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Showing results for "incident".

181. Review of alternatives to root cause analysis: developing a robust system for incident report analysis. | PSNet
     psnet.ahrq.gov/issue/review-alternatives-root-cause-analysis-developing-robust-system-incident-report-analysis
     November 14, 2018 - Review Review of alternatives to root cause analysis: developing a robust system for incident … Review of alternatives to root cause analysis: developing a robust system for incident report analysis … This review highlights alternative approaches to incident analysis that address some of the concerns … Review of alternatives to root cause analysis: developing a robust system for incident report analysis … September 5, 2018 How well do incident reporting systems work on inpatient psychiatric

182. The Patient-Reported Incident in Hospital Instrument (PRIH-I): assessments of data quality, test–retest reliability and hospital-level reliability. | PSNet
     psnet.ahrq.gov/issue/patient-reported-incident-hospital-instrument-prih-i-assessments-data-quality-test-retest
     March 20, 2015 - Study The Patient-Reported Incident in Hospital Instrument (PRIH-I): assessments … The Patient-Reported Incident in Hospital Instrument (PRIH-I): assessments of data quality, test-retest … The Patient-Reported Incident in Hospital Instrument, which consists of 13 questions about patient-perceived … The Patient-Reported Incident in Hospital Instrument (PRIH-I): assessments of data quality, test-retest … June 18, 2013 A comprehensive overview of medical error in hospitals using incident-reporting

183. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/866351/psn-pdf
     July 24, 2024 - Seeking systems-based facilitators of safety and healthcare resilience: a thematic review of incident … Seeking systems-based facilitators of safety and healthcare resilience: a thematic review of incident … psnet.ahrq.gov/issue/seeking-systems-based-facilitators-safety-and-healthcare-resilience-thematic- review-incident … Incident reports provide valuable learning opportunities at individual, team, and organizational levels … This study used incident reports involving anticoagulant medication errors to demonstrate the effectiveness

184. The impact of COVID-19 workflow changes on radiation oncology incident reporting. | PSNet
     psnet.ahrq.gov/issue/impact-covid-19-workflow-changes-radiation-oncology-incident-reporting
     June 30, 2021 - Study The impact of COVID-19 workflow changes on radiation oncology incident reporting … The impact of COVID‐19 workflow changes on radiation oncology incident reporting. … The impact of COVID‐19 workflow changes on radiation oncology incident reporting. … Resources From the Same Author(s) Impact of technological and departmental changes on incident … June 30, 2021 Evaluating incident learning systems and safety culture in two radiation

185. Evaluation of the contributions of an electronic web-based reporting system: enabling action. | PSNet
     psnet.ahrq.gov/issue/evaluation-contributions-electronic-web-based-reporting-system-enabling-action
     March 21, 2017 - The limitations of standard incident reporting systems have been well documented.  … A prior article presented a framework for using incident reporting data to improve patient safety. … July 13, 2022 Characteristics of critical incident reporting systems in primary care: … August 24, 2011 Voluntary incident reporting by anaesthetic trainees in an Australian … : description of 4846 incident reports.

186. Classification of patient-safety incidents in primary care. | PSNet
     psnet.ahrq.gov/issue/classification-patient-safety-incidents-primary-care
     October 12, 2016 - Health Organization International Classification for Patient Safety enables measurement of safety incident … October 12, 2016 Nature of blame in patient safety incident reports: mixed methods analysis … December 16, 2020 Harms from discharge to primary care: mixed methods analysis of incident … Sources of unsafe primary care for older adults: a mixed-methods analysis of patient safety incident … February 11, 2015 Incident reporting practices in the preanalytical phase: low reported

187. Efficacy of an incident-reporting system in cellular pathology: a practical experience. | PSNet
     psnet.ahrq.gov/issue/efficacy-incident-reporting-system-cellular-pathology-practical-experience
     August 21, 2024 - Study Efficacy of an incident-reporting system in cellular pathology: a practical … Efficacy of an incident-reporting system in cellular pathology: a practical experience. … Efficacy of an incident-reporting system in cellular pathology: a practical experience. … impact of errors in the clinical laboratory testing process leading to diagnostic error: a voluntary incident … February 15, 2010 Classifying laboratory incident reports to identify problems that jeopardize

188. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/50775/psn-pdf
     January 01, 2021 - Content analysis of patient safety incident reports for older adult patient transfers, handovers, and … Content analysis of patient safety incident reports for older adult patient transfers, handovers, and … https://psnet.ahrq.gov/issue/content-analysis-patient-safety-incident-reports-older-adult-patient-transfers … Half of all incident reports involved interunit/department/team transfers and the majority (69%) of … Few incident reports referenced individual or organizational learning (e.g., team discussions, root

189. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/866590/psn-pdf
     August 28, 2024 - Risk controls identified in action plans following serious incident investigations in secondary care … Risk controls identified in action plans following serious incident investigations in secondary care … https://psnet.ahrq.gov/issue/risk-controls-identified-action-plans-following-serious-incident-investigations … - secondary Patient safety incident investigations offer unique opportunities to encourage continuous … hospital in the United Kingdom to assess how well the proposed patient safety actions generated from incident

