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psnet.ahrq.gov/web-mm/open-wider-failure-use-interpreter-results-fractured-teeth-and-hypoxia-during-simple
January 29, 2021 - Open wider: Failure to use an interpreter results in fractured teeth and hypoxia during a simple elective operation.
Citation Text:
Bohringer C, Godoy L. Open wider: Failure to use an interpreter results in fractured teeth and hypoxia during a simple elective operation.. PSNet [internet]. Rockville (MD): Ag…
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psnet.ahrq.gov/innovation/algorithm-based-decision-support-system-guides-trauma-staff-during-initial-treatment
May 31, 2023 - Algorithm-Based Decision Support System Guides Trauma Staff During Initial Treatment, Leading to Fewer Medical Errors
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March 3, 2021
Innovation…
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digital.ahrq.gov/sites/default/files/docs/page/e-prescribing-toolset-pharmacy.pdf
January 01, 2020 - it is rare for the e-prescribing functionality of your pharmacy system to stop
functioning, it can happen … things you can do to prepare for the
possibility of this occurrence and to handle it when it does happen
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effectivehealthcare.ahrq.gov/health-topics/wounds-and-injuries
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effectivehealthcare.ahrq.gov/sites/default/files/s29.pdf
October 01, 2007 - Subjects also questioned what
would happen to patients who were started on a study drug
that would become
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digital.ahrq.gov/sites/default/files/docs/citation/uc1hs015182-bentley-final-report-2008.pdf
January 01, 2008 - Transferring to an electronic system cannot happen
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digital.ahrq.gov/sites/default/files/docs/citation/state-regional-demonstration-hit-co-final-report.pdf
July 01, 2015 - From the outset, Colorado was convinced that health care reform was required but
would not happen solely
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www.ahrq.gov/sites/default/files/2024-01/arbaje-report.pdf
January 01, 2024 - Final Progress Report: Older adult safety while receiving home health services after hospital discharge
Older adult safety while receiving home health services after hospital discharge
Principal Investigator: Alicia I. Arbaje, MD, MPH, PhD
Other team members:
Bruce Leff, MD (Primary mentor)
Ayse P. Gurses, PhD, MS…
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www.ahrq.gov/sites/default/files/2024-07/hatlie-report.pdf
January 01, 2024 - Who worked together and how did that happen? What was
remedied?
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psnet.ahrq.gov/perspective/special-edition-perspective-technology-responses-covid-19
August 31, 2020 - forward because all the restrictions on telehealth have been suspended, but it's unclear what is going to happen
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psnet.ahrq.gov/perspective/emergence-application-based-healthcare
August 05, 2022 - So, we thought, what would happen if we reengineered the process of being discharged from the hospital
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety-2/vol2/Advances-Valade_46.pdf
May 05, 2008 - The team also established nine recommendation
target codes for “who” should make a recommendation happen
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psnet.ahrq.gov/perspective/conversation-francoise-marvel-md
August 05, 2022 - So, we thought, what would happen if we reengineered the process of being discharged from the hospital
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effectivehealthcare.ahrq.gov/health-topics/urethral-disorders
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effectivehealthcare.ahrq.gov/health-topics/male-breast-cancer
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effectivehealthcare.ahrq.gov/health-topics/organ-transplantation
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www.ahrq.gov/sites/default/files/publications/files/lepguide.pdf
September 01, 2012 - Patient Safety Terminology
Medical errors*:
Medical errors happen when something that was planned as … They can happen during even the most routine
tasks, such as when a hospital patient on a salt-free diet … Most errors result from
problems created by today’s complex health care system, but errors also happen … It happen in the morning.
Nurse: OK, so you have been tired since this morning.
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psnet.ahrq.gov/perspective/becoming-certified-professional-patient-safety-registered-nurses-perspective
June 01, 2016 - When I think back to my days at AHRQ, we had a fantasy that something like this would begin to happen
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psnet.ahrq.gov/node/857061/psn-pdf
November 27, 2023 - They clearly don’t understand the
potential risks and harms that could happen based on their care.
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www.ahrq.gov/sites/default/files/wysiwyg/hai/tools/perinatal-care-2/hemorrhage_2-team-structure-speaker-notes.pdf
July 01, 2023 - safety; however, as examples in
aviation and other high‐risk industries have shown, the change will not happen