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psnet.ahrq.gov/node/843080/psn-pdf
January 25, 2023 - Bad things can happen: are medical students aware of
patient centered care and safety? … Bad things can happen: are medical students aware of patient
centered care and safety? … https://psnet.ahrq.gov/issue/bad-things-can-happen-are-medical-students-aware-patient-centered-care- … https://psnet.ahrq.gov/issue/bad-things-can-happen-are-medical-students-aware-patient-centered-care-and-safety … https://psnet.ahrq.gov/issue/bad-things-can-happen-are-medical-students-aware-patient-centered-care-and-safety
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psnet.ahrq.gov/node/60877/psn-pdf
September 02, 2020 - When bad things happen: training medical students to
anticipate the aftermath of medical errors. … When bad things happen: training medical students to anticipate the
aftermath of medical errors. … https://psnet.ahrq.gov/issue/when-bad-things-happen-training-medical-students-anticipate-aftermath- … https://psnet.ahrq.gov/issue/when-bad-things-happen-training-medical-students-anticipate-aftermath-medical-errors … https://psnet.ahrq.gov/issue/when-bad-things-happen-training-medical-students-anticipate-aftermath-medical-errors
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www.ahrq.gov/patient-safety/settings/hospital/candor/impguide/apd.html
February 01, 2017 - Steps
How will this happen? … [Be specific and include important steps to make the idea/activity happen.] … Who will make this happen? [Be specific for each task.] … What other information do I need to make this happen?
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www.ahrq.gov/hai/tools/ambulatory-surgery/sections/implementation/training-tools/defects.html
May 01, 2017 - the types of systems that contributed to the defect (an event or situation that you do not want to happen … Why did it happen?
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effectivehealthcare.ahrq.gov/sites/default/files/zikmund.pdf
May 29, 2025 - Absolute Probability
• Comparative Probability
• Incremental Probability
Sample Cognition:
• Might happen … Absolute Probability
• Comparative Probability1
• Incremental Probability
Sample Cognition:
• Might happen … to me.”
• “It is
more likely to happen to me.”
• “I am more likely to have this
happen to me … than to have that happen to me.”
• “I am a person who has
a higher
chance of
this happening … Need:
• Avoid Surprise and Regret
What Patients Care About:
• Care that this could
happen
Congruent
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www.ahrq.gov/hai/quality/tools/cauti-ltc/modules/implementation/long-term-modules/module2/defects.html
March 01, 2017 - the types of systems that contributed to the defect (an event or situation that you do not want to happen … Why did it happen?
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www.ahrq.gov/hai/tools/ambulatory-surgery/sections/implementation/training-tools/learn.html
April 01, 2017 - the types of systems that contributed to the defect (an event or situation that you do not want to happen … Why did it happen?
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psnet.ahrq.gov/node/850356/psn-pdf
June 14, 2023 - Prescribing errors in children: why they happen and how
to prevent them. … Prescribing errors in children: why they happen and how to prevent
them. … https://psnet.ahrq.gov/issue/prescribing-errors-children-why-they-happen-and-how-prevent-them
Children … https://psnet.ahrq.gov/issue/prescribing-errors-children-why-they-happen-and-how-prevent-them
https:/
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www.ahrq.gov/patient-safety/settings/long-term-care/resource/injuries/fallspx/manapb.html
December 01, 2017 - Fall Interventions Monitor
Staff Materials
Pre and Posttests for Inservice #1, Why Falls Happen … and Posttests for Inservice #2, How to Reduce Falls
Pre and Posttests for Inservice #1, Why Falls Happen … for Inservice #2, How to Reduce Falls, Spanish
Appendix B17: Handout for Inservice #1, Why Falls Happen … Inservice #2, How to Reduce Falls in Nursing Facilities
Appendix B19: Handout for Inservice #1, Why Falls Happen
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psnet.ahrq.gov/issue/program-encourages-reporting-accidents-waiting-happen-good-catch-awards
February 13, 2013 - Newspaper/Magazine Article
Program encourages reporting accidents waiting to happen … Citation Text:
Program encourages reporting accidents waiting to happen: the Good Catch Awards. … Cite
Citation
Citation Text:
Program encourages reporting accidents waiting to happen
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psnet.ahrq.gov/node/36149/psn-pdf
September 29, 2010 - When incidents happen.
