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Showing results for "happened".

21. Psn-Pdf (pdf file)
    psnet.ahrq.gov/node/850358/psn-pdf
    June 14, 2023 - What Happened to Patient Safety. June 14, 2023 Sheridan S. Turn on the Lights. …   May 2023 https://psnet.ahrq.gov/issue/what-happened-patient-safety Patient engagement is an … https://psnet.ahrq.gov/issue/what-happened-patient-safety https://psnet.ahrq.gov/primer/patient-engagement-and-safety

22. Psn-Pdf (pdf file)
    psnet.ahrq.gov/node/47885/psn-pdf
    May 01, 2019 - Deny, Dismiss, Dehumanise: What Happened When I Went to Hospital. May 1, 2019 Cullen A. … https://psnet.ahrq.gov/issue/deny-dismiss-dehumanise-what-happened-when-i-went-hospital Patient stories … https://psnet.ahrq.gov/issue/deny-dismiss-dehumanise-what-happened-when-i-went-hospital https://psnet.ahrq.gov

23. Psn-Pdf (pdf file)
    psnet.ahrq.gov/node/848092/psn-pdf
    April 26, 2023 - It happened to me, as a pregnant OB-GYN. April 26, 2023 Gillispie-Bell V. USA Today. … https://psnet.ahrq.gov/issue/doctors-must-stop-tuning-out-black-women-it-happened-me-pregnant-ob-gyn … https://psnet.ahrq.gov/issue/doctors-must-stop-tuning-out-black-women-it-happened-me-pregnant-ob-gyn

24. Psn-Pdf (pdf file)
    psnet.ahrq.gov/node/847060/psn-pdf
    January 01, 2001 - The Emperor’s New Clothes: Or Whatever Happened To “Human Error”? … https://psnet.ahrq.gov/issue/emperors-new-clothes-or-whatever-happened-human-error This thought piece … https://psnet.ahrq.gov/issue/emperors-new-clothes-or-whatever-happened-human-error https://psnet.ahrq.gov

25. Hidden Heparins: HIT Happens | PSNet
    psnet.ahrq.gov/web-mm/hidden-heparins-hit-happens
    March 27, 2024 - SPOTLIGHT CASE Hidden Heparins: HIT Happens Citation Text: Fogarty PF. Hidden Heparins: HIT Happens. 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…

26. When incidents happen. | PSNet
    psnet.ahrq.gov/issue/when-incidents-happen
    January 14, 2011 - Commentary When incidents happen. Citation Text: Newfield JS. When Incidents Happen. Home Health Care Manag Pract. 2006;18(5). doi:10.1177/1084822306287998. Copy Citation Format: DOI Google Scholar BibTeX EndNote X3 XML EndNote 7 XML Endnote tagged PubMedId RIS …

27. How could this happen? | PSNet
    psnet.ahrq.gov/issue/how-could-happen
    September 19, 2007 - Newspaper/Magazine Article How could this happen? Citation Text: How could this happen? Westfall SS; Mascia K. People. October 5, 2009. Copy Citation Save Save to your library Print Download PDF Share Facebook Twitter Linkedin…

28. Psn-Pdf (pdf file)
    psnet.ahrq.gov/node/33678/psn-pdf
    January 01, 2009 - You just went and told the patient what happened. … They protect the words, "I'm sorry," but they don't protect the statement about what happened. … Here's what we know about what happened, and what we've done to mitigate its impact on you. … I think an expression of regret about what happened at that point is also appropriate. … But that follow-up conversation usually is an opportunity to again explain what happened.

29. Psn-Pdf (pdf file)
    psnet.ahrq.gov/node/853240/psn-pdf
    September 06, 2023 - Debriefing after significant clinical events helps affected staff develop a shared mental model of what happened … , why it happened, and how it can be prevented in the future.

30. Psn-Pdf (pdf file)
    psnet.ahrq.gov/node/867653/psn-pdf
    February 26, 2025 - They happened behind closed doors, and we did not talk about them much. … They saw that a group of people got together to discuss what happened, but then frontline staff would … not know what happened after that. … There are three basic questions we use all the time: “What happened?” “Why did it happen?” … In RCA2, we use the Five Whys to ask why this event happened and create causal chains.

