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Showing results for "involving".

3021. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/36898/psn-pdf
      February 01, 2011 - What cannot be said on television about health care. February 1, 2011 Emanuel EJ. What Cannot Be Said on Television About Health Care. JAMA. 2007;297(19). doi:10.1001/jama.297.19.2131. https://psnet.ahrq.gov/issue/what-cannot-be-said-television-about-health-care The author discusses how changes in language used to…

3022. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/35020/psn-pdf
      June 22, 2009 - Surgical skill is predicted by the ability to detect errors. June 22, 2009 Bann S, Khan M, Datta V, et al. Surgical skill is predicted by the ability to detect errors. Am J Surg. 2005;189(4):412-5. https://psnet.ahrq.gov/issue/surgical-skill-predicted-ability-detect-errors The investigators observed surgeons parti…

3023. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/44632/psn-pdf
      March 24, 2016 - Clash in the name of care. March 24, 2016 Abelson J, Saltzman J, Kowalcyzk L, Allen S. Boston Globe. October 26, 2015. https://psnet.ahrq.gov/issue/clash-name-care Scheduling concurrent surgeries can have negative effects on staff and patients. This investigative news article explores the practice of overlapping p…

3024. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/35177/psn-pdf
      June 23, 2009 - Narrativizing errors of care: critical incident reporting in clinical practice. June 23, 2009 Iedema R, Flabouris A, Grant S, et al. Narrativizing errors of care: critical incident reporting in clinical practice. Soc Sci Med. 2006;62(1):134-44. https://psnet.ahrq.gov/issue/narrativizing-errors-care-critical-incide…

3025. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/33691/psn-pdf
      December 01, 2009 - How to Identify and Manage Problem Behaviors December 1, 2009 Rosenstein AH, O'Daniel M. How to Identify and Manage Problem Behaviors. PSNet [internet]. 2009. https://psnet.ahrq.gov/perspective/how-identify-and-manage-problem-behaviors Perspective The 1999 Institute of Medicine report highlighted the need for heal…

3026. Say It Again | PSNet
      psnet.ahrq.gov/web-mm/say-it-again
      January 31, 2020 - Say It Again Citation Text: Henriksen K, Hall KK. Say It Again. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2011. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML EndNote 7 XML Endnote tagged PubMedId RIS …

3027. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/50389/psn-pdf
      September 25, 2019 - Getting the Diagnosis Both Right and Wrong September 25, 2019 Olson AP. Getting the Diagnosis Both Right and Wrong. PSNet [internet]. 2019. https://psnet.ahrq.gov/web-mm/getting-diagnosis-both-right-and-wrong The Case A 27-year-old woman with a history of acute myeloid leukemia was sent to the emergency department…

3028. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/61079/psn-pdf
      October 28, 2020 - When Looks Aren’t All They Appear to Be: A Medication Error in an Uncommon Indication October 28, 2020 Ton K. When Looks Aren’t All They Appear to Be: A Medication Error in an Uncommon Indication . PSNet [internet]. 2020. https://psnet.ahrq.gov/web-mm/when-looks-arent-all-they-appear-be-medication-error-uncommon- …

3029. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49638/psn-pdf
      January 01, 2012 - Communication Failure—Who's in Charge? October 1, 2011 Fackler J, Schwartz JM. Communication Failure—Who's in Charge? PSNet [internet]. 2011. https://psnet.ahrq.gov/web-mm/communication-failure-whos-charge The Case A 20-month-old boy was admitted to the intensive care unit (ICU) following a Fontan surgical procedu…

3030. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/50756/psn-pdf
      December 18, 2019 - A Mistaken Dose of Naloxone? December 18, 2019 Cutler E, Gunawardena D. A Mistaken Dose of Naloxone?. PSNet [internet]. 2019. https://psnet.ahrq.gov/web-mm/mistaken-dose-naloxone The Case A 55-year-old man with widely metastatic gastric cancer presented to his oncologist's office for a follow-up appointment. He h…

