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Showing results for "how to do a case study".

61. How Does Health Care Simulation Affect Patient Care? | PSNet
    psnet.ahrq.gov/perspective/how-does-health-care-simulation-affect-patient-care
    August 01, 2018 - developed technologically where it wasn't a huge ordeal to do one study. … RW : In a field like nuclear power or aviation, how do you know when you're doing too much? … How do you calibrate that? … how that's going to play out. … malpractice studies and other case reports, such as failure to escalate therapy when the initial therapy

62. Learning not to take it seriously: junior doctors' accounts of error. | PSNet
    psnet.ahrq.gov/issue/learning-not-take-it-seriously-junior-doctors-accounts-error
    December 16, 2015 - did not receive constructive feedback on their performance or training in how to disclose errors to … February 22, 2019 Exploring the role of communications in quality improvement: a case … study of the 1000 Lives Campaign in NHS Wales. … March 18, 2011 Teaching but not learning: how medical residency programs handle errors … October 28, 2010 WebM&M Cases Do Not Disturb!

63. Does the concept of safety culture help or hinder systems thinking in safety? | PSNet
    psnet.ahrq.gov/issue/does-concept-safety-culture-help-or-hinder-systems-thinking-safety
    October 12, 2011 - One example is for an organization to establish a safety practice and implement processes to ensure the … December 1, 2010 Learning from accidents—what more do we need to know? … leaders of nursing homes negotiate their dual responsibilities- a case study. … December 4, 2024 Leading quality and safety on the frontline - a case study of department … safety: learning from what we do well.

64. Spotlight Case [MONTH] 2003 (ppt file)
    psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.64_slideshow.ppt
    June 01, 2004 - Do house officers learn from their mistakes? … Reasons: Physicians believe disclosure is the right thing to do, but encounter insurmountable obstacles … ; or Physicians unclear about whether and how to disclose errors Case (cont.): The Wrong Shot … Vincent C, Young M, Phillips A. Why do people sue doctors? … administer an important vaccine to a child.

65. Ascension Health's demonstration of full disclosure protocol for unexpected events during labor and delivery shows promise. | PSNet
    psnet.ahrq.gov/issue/ascension-healths-demonstration-full-disclosure-protocol-unexpected-events-during-labor-and
    January 22, 2017 - This case study evaluated Ascension Health's implementation of a full disclosure protocol during a 2- … A major barrier to widespread dissemination remains convincing liability insurers to support this type … 1,500 avoidable deaths a year—and aim to do even better. … September 15, 2010 How active resisters and organizational constipators affect health … November 25, 2020 Why do hundreds of US women die annually in childbirth?

66. Baccalaureate nursing students' accounts of medical mistakes occurring in the clinical setting: implications for curricula. | PSNet
    psnet.ahrq.gov/issue/baccalaureate-nursing-students-accounts-medical-mistakes-occurring-clinical-setting
    June 24, 2009 - According to this qualitative study, only half of nursing trainees had received training on how to … April 8, 2008 To do no harm - and the most good - with AI in health care. … adverse events: a collection of vignettes. … Socio-technical issues and challenges in implementing safe patient handovers: insights from ethnographic case … studies.

67. Spotlight Case July 2008 (ppt file)
    psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.269_slideshow.ppt
    June 01, 2012 - Understand the frequency of errors and adverse events in the transfer of patients between hospitals Describe how … Inter-facility patient transfers in Ontario: Do you know what your local ambulance is being used for? … transport services - a case study. … transport services - a case study. … Do specialist transport personnel improve hospital outcome in critically ill patients transferred to

68. Measurement of harms in community care: a qualitative study of use of the NHS Safety Thermometer. | PSNet
    psnet.ahrq.gov/issue/measurement-harms-community-care-qualitative-study-use-nhs-safety-thermometer
    January 23, 2019 - A qualitative study of a large-scale exercise in seeking to measure for improvement, not blame. … A multisite case study. … case study. … April 17, 2019 How to be a very safe maternity unit: an ethnographic study. … September 24, 2017 Exploring how ward staff engage with the implementation of a patient

69. Spotlight Case July 2008 (ppt file)
    psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.266_slideshow.ppt
    May 01, 2012 - Using a communication framework at handover to boost patient outcomes. … prioritize appropriately Egocentric heuristic: sender underestimates how much information receivers … need and assumes receiver has access to same information they do Importance of structured written sign-out … . http://www.ncbi.nlm.nih.gov/pubmed/15382983 Arora V, Johnson J, Lovinger D, Humphrey HJ, Meltzer DO … elements of handoff, such as anticipatory guidance and to-do items with residents.

70. Escape Fire: Designs for the Future of Health Care. | PSNet
    psnet.ahrq.gov/issue/escape-fire-designs-future-health-care
    May 26, 2010 - August 16, 2016 To Do No Harm: Ensuring Patient Safety in Health Care Organizations. … February 7, 2019 Medical Error: What Do We Know? What Do We Do? … February 4, 2009 Error Reduction in Health Care: A Systems Approach to Improving Patient … January 2, 2017 Stories from the sharp end: case studies in safety improvement. … January 4, 2006 Sources of Power: How People Make Decisions.