September 29, 2010
Newfield JS. When Incidents Happen. … https://psnet.ahrq.gov/issue/when-incidents-happen
The author discusses post-incident documentation … https://psnet.ahrq.gov/issue/when-incidents-happen
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psnet.ahrq.gov/node/45874/psn-pdf
February 22, 2017 - Ethics in the pediatric emergency department: when
mistakes happen: an approach to the process, evaluation … Ethics in the Pediatric Emergency Department: When Mistakes Happen: An
Approach to the Process, Evaluation … https://psnet.ahrq.gov/issue/ethics-pediatric-emergency-department-when-mistakes-happen-approach-
process-evaluation-and … https://psnet.ahrq.gov/issue/ethics-pediatric-emergency-department-when-mistakes-happen-approach-process-evaluation-and … https://psnet.ahrq.gov/issue/ethics-pediatric-emergency-department-when-mistakes-happen-approach-process-evaluation-and
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www.ahrq.gov/sites/default/files/wysiwyg/sops/surveys/medical-office/MO_Items-Composite_Measures.pdf
June 02, 2025 - Sometimes, Most of the time, Always, Does Not Apply or Don’t Know)
How often do the following things happen … This office is good at changing office processes to make sure the same problems don’t happen again. … Mistakes happen more than they should in this office. (negatively worded)
F4. … They overlook patient care mistakes that happen over and over. (negatively worded)
E3. … In your best estimate, how often did the following things happen in your medical office OVER THE PAST
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psnet.ahrq.gov/node/39923/psn-pdf
September 03, 2014 - It could happen to you.
September 3, 2014
Lippman H, Davenport J. Sued for misdiagnosis? … It could happen to you. J Fam Pract. 2010;59(9):498-508. … https://psnet.ahrq.gov/issue/sued-misdiagnosis-it-could-happen-you
This article explains how to avoid … https://psnet.ahrq.gov/issue/sued-misdiagnosis-it-could-happen-you
https://psnet.ahrq.gov/primer/diagnostic-errors
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psnet.ahrq.gov/node/38215/psn-pdf
November 14, 2011 - Could it happen here? Learning from other organizations'
safety errors. … Could it happen here? Learning from other organizations' safety errors. … https://psnet.ahrq.gov/issue/could-it-happen-here-learning-other-organizations-safety-errors
This brief … https://psnet.ahrq.gov/issue/could-it-happen-here-learning-other-organizations-safety-errors
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psnet.ahrq.gov/issue/bad-things-can-happen-are-medical-students-aware-patient-centered-care-and-safety
July 06, 2022 - Study
Bad things can happen: are medical students aware of patient centered care … Bad things can happen: are medical students aware of patient centered care and safety? … Bad things can happen: are medical students aware of patient centered care and safety?
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psnet.ahrq.gov/issue/surgical-safety-does-not-happen-accident-learning-perioperative-near-miss-case-studies
August 04, 2021 - Commentary
Surgical safety does not happen by accident: learning from perioperative … Surgical safety does not happen by accident: learning from perioperative near miss case studies. … Surgical safety does not happen by accident: learning from perioperative near miss case studies.
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psnet.ahrq.gov/node/44132/psn-pdf
May 13, 2015 - Adverse outcomes: why bad things happen to good
people.
May 13, 2015
Sonnenberg A. … Adverse outcomes: why bad things happen to good people. … https://psnet.ahrq.gov/issue/adverse-outcomes-why-bad-things-happen-good-people
This commentary provides … https://psnet.ahrq.gov/issue/adverse-outcomes-why-bad-things-happen-good-people
https://psnet.ahrq.gov
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psnet.ahrq.gov/node/47914/psn-pdf
May 22, 2019 - Hospitals look to computers to predict patient
emergencies before they happen. … https://psnet.ahrq.gov/issue/hospitals-look-computers-predict-patient-emergencies-they-happen
Nuisance … https://psnet.ahrq.gov/issue/hospitals-look-computers-predict-patient-emergencies-they-happen
https:/
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psnet.ahrq.gov/issue/err-human-what-happens-when-surgeons-err
August 04, 2021 - Study
To err is human, but what happens when surgeons err?
Citation Text:
Lin JS, Olutoye OO, Samora JB. To err is human, but what happens when surgeons err? J Pediatr Surg. 2023;58(3):496-502. doi:10.1016/j.jpedsurg.2022.06.019.
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