190. Challenges and opportunities of patient safety event reporting. | PSNet
     psnet.ahrq.gov/issue/challenges-and-opportunities-patient-safety-event-reporting
     June 23, 2021 - This article discusses the technological challenges of incident reporting and offers recommendations … 2022 View More Related Resources Characteristics of critical incident … January 19, 2022 Incident reporting systems: what will it take to make them less frustrating … March 7, 2012 Voluntary incident reporting by anaesthetic trainees in an Australian hospital … June 29, 2011 Implementation of a patient safety incident management system as viewed

191. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/866814/psn-pdf
     September 25, 2024 - Accuracy of a proprietary large language model in labeling obstetric incident reports. … Accuracy of a proprietary large language model in labeling obstetric incident reports. … https://psnet.ahrq.gov/issue/accuracy-proprietary-large-language-model-labeling-obstetric-incident-reports … Voluntary incident reporting is an important resource for identifying adverse events and near misses … https://psnet.ahrq.gov/issue/accuracy-proprietary-large-language-model-labeling-obstetric-incident-reports

192. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/60872/psn-pdf
     September 02, 2020 - How incident reporting systems can stimulate social and participative learning: a mixed-methods study … How incident reporting systems can stimulate social and participative learning: a mixed-methods study … https://psnet.ahrq.gov/issue/how-incident-reporting-systems-can-stimulate-social-and-participative-learning … - mixed-methods Using qualitative and quantitative data, this study evaluated how incident reporting … The authors identified five core areas related to incident reporting: (1) changed staff attitudes and

193. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/50659/psn-pdf
     November 13, 2019 - Barriers and facilitators to incident reporting in mental healthcare settings: a qualitative study. … Barriers and facilitators to incident reporting in mental healthcare settings: a qualitative study. … https://psnet.ahrq.gov/issue/barriers-and-facilitators-incident-reporting-mental-healthcare-settings- … qualitative study of staff in mental healthcare settings and assessed the barriers and facilitators to incident … The authors identified unique challenges to incident reporting in mental health, including the incidence

194. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/73923/psn-pdf
     October 06, 2021 - Suicide risk, changing jobs, or leaving the nursing profession in the aftermath of a patient safety incident … Suicide risk, changing jobs, or leaving the nursing profession in the aftermath of a patient safety incident … psnet.ahrq.gov/issue/suicide-risk-changing-jobs-or-leaving-nursing-profession-aftermath-patient- safety-incident … Clinicians who are involved in a patient safety incident often experience significant emotional consequences … This study found that nurses involved in an patient safety incident resulting in patient death were

195. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/837144/psn-pdf
     May 18, 2022 - Differences in hospitals' workplace violence incident reporting practices: a mixed methods study. … Differences in hospitals' workplace violence incident reporting practices: a mixed methods study. … https://psnet.ahrq.gov/issue/differences-hospitals-workplace-violence-incident-reporting-practices-mixed … This article describes data collected during the first three years of a new statewide incident reporting … system, California’s Workplace Violent Incident Reporting System (WVIRS) for Hospitals.

196. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/50753/psn-pdf
     December 18, 2019 - The contribution of staffing to medication administration errors: a text mining analysis of incident … The Contribution of Staffing to Medication Administration Errors: A Text Mining Analysis of Incident … /psnet.ahrq.gov/issue/contribution-staffing-medication-administration-errors-text-mining-analysis- incident-report … retrospective study used descriptive statistics, manual analysis, and text mining of medication-related incident … The key importance of this article is the use of an automated system to analyze incident reports.

197. Hospital Incident Reporting Systems Do Not Capture Most Patient Harm. | PSNet
     psnet.ahrq.gov/issue/hospital-incident-reporting-systems-do-not-capture-most-patient-harm
     September 20, 2011 - Book/Report Hospital Incident Reporting Systems Do Not Capture Most Patient Harm. … Citation Text: Hospital Incident Reporting Systems Do Not Capture Most Patient Harm. … Incident reporting systems are ubiquitous, but their effectiveness as a means of monitoring for patient … This follow-up analysis found that incident reports were not filed for the vast majority of these adverse … Copy URL Cite Citation Citation Text: Hospital Incident

198. Adverse event reporting: harnessing residents to improve patient safety. | PSNet
     psnet.ahrq.gov/issue/adverse-event-reporting-harnessing-residents-improve-patient-safety
     July 02, 2019 - Physicians are known to underuse voluntary incident reporting systems in hospitals. … physicians and simplifying their reporting system, investigators observed a 230% increase in trainee incident … A prior WebM&M commentary discussed the value of incident reporting for errors and near misses. … February 15, 2017 Improving incident reporting among physician trainees. … July 2, 2014 Possible solutions for barriers in incident reporting by residents.

199. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/50795/psn-pdf
     January 15, 2020 - Diagnostic error in the emergency department: learning from national patient safety incident report … Diagnostic error in the emergency department: learning from national patient safety incident report … https://psnet.ahrq.gov/issue/diagnostic-error-emergency-department-learning-national-patient-safety- incident-report … This retrospective study reviewed incident reports to characterize diagnostic errors occurring in emergency … https://psnet.ahrq.gov/issue/problem-incident-reporting https://psnet.ahrq.gov/primer/diagnostic-errors

200. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/858171/psn-pdf
     December 13, 2023 - Uncovering the risks of anticancer therapy through incident report analysis using a newly developed … medical oncology incident taxonomy. … Uncovering the risks of anticancer therapy through incident report analysis using a newly developed … medical oncology incident taxonomy. … https://psnet.ahrq.gov/issue/uncovering-risks-anticancer-therapy-through-incident-report-analysis-using