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Showing results for "incident".

301. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/38595/psn-pdf
     June 15, 2011 - Implementation of a patient safety incident management system as viewed by doctors, nurses and allied … Implementation of a patient safety incident management system as viewed by doctors, nurses and allied … https://psnet.ahrq.gov/issue/implementation-patient-safety-incident-management-system-viewed-doctors- … nurses-and-allied Physicians had a more negative view of incident reporting systems and tended to … use more narrow and physician-centric descriptors when reporting an incident.

302. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/42913/psn-pdf
     January 29, 2014 - What to do with healthcare incident reporting systems. … What to do with healthcare Incident Reporting Systems. … https://psnet.ahrq.gov/issue/what-do-healthcare-incident-reporting-systems Incident reporting systems … This review highlights limitations and strengths of incident reporting in safety improvement programs … https://psnet.ahrq.gov/issue/what-do-healthcare-incident-reporting-systems https://psnet.ahrq.gov/primer

303. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/39985/psn-pdf
     November 10, 2010 - Establishing a global learning community for incident- reporting systems. … Establishing a global learning community for incident-reporting systems. … https://psnet.ahrq.gov/issue/establishing-global-learning-community-incident-reporting-systems Voluntary … together an international group of error reporting experts in order to develop a learning community for incident … https://psnet.ahrq.gov/issue/establishing-global-learning-community-incident-reporting-systems https:

304. Innovative approaches to analysing aged care falls incident data: International Classification for Patient Safety and correspondence analysis. | PSNet
     psnet.ahrq.gov/issue/innovative-approaches-analysing-aged-care-falls-incident-data-international-classification
     January 18, 2023 - Study Innovative approaches to analysing aged care falls incident data: International … Innovative approaches to analysing aged care falls incident data: international classification for patient … Innovative approaches to analysing aged care falls incident data: international classification for patient … August 26, 2020 Paediatric medication incident reporting: a multicentre comparison study … of medication errors identified at audit, detected by staff and reported to an incident system.

305. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/36769/psn-pdf
     June 15, 2011 - Using incident reporting to improve patient safety: a conceptual model. … Using Incident Reporting to Improve Patient Safety. … https://psnet.ahrq.gov/issue/using-incident-reporting-improve-patient-safety-conceptual-model Though … all hospitals are mandated to maintain an incident reporting system, there is limited evidence that … https://psnet.ahrq.gov/issue/using-incident-reporting-improve-patient-safety-conceptual-model https:/

306. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/836812/psn-pdf
     March 30, 2022 - Tools covered in this primer include incident reporting systems, Root Cause Analysis (RCA), and Failure … Incident Reporting Systems Incident reporting systems are widely used by health care organizations to … To be maximally effective, incident reporting systems should be coupled with supportive institutional … Incident reporting systems are a form of passive surveillance and therefore have limitations in their … Barriers to incident reporting include an organizational culture of blame, health care staff's fear

307. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/47365/psn-pdf
     January 01, 2019 - How well do incident reporting systems work on inpatient psychiatric units? … How Well Do Incident Reporting Systems Work on Inpatient Psychiatric Units? … https://psnet.ahrq.gov/issue/how-well-do-incident-reporting-systems-work-inpatient-psychiatric-units … A recent commentary discussed the inherent limitations of incident reporting systems and suggested ways … https://psnet.ahrq.gov/issue/how-well-do-incident-reporting-systems-work-inpatient-psychiatric-units

308. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/44628/psn-pdf
     September 12, 2016 - Rates of safety incident reporting in MRI in a large academic medical center. … Rates of safety incident reporting in MRI in a large academic medical center. … https://psnet.ahrq.gov/issue/rates-safety-incident-reporting-mri-large-academic-medical-center This … analysis of incident reports related to magnetic resonance imaging found that, similar to other settings … , incident reports are infrequent, and most do not result in patient harm.

309. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/44797/psn-pdf
     March 15, 2016 - Incident and error reporting systems in intensive care: a systematic review of the literature. … Incident and error reporting systems in intensive care: a systematic review of the literature. … https://psnet.ahrq.gov/issue/incident-and-error-reporting-systems-intensive-care-systematic-review- … literature This systematic review found that incident reporting systems used in intensive care units … https://psnet.ahrq.gov/issue/incident-and-error-reporting-systems-intensive-care-systematic-review-literature

310. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/45207/psn-pdf
     August 17, 2016 - Unit-based incident reporting and root cause analysis: variation at three hospital unit types. … Unit-based incident reporting and root cause analysis: variation at three hospital unit types. … https://psnet.ahrq.gov/issue/unit-based-incident-reporting-and-root-cause-analysis-variation-three-hospital … - unit-types Incident reporting systems and root cause analyses remain the main mechanisms by which … This study sought to determine whether more localized, unit-based incident reporting systems might provide

311. In Conversation With…Kaveh G. Shojania, MD | PSNet
     psnet.ahrq.gov/perspective/conversation-withkaveh-g-shojania-md
     September 01, 2011 - that incident reporting was designed to capture. … In fact, the original definition of a "critical incident" was basically an incident involving the potential … But the biggest limitation for incident reporting is not the incident reporting itself; it's the actual … Physicians file only 1%–3% of incident reports.( 10,12 ) Thus, incident reporting is most useful for … Clinical incident reporting. In: Vincent C, ed.

312. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/38653/psn-pdf
     May 20, 2009 - The frustrating case of incident-reporting systems. May 20, 2009 Shojania KG. … The frustrating case of incident-reporting systems. Qual Saf Health Care. 2008;17(6):400-2. … https://psnet.ahrq.gov/issue/frustrating-case-incident-reporting-systems This commentary discusses the … limitations of incident reporting systems and provides suggestions for how data gathered from incident … https://psnet.ahrq.gov/issue/frustrating-case-incident-reporting-systems

313. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/45684/psn-pdf
     January 01, 2020 - A previous PSNet perspective highlighted the importance of providing feedback with regard to incident … reporting-patient-safety-events https://psnet.ahrq.gov/issue/cultural-and-associated-enablers-and-barriers-adverse-incident-reporting … https://psnet.ahrq.gov/issue/can-we-use-incident-reports-detect-hospital-adverse-events https://psnet.ahrq.gov … /issue/surveys-patient-safety-culture https://psnet.ahrq.gov/perspective/incident-reporting-more-attention-safety-action-feedback-loop-please … https://psnet.ahrq.gov/perspective/incident-reporting-more-attention-safety-action-feedback-loop-please

314. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/37985/psn-pdf
     July 14, 2010 - Incident reporting in surgical trainees-revisited. … Incident Reporting in Surgical Trainees-Revisited. … https://psnet.ahrq.gov/issue/incident-reporting-surgical-trainees-revisited The majority of physicians … in this UK study felt that incident reporting was of limited utility, primarily because they did not … receive feedback after reporting an incident.

315. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/40822/psn-pdf
     October 05, 2011 - Data consistency in a voluntary medical incident reporting system. October 5, 2011 Gong Y. … Data consistency in a voluntary medical incident reporting system. J Med Syst. 2011;35(4):609-15. … https://psnet.ahrq.gov/issue/data-consistency-voluntary-medical-incident-reporting-system This retrospective … study found that nearly one quarter of incident reports lacked sufficient information to accurately … classify and analyze the incident.

316. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/47921/psn-pdf
     June 18, 2019 - Using incident reports to assess communication failures and patient outcomes. … Using Incident Reports to Assess Communication Failures and Patient Outcomes. … https://psnet.ahrq.gov/issue/using-incident-reports-assess-communication-failures-and-patient-outcomes … Investigators examined incident reports at an academic medical center to characterize how communication … https://psnet.ahrq.gov/issue/using-incident-reports-assess-communication-failures-and-patient-outcomes

317. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/61037/psn-pdf
     January 01, 2021 - Analysis of incident reports from a patient safety organization. … Analysis of incident reports from a patient safety organization. … https://psnet.ahrq.gov/issue/what-safety-events-are-reported-ambulatory-care-analysis-incident-reports … https://psnet.ahrq.gov/issue/what-safety-events-are-reported-ambulatory-care-analysis-incident-reports-patient-safety … https://psnet.ahrq.gov/issue/what-safety-events-are-reported-ambulatory-care-analysis-incident-reports-patient-safety

318. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/48176/psn-pdf
     July 31, 2019 - Duration of second victim symptoms in the aftermath of a patient safety incident and association with … Duration of second victim symptoms in the aftermath of a patient safety incident and association with … https://psnet.ahrq.gov/issue/duration-second-victim-symptoms-aftermath-patient-safety-incident-and- … https://psnet.ahrq.gov/issue/duration-second-victim-symptoms-aftermath-patient-safety-incident-and-association-level … https://psnet.ahrq.gov/issue/duration-second-victim-symptoms-aftermath-patient-safety-incident-and-association-level

319. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/860732/psn-pdf
     April 16, 2024 - Retained Swabs Following Invasive Procedures: Themes Identified from a Review of NHS Serious Incident … psnet.ahrq.gov/issue/retained-swabs-following-invasive-procedures-themes-identified-review-nhs- serious-incident … psnet.ahrq.gov/issue/retained-swabs-following-invasive-procedures-themes-identified-review-nhs-serious-incident … psnet.ahrq.gov/issue/retained-swabs-following-invasive-procedures-themes-identified-review-nhs-serious-incident

320. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/44532/psn-pdf
     December 21, 2018 - The problem with incident reporting. December 21, 2018 Macrae C. … The problem with incident reporting. … https://psnet.ahrq.gov/issue/problem-incident-reporting This commentary discusses weaknesses in health … care incident reporting systems that limit their ability to contribute to improvements, including overreporting … https://psnet.ahrq.gov/issue/problem-incident-reporting https://psnet.ahrq.gov/primer/reporting-patient-safety-events