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Showing results for "learned".

  1. People, systems and safety: resilience and excellence in healthcare practice. | PSNet

    psnet.ahrq.gov/issue/people-systems-and-safety-resilience-and-excellence-healthcare-practice
    March 04, 2020 - Review Emerging Classic People, systems and safety: resilience and excellence in healthcare practice. Citation Text: Smith AF, Plunkett E. People, systems and safety: resilience and excellence in healthcare practice. Anaesthesia. 2019;74(4):508-517. doi:10.1111/…

  2. Patient safety's missing link: using clinical expertise to recognize, respond to and reduce risks at a population level. | PSNet

    psnet.ahrq.gov/issue/patient-safetys-missing-link-using-clinical-expertise-recognize-respond-and-reduce-risks
    May 08, 2017 - Commentary Patient safety's missing link: using clinical expertise to recognize, respond to and reduce risks at a population level. Citation Text: Hibbert PD, Healey F, Lamont T, et al. Patient safety's missing link: using clinical expertise to recognize, respond to and reduce risks at a…

  3. Requirements for implementing a 'just culture' within healthcare organisations: an integrative review. | PSNet

    psnet.ahrq.gov/issue/requirements-implementing-just-culture-within-healthcare-organisations-integrative-review
    October 31, 2014 - Review Requirements for implementing a 'just culture' within healthcare organisations: an integrative review. Citation Text: Murray JS, Lee J, Larson S, et al. Requirements for implementing a ‘just culture’ within healthcare organisations: an integrative review. BMJ Open Qual. 2023;12(2)…

  4. Intensive care unit safety culture and outcomes: a US multicenter study. | PSNet

    psnet.ahrq.gov/issue/intensive-care-unit-safety-culture-and-outcomes-us-multicenter-study
    June 16, 2011 - Study Intensive care unit safety culture and outcomes: a US multicenter study. Citation Text: Huang DT, Clermont G, Kong L, et al. Intensive care unit safety culture and outcomes: a US multicenter study. Int J Qual Health Care. 2010;22(3):151-61. doi:10.1093/intqhc/mzq017. Copy Citat…

  5. Developing tools to enhance the adaptive capacity (Safety II) of health care providers at a children's hospital. | PSNet

    psnet.ahrq.gov/issue/developing-tools-enhance-adaptive-capacity-safety-ii-health-care-providers-childrens-hospital
    July 22, 2020 - Commentary Developing tools to enhance the adaptive capacity (Safety II) of health care providers at a children's hospital. Citation Text: Bartman T, Merandi J, Maa T, et al. Developing tools to enhance the adaptive capacity (Safety II) of health care providers at a children's hospital. …

  6. The future of safety and quality in radiation oncology. | PSNet

    psnet.ahrq.gov/issue/future-safety-and-quality-radiation-oncology
    May 17, 2023 - Commentary The future of safety and quality in radiation oncology. Citation Text: Talcott W, Covington E, Bazan J, et al. The future of safety and quality in radiation oncology. Semin Radiat Oncol. 2024;34(4):433-440. doi:10.1016/j.semradonc.2024.07.008. Copy Citation Format: …

  7. Informing the design of a new pragmatic registry to stimulate near miss reporting in ambulatory care. | PSNet

    psnet.ahrq.gov/issue/informing-design-new-pragmatic-registry-stimulate-near-miss-reporting-ambulatory-care
    January 12, 2011 - Review Informing the design of a new pragmatic registry to stimulate near miss reporting in ambulatory care. Citation Text: Pfoh ER, Engineer L, Singh H, et al. Informing the Design of a New Pragmatic Registry to Stimulate Near Miss Reporting in Ambulatory Care. J Patient Saf. 2021;17(3)…

  8. Medical morbidity and mortality conferences: past, present and future. | PSNet

    psnet.ahrq.gov/issue/medical-morbidity-and-mortality-conferences-past-present-and-future
    November 30, 2022 - Review Medical morbidity and mortality conferences: past, present and future. Citation Text: George J. Medical morbidity and mortality conferences: past, present and future. Postgrad Med J. 2017;93(1097):148-152. doi:10.1136/postgradmedj-2016-134103. Copy Citation Format: D…