71. Building comprehensive strategies for obstetric safety: simulation drills and communication. | PSNet
    psnet.ahrq.gov/issue/building-comprehensive-strategies-obstetric-safety-simulation-drills-and-communication
    May 08, 2019 - positive-exemplar case study of a new patient safety tool. … December 6, 2023 Bringing perioperative emergency manuals to your institution: a "How … To" from concept to implementation in 10 steps. … April 27, 2019 What we can do about maternal mortality—and how to do it quickly. … June 3, 2015 In situ simulation: a method of experiential learning to promote safety

72. From reporting to improving: how root cause analysis in teams shape patient safety culture. | PSNet
    psnet.ahrq.gov/issue/reporting-improving-how-root-cause-analysis-teams-shape-patient-safety-culture
    July 31, 2024 - Study From reporting to improving: how root cause analysis in teams shape patient … From reporting to improving: how root cause analysis in teams shape patient safety culture. … From reporting to improving: how root cause analysis in teams shape patient safety culture. … to improve teamwork and quality for hospitalized patients: a multi-site qualitative comparative case … study.

73. Transfer Troubles | PSNet
    psnet.ahrq.gov/web-mm/transfer-troubles
    December 29, 2014 - Describe how communication lapses can lead to errors and adverse events in the transfer of patients between … Although it is difficult to accurately determine how many patients are transferred each year worldwide … In addition to these emergent transfers, many transfers do involve medically stable patients and are … transport services–a case study. … Do specialist transport personnel improve hospital outcome in critically ill patients transferred to

74. Interdisciplinary team training: five lessons learned. | PSNet
    psnet.ahrq.gov/issue/interdisciplinary-team-training-five-lessons-learned
    August 21, 2013 - This commentary describes a teamwork initiative in a labor and delivery unit to improve communication … March 10, 2021 What we can do about maternal mortality—and how to do it quickly. … August 30, 2017 How communication among members of the health care team affects maternal … December 30, 2012 In situ simulation: a method of experiential learning to promote safety … threats to patient safety: case study involving a labor and delivery ward.

75. Production Pressures | PSNet
    psnet.ahrq.gov/web-mm/production-pressures
    November 16, 2022 - understand how to design the work system to minimize pressures and stress on the health care providers … For instance, high workload or having a lot to do, a characteristic of the "tasks," can be a source of … A test of the methodology with 10 case studies in an academic medical center shows that this novel approach … As this one influential case study described, workers on the assembly line were told that they could … This would be far trickier to do in health care.

76. Do patient safety events increase readmissions? | PSNet
    psnet.ahrq.gov/issue/do-patient-safety-events-increase-readmissions
    November 04, 2015 - Do patient safety events increase readmissions? … were significantly more likely to be readmitted within 1 month, and a broad array of adverse events … were linked to a 3-month increased readmission risk. … Do patient safety events increase readmissions? … February 1, 2012 How best to measure surgical quality?

77. A risk analysis method to evaluate the impact of a Computerized Provider Order Entry system on patient safety. | PSNet
    psnet.ahrq.gov/issue/risk-analysis-method-evaluate-impact-computerized-provider-order-entry-system-patient-safety
    September 15, 2021 - Study A risk analysis method to evaluate the impact of a Computerized Provider Order … A risk analysis method to evaluate the impact of a computerized provider order entry system on patient … A risk analysis method to evaluate the impact of a computerized provider order entry system on patient … October 21, 2020 How do community pharmacies recover from e-prescription errors? … January 7, 2015 Case study: identifying potential problems at the human/technical interface

78. Preventing overdiagnosis: how to stop harming the healthy. | PSNet
    psnet.ahrq.gov/issue/preventing-overdiagnosis-how-stop-harming-healthy
    January 02, 2013 - Commentary Preventing overdiagnosis: how to stop harming the healthy. … Preventing overdiagnosis: how to stop harming the healthy. … Preventing overdiagnosis: how to stop harming the healthy. … January 2, 2013 Why do hospital prescribers continue antibiotics when it is safe to stop … improvement: findings from six case studies.

79. Identifying no-harm incidents in home healthcare: a cohort study using trigger tool methodology. | PSNet
    psnet.ahrq.gov/issue/identifying-no-harm-incidents-home-healthcare-cohort-study-using-trigger-tool-methodology
    January 25, 2023 - This study used a trigger tool to retrospectively identify and characterize no-harm incidents affecting … August 12, 2020 How does the WHO Surgical Safety Checklist fit with existing perioperative … March 18, 2020 Closing the loop on test results to reduce communication failures: a rapid … October 28, 2020 A qualitative study of what care workers do to provide patient safety … case study as basis for theory development.

80. Do my feelings fit the diagnosis? Avoiding misdiagnoses in psychosomatic consultation services. | PSNet
    psnet.ahrq.gov/issue/do-my-feelings-fit-diagnosis-avoiding-misdiagnoses-psychosomatic-consultation-services
    March 18, 2020 - RIS Download Citation Related Resources From the Same Author(s) How … : a key enabler to successful implementation of audit and feedback. … April 3, 2017 When do supervising physicians decide to entrust residents with unsupervised … A study of US hospitals. … August 10, 2022 Standardized orders for titrating vasopressors: do efforts to improve