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Total Results: 3,974 records

Showing results for "happened".

281. PowerPoint Presentation
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/esrd/using-checklists/checklistandauditslides.pptx
     September 03, 2014 - When learning from defects, teams identify: What happened? Why did it happen? … Analyzing what happened and why it happened helps the team understand the contributing factors and processes … What happened? Step 1. Reconstruct the timeline to understand what happened. Step 2. … What happened? 2. Why did it happen? 3. What will you do to reduce the risk of recurrence? 4.

282. Incident Reporting: More Attention to the Safety Action Feedback Loop, Please | PSNet
     psnet.ahrq.gov/perspective/incident-reporting-more-attention-safety-action-feedback-loop-please
     September 01, 2011 - you wouldn't want to do the whole aviation style, let's get the black box and find out exactly what happened … Because otherwise, you'll never really find out what happened and any resulting root cause analysis will … We know that it's very difficult to track down what's happened if weeks to months have gone by. … , and if you can identify them 6 months later, they're probably not going to remember a lot of what happened … They just want to let somebody know that something important happened, and if somebody in a position

283. In Conversation With…Kaveh G. Shojania, MD | PSNet
     psnet.ahrq.gov/perspective/conversation-withkaveh-g-shojania-md
     September 01, 2011 - you wouldn't want to do the whole aviation style, let's get the black box and find out exactly what happened … Because otherwise, you'll never really find out what happened and any resulting root cause analysis will … We know that it's very difficult to track down what's happened if weeks to months have gone by. … , and if you can identify them 6 months later, they're probably not going to remember a lot of what happened … They just want to let somebody know that something important happened, and if somebody in a position

284. These patients had to lobby for correct diabetes diagnoses. Was their race a reason? | PSNet
     psnet.ahrq.gov/issue/these-patients-had-lobby-correct-diabetes-diagnoses-was-their-race-reason
     July 10, 2024 - It happened to me, as a pregnant OB-GYN.

285. Hospitals look to improve informed consent process. | PSNet
     psnet.ahrq.gov/issue/hospitals-look-improve-informed-consent-process
     November 10, 2010 - June 28, 2023 Inside the preventable deaths that happened within a prominent transplant

286. Reducing Diagnostic Error: Measurement Considerations. | PSNet
     psnet.ahrq.gov/issue/reducing-diagnostic-error-measurement-considerations
     September 06, 2011 - June 2, 2020 Deny, Dismiss, Dehumanise: What Happened When I Went to Hospital.

287. For doctors, diagnosing gets a technological boost. | PSNet
     psnet.ahrq.gov/issue/doctors-diagnosing-gets-technological-boost
     May 18, 2005 - It happened to me, as a pregnant OB-GYN.

288. This man wants to heal health care. | PSNet
     psnet.ahrq.gov/issue/man-wants-heal-health-care
     January 18, 2006 - Here's how it happened.

289. Patient Safety Supplement. | PSNet
     psnet.ahrq.gov/issue/patient-safety-supplement
     November 01, 2012 - April 30, 2008 The Emperor’s New Clothes: Or Whatever Happened To “Human Error”?

290. Why false positives merit concern, too. | PSNet
     psnet.ahrq.gov/issue/why-false-positives-merit-concern-too
     February 19, 2010 - How could it have happened? October 30, 2019 My human doctor.

291. Death of a boy prompts new medical efforts nationwide. | PSNet
     psnet.ahrq.gov/issue/death-boy-prompts-new-medical-efforts-nationwide
     March 22, 2014 - How could it have happened?

292. Maternal deaths at MetroWest hospital prompt state probes. | PSNet
     psnet.ahrq.gov/issue/maternal-deaths-metrowest-hospital-prompt-state-probes
     August 24, 2016 - It happened to me, as a pregnant OB-GYN.

293. Simulation in Healthcare. | PSNet
     psnet.ahrq.gov/issue/simulation-healthcare
     November 23, 2014 - March 27, 2005 The Emperor’s New Clothes: Or Whatever Happened To “Human Error”?

294. Minnesota hospitals are testing ways to reduce return trips. | PSNet
     psnet.ahrq.gov/issue/minnesota-hospitals-are-testing-ways-reduce-return-trips
     January 18, 2012 - Here's how it happened.

295. Healthcare industry representatives: maximizing benefits and reducing risks. | PSNet
     psnet.ahrq.gov/issue/healthcare-industry-representatives-maximizing-benefits-and-reducing-risks
     March 18, 2010 - September 20, 2023 Inside the preventable deaths that happened within a prominent transplant

296. Working Knowledge: How Organizations Manage What They Know. | PSNet
     psnet.ahrq.gov/issue/working-knowledge-how-organizations-manage-what-they-know
     May 24, 2016 - March 10, 2021 Deny, Dismiss, Dehumanise: What Happened When I Went to Hospital.

297. Patients' and physicians' attitudes regarding the disclosure of medical errors. | PSNet
     psnet.ahrq.gov/issue/patients-and-physicians-attitudes-regarding-disclosure-medical-errors
     March 21, 2017 - Patients wanted disclosure of all harmful errors, why the errors happened, and how recurrences would

298. When there's no one to whom an error can be disclosed, how should an error be handled? | PSNet
     psnet.ahrq.gov/issue/when-theres-no-one-whom-error-can-be-disclosed-how-should-error-be-handled
     March 19, 2018 - the author argues that the clinician and organization still have the responsibility to document what happened

299. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/33877/psn-pdf
     April 01, 2019 - They were allowed to call a hotline number and report issues that had happened. … That is how physicians became engaged in notifying the organization about things that had happened. … about 16% of them will say anything empathically, anything along the lines of "I'm so sorry this has happened … You don't know the facts yet, but you do know something terrible has happened to her."

300. Patient Safety in the Context of Perinatal, Neonatal, and Pediatric Care. | PSNet
     psnet.ahrq.gov/issue/patient-safety-context-perinatal-neonatal-and-pediatric-care
     April 01, 2024 - October 15, 2008 The Emperor’s New Clothes: Or Whatever Happened To “Human Error”?