  9. Lost in translation? Addressing barriers in the application of industrial process improvement methodologies to health care. | PSNet

    psnet.ahrq.gov/issue/lost-translation-addressing-barriers-application-industrial-process-improvement-methodologies
    May 11, 2019 - Commentary Lost in translation? Addressing barriers in the application of industrial process improvement methodologies to health care. Citation Text: Gray D, Johnson KD, Watts B. Lost In Translation? Addressing Barriers in the Application of Industrial Process Improvement Methodologies t…

  10. Patient and family engagement in incident investigations: exploring hospital manager and incident investigators' experiences and challenges. | PSNet

    psnet.ahrq.gov/issue/patient-and-family-engagement-incident-investigations-exploring-hospital-manager-and-incident
    November 04, 2020 - Study Patient and family engagement in incident investigations: exploring hospital manager and incident investigators' experiences and challenges. Citation Text: Kok J, Leistikow I, Bal R. Patient and family engagement in incident investigations: exploring hospital manager and incident i…

  11. Medication errors involving nursing students: a systematic review. | PSNet

    psnet.ahrq.gov/issue/medication-errors-involving-nursing-students-systematic-review
    March 09, 2022 - Review Medication errors involving nursing students: a systematic review. Citation Text: Asensi-Vicente J, Jiménez-Ruiz I, Vizcaya-Moreno F. Medication Errors Involving Nursing Students: A Systematic Review. Nurse Educ. 2018;43(5):E1-E5. doi:10.1097/NNE.0000000000000481. Copy Citation …

  12. Reducing diagnostic errors—why now? | PSNet

    psnet.ahrq.gov/issue/reducing-diagnostic-errors-why-now
    July 28, 2014 - Commentary Classic Reducing diagnostic errors—why now? Citation Text: Khullar D, Jha AK, Jena AB. Reducing diagnostic errors--why now? N Engl J Med. 2015;373(26):2491-2493. doi:10.1056/NEJMp1508044. Copy Citation Format: DOI Google Scholar PubMed B…

  13. Selecting indicators for patient safety at the health system level in OECD countries. | PSNet

    psnet.ahrq.gov/issue/selecting-indicators-patient-safety-health-system-level-oecd-countries
    June 28, 2011 - Study Selecting indicators for patient safety at the health system level in OECD countries. Citation Text: McLoughlin V, Millar J, Mattke S, et al. Selecting indicators for patient safety at the health system level in OECD countries. Int J Qual Health Care. 2006;18 Suppl 1:14-20. Cop…

  14. Detection and prevention of medication misadventures in general practice. | PSNet

    psnet.ahrq.gov/issue/detection-and-prevention-medication-misadventures-general-practice
    May 13, 2020 - Study Detection and prevention of medication misadventures in general practice. Citation Text: Tam KWT, Kwok KH, Fan YMC, et al. Detection and prevention of medication misadventures in general practice. Int J Qual Health Care. 2008;20(3):192-9. doi:10.1093/intqhc/mzn002. Copy Citatio…

  15. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/34735/psn-pdf
    June 16, 2014 - goals to create unified reporting mechanisms, support an open learning culture, ensure that lessons learned

  16. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/37478/psn-pdf
    February 22, 2011 - adversedrugevent https://psnet.ahrq.gov/issue/intravenous-medication-safety-and-smart-infusion-systems-lessons-learned-and-future

  17. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/45490/psn-pdf
    September 01, 2018 - collaboration-regulators-support-quality-and-accountability-following-medical-errors https://psnet.ahrq.gov/issue/communication-and-resolution-programs-challenges-and-lessons-learned-six-early-adopters

  18. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/34849/psn-pdf
    May 14, 2012 - improving-patient-safety-five-years-after-iom-report https://psnet.ahrq.gov/issue/five-years-after-err-human-what-have-we-learned

  19. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/45350/psn-pdf
    October 21, 2016 - This report discusses the need to ensure that lessons learned in military trauma care are acted on and

  20. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/47505/psn-pdf
    March 19, 2019 - A past PSNet perspective explored insights learned from experience with the AHRQ-supported teamwork
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