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Total Results: 1,790 records

Showing results for "happen".

201. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/39721/psn-pdf
     September 20, 2011 - Barriers to reporting included a belief that it wasn’t their responsibility, nothing would happen from

202. Patient Safety. | PSNet
     psnet.ahrq.gov/issue/patient-safety-0
     February 28, 2015 - February 13, 2013 Program encourages reporting accidents waiting to happen: the Good

203. Exploring clinical lessons learned by experienced hospitalists from diagnostic errors and successes. | PSNet
     psnet.ahrq.gov/issue/exploring-clinical-lessons-learned-experienced-hospitalists-diagnostic-errors-and-successes
     January 15, 2025 - Study Exploring clinical lessons learned by experienced hospitalists from diagnostic errors and successes. Citation Text: Kotwal S, Howell M, Zwaan L, et al. Exploring clinical lessons learned by experienced hospitalists from diagnostic errors and successes. J Gen Intern Med. 2024;39(8):…

204. Unexpected hypoglycemia in a critically ill patient. | PSNet
     psnet.ahrq.gov/issue/unexpected-hypoglycemia-critically-ill-patient
     July 25, 2018 - is presented to illustrate the importance of bridging what happens at the bedside with what needs to happen

205. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/33783/psn-pdf
     April 01, 2015 - create a safe environment in an operating room, and that turns out to be difficult and doesn't just happen … Why can't you just make it happen? … They've learned over the last 10 years how to get this to happen. … Even though we haven't found the magic bullet to make it happen or pulled the right lever, I'm hopeful … Finally, I think the culture change we seek will happen faster than we expect.

206. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/840174/psn-pdf
     August 28, 2024 - for the liaison to set expectations for surviving family members so they can prepare for what will happen … explanation is particularly important, as most families want to know that what happened to them will not happen

207. In Conversation With…Christine A. Sinsky, MD | PSNet
     psnet.ahrq.gov/perspective/conversation-withchristine-sinsky-md
     February 26, 2025 - When computers entered your world, is it something you thought would happen or were you optimistic and … RW : It may not be obvious to everyone why that would happen since the imperatives to do the clerical … How can I make that happen?

208. Using trainee failures to enhance learning: a qualitative study of pediatric hospitalists on allowing failure. | PSNet
     psnet.ahrq.gov/issue/using-trainee-failures-enhance-learning-qualitative-study-pediatric-hospitalists-allowing
     December 14, 2022 - allowing failure, the process of allowing or interrupting failure, and how they decide to allow failure to happen

209. Debriefing in the emergency department after clinical events: a practical guide. | PSNet
     psnet.ahrq.gov/issue/debriefing-emergency-department-after-clinical-events-practical-guide
     November 16, 2022 - debriefing in the emergency department, this commentary outlines how to determine when a debrief should happen

210. Delayed Admissions to the Pediatric Intensive Care Unit: Progression of Disease or Errors in Emergency Department Management | PSNet
     psnet.ahrq.gov/issue/delayed-admissions-pediatric-intensive-care-unit-progression-disease-or-errors-emergency
     June 14, 2019 - Transitions of care happen multiple times in a patient’s hospital stay and are common times for preventable

211. In Conversation with...Steven J. Spear, DBA, MS, MS | PSNet
     psnet.ahrq.gov/perspective/conversation-withsteven-j-spear-dba-ms-ms
     August 01, 2009 - time at the right dose without asking the nurses to do endless workarounds to make sure that will all happen … Now without stopping the work, what could happen at that point is that the nurse does go procure the … RW: Does this not happen in health care because the nurse doesn't think about her work that way? … If you look at the financial market, what will happen is that for all the finger pointing that's going … Maybe the first measures are very simple: yes or no, did a never event happen?

212. Workarounds and Resiliency on the Front Lines of Health Care | PSNet
     psnet.ahrq.gov/perspective/workarounds-and-resiliency-front-lines-health-care
     August 01, 2009 - time at the right dose without asking the nurses to do endless workarounds to make sure that will all happen … Now without stopping the work, what could happen at that point is that the nurse does go procure the … RW: Does this not happen in health care because the nurse doesn't think about her work that way? … If you look at the financial market, what will happen is that for all the finger pointing that's going … Maybe the first measures are very simple: yes or no, did a never event happen?

213. Preventing medication errors during codes. | PSNet
     psnet.ahrq.gov/issue/preventing-medication-errors-during-codes
     February 22, 2023 - Related Resources Hospitals look to computers to predict patient emergencies before they happen

214. 20 years after To Err Is Human: a bibliometric analysis of ‘the IOM report’s’ impact on research on patient safety. | PSNet
     psnet.ahrq.gov/issue/20-years-after-err-human-bibliometric-analysis-iom-reports-impact-research-patient-safety
     July 15, 2020 - Review 20 years after To Err Is Human: a bibliometric analysis of ‘the IOM report’s’ impact on research on patient safety. Citation Text: St.Pierre M, Grawe P, Bergström J, et al. 20 years after To Err Is Human: a bibliometric analysis of ‘the IOM report’s’ impact on research on patient …

215. Duty to Disclose Someone Else's Error? | PSNet
     psnet.ahrq.gov/web-mm/duty-disclose-someone-elses-error
     June 01, 2004 - Angry and upset, the parents asked repeatedly, "How could this happen? … another health care worker's error can help ensure that these challenging but important conversations happen

216. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/33863/psn-pdf
     August 01, 2018 - You can imagine 1 week in 5 for circumstances that virtually never happen. … I imagine that some of it they're training over and over again for things that essentially never happen … someone is saying "push a drug," then there has to be someone behind the curtain showing what would happen

217. Organizational Change in the Face of Highly Public Errors—II. The Duke Experience | PSNet
     psnet.ahrq.gov/perspective/organizational-change-face-highly-public-errors-ii-duke-experience
     July 20, 2010 - How could such a terrible mistake happen to a team of highly qualified and dedicated individuals in an … journey; the transition to an optimal culture of shared responsibility and accountability does not happen … have maintained the status quo, based on the mistaken premise that "mistakes like that could never happen

218. Missed CANDOR Implementation Opportunities. | PSNet
     psnet.ahrq.gov/web-mm/missed-candor-implementation-opportunities
     November 11, 2020 - for the liaison to set expectations for surviving family members so they can prepare for what will happen … explanation is particularly important, as most families want to know that what happened to them will not happen

219. What happens between visits? Adverse and potential adverse events among a low-income, urban, ambulatory population with diabetes. | PSNet
     psnet.ahrq.gov/issue/what-happens-between-visits-adverse-and-potential-adverse-events-among-low-income-urban
     February 22, 2011 - Study What happens between visits? Adverse and potential adverse events among a low-income, urban, ambulatory population with diabetes. Citation Text: Sarkar U, Handley MA, Gupta R, et al. What happens between visits? Adverse and potential adverse events among a low-income, urban, ambu…

220. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/33679/psn-pdf
     January 01, 2009 - Thus, these data do not necessarily speak to what will happen to liability if a physician's disclosure … We are going to do what it takes to make you better and make sure the same thing does not happen again