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Showing results for "individual".

121. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/37510/psn-pdf
     March 04, 2011 - efforts to study PSIs in the VA system, investigators concluded that PSIs are unreliable in comparing individual … settings rather than for purposes of measuring quality improvement interventions or rating the quality of individual

122. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/36634/psn-pdf
     March 03, 2011 - events were identified, including blurring of provider responsibility and decreased familiarity with individual … group data were combined with a literature review to establish best practices for ITC at both the individual

123. Surgeon information transfer and communication: factors affecting quality and efficiency of inpatient care. | PSNet
     psnet.ahrq.gov/issue/surgeon-information-transfer-and-communication-factors-affecting-quality-and-efficiency
     December 21, 2014 - events were identified, including blurring of provider responsibility and decreased familiarity with individual … focus group data were combined with a literature review to establish best practices for ITC at both the individual

124. Identification of doctors at risk of recurrent complaints: a national study of healthcare complaints in Australia. | PSNet
     psnet.ahrq.gov/issue/identification-doctors-risk-recurrent-complaints-national-study-healthcare-complaints
     September 07, 2011 - Although most patient safety efforts focus on identifying and addressing flawed systems, individual clinicians … physician gender, clinical specialty, and number of prior complaints) predicted the likelihood that an individual

125. Rare adverse medical events in VA inpatient care: reliability limits to using patient safety indicators as performance measures. | PSNet
     psnet.ahrq.gov/issue/rare-adverse-medical-events-va-inpatient-care-reliability-limits-using-patient-safety
     February 27, 2008 - efforts to study PSIs in the VA system , investigators concluded that PSIs are unreliable in comparing individual … rather than for purposes of measuring quality improvement interventions or rating the quality of individual

126. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/36909/psn-pdf
     January 05, 2017 - Individual hospitals selected among specific teamwork training programs developed by the VA's National … evaluation of the programs are described in detail, along with examples of projects carried out at individual

127. Combining multiple large language models improves diagnostic accuracy. | PSNet
     psnet.ahrq.gov/issue/combining-multiple-large-language-models-improves-diagnostic-accuracy
     March 02, 2011 - The collective diagnosis was more accurate than individual LLMs, even when the highest performing LLM … Comparative accuracy of diagnosis by collective intelligence of multiple physicians vs individual

128. Cognitive interventions to reduce diagnostic error: a narrative review. | PSNet
     psnet.ahrq.gov/issue/cognitive-interventions-reduce-diagnostic-error-narrative-review
     October 16, 2012 - Cognitive errors by individual physicians are at the root of most diagnostic errors , combining with … Comparative accuracy of diagnosis by collective intelligence of multiple physicians vs individual

129. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/33762/psn-pdf
     March 01, 2014 - AH: The difference is that some of the examples that you're giving impact only that individual at that … Every time you use antibiotics, you have to think about not only the treatment of that individual and … infection but also the impact it will have on that individual, treating subsequent infections, and … The tension is between the individual and public health implications. … You need to be able to provide individual level feedback and data.

130. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/42231/psn-pdf
     June 18, 2013 - complaints Although most patient safety efforts focus on identifying and addressing flawed systems, individual … physician gender, clinical specialty, and number of prior complaints) predicted the likelihood that an individual

131. Systems analysis of adverse drug events. | PSNet
     psnet.ahrq.gov/issue/systems-analysis-adverse-drug-events
     February 10, 2011 - of the underlying, or "system," causes of the ADEs as distinct from attributing the ADEs solely to individual … nonpunitive systems approach as a more effective means of preventing error than approaches focused on the individual

132. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/45911/psn-pdf
     June 27, 2018 - postoperative Most patient safety problems can be ascribed to underlying systems failures, but issues with individual … This study extends upon prior research by demonstrating an association between patient concerns about individual

133. Balancing "no blame" with accountability in patient safety. | PSNet
     psnet.ahrq.gov/issue/balancing-no-blame-accountability-patient-safety
     March 13, 2013 - An early focus of the patient safety movement was a shift from the traditional culture of individual … systems-focused model, with past commentaries exploring the tension between a "no blame" culture and individual

134. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/867652/psn-pdf
     February 26, 2025 - on the ability to systematically dissect an incident, helping healthcare organizations move beyond individual … aimed to address the most persistent ineffectual issues with traditional RCA, especially the focus on individual … understanding how organizational systems and processes contribute to adverse events, as opposed to individual-level … For example, “this staff member did not follow protocol” is an individual-level factor. … multiple events within a category (such as medication errors or patient falls) rather than focusing on individual

135. Effect of a postdischarge virtual ward on readmission or death for high-risk patients: a randomized clinical trial. | PSNet
     psnet.ahrq.gov/issue/effect-postdischarge-virtual-ward-readmission-or-death-high-risk-patients-randomized-clinical
     October 31, 2011 - recent data indicates that readmissions in adult patients are decreasing slightly, the approaches individual … Variability in antibiotic use across nursing homes and the risk of antibiotic-related adverse outcomes for individual

136. Awareness of human factors in the operating theatres during the COVID-19 pandemic | PSNet
     psnet.ahrq.gov/innovation/awareness-human-factors-operating-theatres-during-covid-19-pandemic
     January 13, 2021 - Understanding the ways in which human factors , such as non-technical skills , influence individual … articulate challenges and barriers, and ensure a shared mental model of the importance of human factors in individual

137. Feeling No Pain | PSNet
     psnet.ahrq.gov/web-mm/feeling-no-pain
     August 30, 2023 - Those problems most likely would be considered errors of omission by the individual nurses, rather than … What it does indicate is that the cause of an incident usually is attributed to the individual associated … behavior reflects the interaction between the person and the environment.( 4 ) Thus, identifying the individual … The message of the artichoke–systems approach is that an act by an individual care provider, which is … Thus, when analyzing an incident, rather than focusing solely on the individual care provider-actor,

138. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/49409/psn-pdf
     July 01, 2003 - Those problems most likely would be considered errors of omission by the individual nurses, rather than … What it does indicate is that the cause of an incident usually is attributed to the individual associated … behavior reflects the interaction between the person and the environment.(4) Thus, identifying the individual … The message of the artichoke–systems approach is that an act by an individual care provider, which is … Thus, when analyzing an incident, rather than focusing solely on the individual care provider-actor,

139. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/33600/psn-pdf
     June 16, 2024 - Traditionally, medicine treated errors as failings on the part of individual providers, reflecting inadequate … Cheese Model of Medical Errors It is important to note that the Swiss cheese model does not absolve individual … Rather, it puts individual actions in the appropriate context and recognizes that the vast majority … Nevertheless, there is a role for individual accountability in patient safety, particularly when clinicians … disciplines to design safer systems of care, rather than implementing targeted programs to prevent individual

140. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/39004/psn-pdf
     April 04, 2011 - balancing-no-blame-accountability-patient-safety An early focus of the patient safety movement was a shift from the traditional culture of individual … systems-focused model, with past commentaries exploring the tension between a "no blame" culture and individual