31. Seeking answers, hearing silence. | PSNet
    psnet.ahrq.gov/issue/seeking-answers-hearing-silence
    October 09, 2024 - whose daughter died from medical error and the resistance she faced when trying to understand what happened … July 5, 2023 Deny, Dismiss, Dehumanise: What Happened When I Went to Hospital.

32. In Conversation With… … Jennifer Schulz Moore, LLB, MA, PhD | PSNet
    psnet.ahrq.gov/perspective/conversation-jennifer-schulz-moore-llb-ma-phd
    February 26, 2025 - But that's not what has happened. There are now many lawyers who specialize in ACC law. … error and this happened to you." … So say, "My bad that this happened." … She expressed how terrible she felt about what had happened. … He said to his mother, I'm really upset by what happened to my sister.

33. Sued for misdiagnosis? It could happen to you. | PSNet
    psnet.ahrq.gov/issue/sued-misdiagnosis-it-could-happen-you
    February 07, 2024 - Commentary Sued for misdiagnosis? It could happen to you. Citation Text: Lippman H, Davenport J. Sued for misdiagnosis? It could happen to you. J Fam Pract. 2010;59(9):498-508. Copy Citation Format: Google Scholar PubMed BibTeX EndNote X3 XML EndNote 7 XML Endnote tagged Pu…

34. Psn-Pdf (pdf file)
    psnet.ahrq.gov/node/33878/psn-pdf
    April 01, 2019 - But that's not what has happened. There are now many lawyers who specialize in ACC law. … error and this happened to you." … So say, "My bad that this happened." … She expressed how terrible she felt about what had happened. … He said to his mother, I'm really upset by what happened to my sister.

35. Videos of simulated after action reviews: a training resource to support social and inclusive learning from patient safety events. | PSNet
    psnet.ahrq.gov/issue/videos-simulated-after-action-reviews-training-resource-support-social-and-inclusive-learning
    May 22, 2024 - Debriefing after significant clinical events helps affected staff develop a shared mental model of what happened … , why it happened, and how it can be prevented in the future.

36. The wrong goodbye. | PSNet
    psnet.ahrq.gov/issue/wrong-goodbye
    October 05, 2022 - How could it have happened? … How could it have happened?

37. Minnesota lets nurses practice while disciplinary investigations drag on. Patients keep getting hurt. | PSNet
    psnet.ahrq.gov/issue/minnesota-lets-nurses-practice-while-disciplinary-investigations-drag-patients-keep-getting
    April 22, 2020 - August 23, 2023 Inside the preventable deaths that happened within a prominent transplant … View More Related Resources Inside the preventable deaths that happened

38. Disclosure of Medical Error | PSNet
    psnet.ahrq.gov/perspective/disclosure-medical-error
    January 01, 2009 - You just went and told the patient what happened. … They protect the words, "I'm sorry," but they don't protect the statement about what happened. … Here's what we know about what happened, and what we've done to mitigate its impact on you. … I think an expression of regret about what happened at that point is also appropriate. … But that follow-up conversation usually is an opportunity to again explain what happened.

39. In Conversation with…Thomas H. Gallagher, MD | PSNet
    psnet.ahrq.gov/perspective/conversation-withthomas-h-gallagher-md
    January 01, 2009 - You just went and told the patient what happened. … They protect the words, "I'm sorry," but they don't protect the statement about what happened. … Here's what we know about what happened, and what we've done to mitigate its impact on you. … I think an expression of regret about what happened at that point is also appropriate. … But that follow-up conversation usually is an opportunity to again explain what happened.

40. In Conversation with Jessica Behrhorst about The Evolution of Root Cause Analysis | PSNet
    psnet.ahrq.gov/perspective/conversation-jessica-behrhorst-about-evolution-root-cause-analysis
    February 26, 2025 - They happened behind closed doors, and we did not talk about them much. … They saw that a group of people got together to discuss what happened, but then frontline staff would … not know what happened after that. … There are three basic questions we use all the time: “What happened?” “Why did it happen?” … In RCA 2 , we use the Five Whys to ask why this event happened and create causal chains.