3031. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49775/psn-pdf
      November 01, 2016 - Unexpected Drawbacks of Electronic Order Sets November 1, 2016 McGreevey JD. Unexpected Drawbacks of Electronic Order Sets. PSNet [internet]. 2016. https://psnet.ahrq.gov/web-mm/unexpected-drawbacks-electronic-order-sets The Case A 70-year-old man with stage 4 prostate cancer presented to the emergency department …

3032. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/41576/psn-pdf
      October 11, 2012 - The role of talking (and keeping silent) in physician coping with medical error: a qualitative study. October 11, 2012 May NB, Plews-Ogan M. The role of talking (and keeping silent) in physician coping with medical error: a qualitative study. Patient Educ Couns. 2012;88(3):449-54. doi:10.1016/j.pec.2012.06.024. ht…

3033. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/37653/psn-pdf
      May 14, 2008 - Getting boards on board: engaging governing boards in quality and safety.  May 14, 2008 Conway JB. Getting boards on board: engaging governing boards in quality and safety. Jt Comm J Qual Saf. 2008;34(4):214-220. https://psnet.ahrq.gov/issue/getting-boards-board-engaging-governing-boards-quality-and-safety This a…

3034. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/42302/psn-pdf
      May 29, 2013 - Analyzing communication errors in an air medical transport service. May 29, 2013 Dalto JD, Weir C, Thomas F. Analyzing communication errors in an air medical transport service. Air Med J. 2013;32(3):129-37. doi:10.1016/j.amj.2012.10.019. https://psnet.ahrq.gov/issue/analyzing-communication-errors-air-medical-trans…

3035. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/854267/psn-pdf
      October 04, 2023 - Why admitting to mistakes can help doctors (and patients). October 4, 2023 McDonald T. TEDxSanDiego. September 23, 2023. https://psnet.ahrq.gov/issue/why-admitting-mistakes-can-help-doctors-and-patients The lack of a safety culture fundamentally restricts the ability of clinicians to address mistakes, psychologic…

3036. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/40863/psn-pdf
      October 19, 2011 - Family of woman who died after a medical error joins hospital's safety panel. October 19, 2011 Shelton DL. Chicago Tribune. October 7, 2011. https://psnet.ahrq.gov/issue/family-woman-who-died-after-medical-error-joins-hospitals-safety-panel Reporting on a fatal medical error, this article describes how the family …

3037. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/60332/psn-pdf
      May 13, 2020 - Circle Up Training. May 13, 2020 Center for Medical Simulation. https://psnet.ahrq.gov/issue/circle-training Communication strategies are important for engaging staff in behaviors that support effective teamwork. This website highlights a process that involves briefings, supportive conversations, and debriefings a…

3038. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/47678/psn-pdf
      December 19, 2018 - When mistakes happen. December 19, 2018 Beck DL. ASH Clinical News. December 1, 2018. https://psnet.ahrq.gov/issue/when-mistakes-happen This article provides an overview of efforts to understand and improve patient safety and covers topics such as the epidemiology of error, its impact on the individuals involved, …

3039. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/43800/psn-pdf
      August 02, 2016 - Patient Safety Culture: Theory, Methods and Application. August 2, 2016 Waterson P, ed. London, UK: Ashgate; 2014. ISBN: 9781409448143. https://psnet.ahrq.gov/issue/patient-safety-culture-theory-methods-and-application This publication covers patient safety culture including its background in high-risk industries, …

3040. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/37013/psn-pdf
      July 14, 2010 - Engagement of leadership in quality improvement initiatives: executive quality improvement survey results. July 14, 2010 Vaughn T, Koepke M, Kroch E, et al. J Patient Saf. 2006;2(1):2-9. https://psnet.ahrq.gov/issue/engagement-leadership-quality-improvement-initiatives-executive-quality- improvement-survey The in…