … February 1, 2014 Perspective Implementing a Fall … Prevention Program December 1, 2011 Perspective

3494. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/857061/psn-pdf
      November 27, 2023 - patient care learning activities in four spheres of care across the lifespan: wellness and disease prevention

3495. In Conversation with…David W. Bates, MD, MSc | PSNet
      psnet.ahrq.gov/perspective/conversation-withdavid-w-bates-md-msc
      May 01, 2018 - RW: It's interesting that, if you go through that list, it seems that where things might fall apart

3496. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/74120/psn-pdf
      November 30, 2021 - The patient re-presented to the ED after a fall at home. He had been living independently.

3497. Infection After Carpal Tunnel Surgery | PSNet
      psnet.ahrq.gov/web-mm/infection-after-carpal-tunnel-surgery
      May 28, 2014 - predictive value for postoperative complications, but the practical threshold for elevated risk may fall

3498. Hindsight is 20/20: Thrombolytics for Alcohol Intoxication | PSNet
      psnet.ahrq.gov/web-mm/hindsight-2020-thrombolytics-alcohol-intoxication
      December 18, 2024 - Clinicians in these high risk, high reward situations may also fall prey to commission bias , which

3499. Integrating Multiple Medication Decision Support Systems: How Will We Make It All Work? | PSNet
      psnet.ahrq.gov/perspective/integrating-multiple-medication-decision-support-systems-how-will-we-make-it-all-work
      May 01, 2008 - RW: It's interesting that, if you go through that list, it seems that where things might fall apart

3500. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/864867/psn-pdf
      April 10, 2024 - Clinicians in these high risk, high reward situations may also fall prey to commission bias, which is