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psnet.ahrq.gov/issue/effect-visitation-restrictions-ed-error
July 01, 2016 - It happened to me, as a pregnant OB-GYN.
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psnet.ahrq.gov/issue/shifting-indirect-patient-care-duties-after-hours-era-work-hours-restrictions
February 18, 2011 - Patient Safety and the Evolution of WebM&M and PSNet
September 1, 2019
What happened
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psnet.ahrq.gov/issue/development-and-evaluation-checklist-support-decision-making-cancer-multidisciplinary-team
September 25, 2011 - May 20, 2020
Deny, Dismiss, Dehumanise: What Happened When I Went to Hospital.
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psnet.ahrq.gov/issue/role-quality-improvement-and-patient-safety-academic-promotion-results-survey-chairs
July 13, 2016 - View More
Related Resources
Inside the preventable deaths that happened
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psnet.ahrq.gov/issue/diagnostic-errors-and-abnormal-diagnostic-tests-lost-follow-source-needless-waste-and-delay
December 22, 2008 - Diagnostic Safety and Quality
April 26, 2023
Deny, Dismiss, Dehumanise: What Happened
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psnet.ahrq.gov/issue/saying-it-without-words-qualitative-study-oncology-staffs-experiences-speaking-about-safety
November 05, 2014 - June 28, 2023
Deny, Dismiss, Dehumanise: What Happened When I Went to Hospital.
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psnet.ahrq.gov/node/60844/psn-pdf
August 26, 2020 - Surgical errors happen, but are learners trained to
recover from them? A survey of North American surgical
residents and fellows.
August 26, 2020
Gabrysz-Forget F, Young M, Zahabi S, et al. Surgical errors happen, but are learners trained to recover
from them? A survey of North American surgical residents and fell…
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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.
September 2, 2020
Musunur S, Waineo E, Walton E, et al. When bad things happen: training medical students to anticipate the
aftermath of medical errors. Acad Psychiatry. 2020;44(5):586-591. doi:10.1007/s40596-020-01278-…
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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?
January 25, 2023
Gillissen A, Kochanek T, Zupanic M, et al. Bad things can happen: are medical students aware of patient
centered care and safety? Diagnosis (Berl). 2023;10(2):110-120. doi:10.1515/dx-2022-0072.
https://psnet.ahr…
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psnet.ahrq.gov/node/45664/psn-pdf
July 02, 2017 - Intraoperative adverse events in abdominal surgery: what
happens in the operating room does not stay in the
operating room.
July 2, 2017
Bohnen JD, Mavros MN, Ramly EP, et al. Intraoperative Adverse Events in Abdominal Surgery: What
Happens in the Operating Room Does Not Stay in the Operating Room. Ann Surg. 2017;…
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psnet.ahrq.gov/issue/fatal-mistakes-why-do-ten-fold-medication-errors-children-keep-happening
April 21, 2021 - Newspaper/Magazine Article
Fatal mistakes: why do ten-fold medication errors in children keep happening?
Citation Text:
Fatal mistakes: why do ten-fold medication errors in children keep happening? Parry C. The Pharmaceutical Journal. April 22 2021.
Copy Citation
…
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psnet.ahrq.gov/node/838180/psn-pdf
January 01, 2023 - To err is human, but what happens when surgeons err?
September 28, 2022
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.
https://psnet.ahrq.gov/issue/err-human-what-happens-when-surgeons-err
Clinicians involv…
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psnet.ahrq.gov/node/33875/psn-pdf
March 01, 2019 - When I asked what happened, the doctor said,
"Oh, the name [of the backup physician] is on the wall, … Tell me from your perspective what happened.
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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. Home Health Care Manag Pract. 2006;18(5).
doi:10.1177/1084822306287998.
https://psnet.ahrq.gov/issue/when-incidents-happen
The author discusses post-incident documentation for the home care setting and addresses legal issues.
https://ps…
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psnet.ahrq.gov/node/42567/psn-pdf
September 11, 2013 - What happens to the medication regimens of older adults
during and after an acute hospitalization?
September 11, 2013
Harris CM, Sridharan A, Landis R, et al. What happens to the medication regimens of older adults during
and after an acute hospitalization? J Patient Saf. 2013;9(3):150-3. doi:10.1097/PTS.0b013e3182…
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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.
June 14, 2023
Conn R, Fox A, Carrington A, et al. Prescribing errors in children: why they happen and how to prevent
them. Pharmaceutical Journal. 2023;310:7973. doi:10.1211/pj.2023.1.184013.
https://psnet.ahrq.gov/issue/prescribing-errors-ch…
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psnet.ahrq.gov/node/39923/psn-pdf
September 03, 2014 - Sued for misdiagnosis? 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 diagnostic error, minimize litigation, and pr…
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psnet.ahrq.gov/perspective/conversation-charles-ornstein
October 01, 2009 - A couple of things happened in the summer of 2003 that caused us to focus on King/Drew. … RW: You mentioned that there was a second thing that happened? … Then, not only is the problem what actually happened, but the problem is that you tried to cover it up … RW: If a hospital that had the same deficiencies and the same Joint Commissioner or state reports happened … It cannot just be frequency: the heparin dosing error experienced by the Quaid twins has happened hundreds
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psnet.ahrq.gov/perspective/media-essential-if-sometimes-arbitrary-promoter-patient-safety
October 01, 2009 - It cannot just be frequency: the heparin dosing error experienced by the Quaid twins has happened hundreds … A couple of things happened in the summer of 2003 that caused us to focus on King/Drew. … RW: You mentioned that there was a second thing that happened? … Then, not only is the problem what actually happened, but the problem is that you tried to cover it up … RW: If a hospital that had the same deficiencies and the same Joint Commissioner or state reports happened
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psnet.ahrq.gov/node/38215/psn-pdf
November 14, 2011 - Could it happen here? Learning from other organizations'
safety errors.
November 14, 2011
Conway JB. Could it happen here? Learning from other organizations' safety errors. Healthcare Executive.
2008;23(6):64, 66-67.
https://psnet.ahrq.gov/issue/could-it-happen-here-learning-other-organizations-safety-errors
This…