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psnet.ahrq.gov/node/39389/psn-pdf
January 03, 2017 - Shaping systems for better behavioral choices: lessons
learned from a fatal medication error. … Shaping systems for better behavioral choices: lessons learned from
a fatal medication error. … https://psnet.ahrq.gov/issue/shaping-systems-better-behavioral-choices-lessons-learned-fatal-medication … https://psnet.ahrq.gov/issue/shaping-systems-better-behavioral-choices-lessons-learned-fatal-medication-error … https://psnet.ahrq.gov/issue/shaping-systems-better-behavioral-choices-lessons-learned-fatal-medication-error
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psnet.ahrq.gov/node/43309/psn-pdf
August 02, 2015 - Wrong-side thoracentesis: lessons learned from root
cause analysis. … Wrong-side thoracentesis: lessons learned from root cause analysis. … https://psnet.ahrq.gov/issue/wrong-side-thoracentesis-lessons-learned-root-cause-analysis
Wrong-site … https://psnet.ahrq.gov/issue/wrong-side-thoracentesis-lessons-learned-root-cause-analysis
https://psnet.ahrq.gov
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psnet.ahrq.gov/node/39801/psn-pdf
December 21, 2014 - Gossypiboma: tales of lost sponges and lessons learned.
December 21, 2014
McIntyre LK. … https://psnet.ahrq.gov/issue/gossypiboma-tales-lost-sponges-and-lessons-learned
This study describes … https://psnet.ahrq.gov/issue/gossypiboma-tales-lost-sponges-and-lessons-learned
https://psnet.ahrq.gov
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psnet.ahrq.gov/node/35032/psn-pdf
February 03, 2011 - Five years after 'To Err is Human': what have we learned?
February 3, 2011
Leape L, Berwick DM. … Five years after To Err Is Human: what have we learned? JAMA.
2005;293(19):2384-90. … https://psnet.ahrq.gov/issue/five-years-after-err-human-what-have-we-learned
Two of the leaders in the … https://psnet.ahrq.gov/issue/five-years-after-err-human-what-have-we-learned
https://psnet.ahrq.gov/issue
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psnet.ahrq.gov/node/40523/psn-pdf
August 31, 2011 - A Hospital Accident: Lessons Learned – A Death, A
Conviction, and A Healing. … https://psnet.ahrq.gov/issue/hospital-accident-lessons-learned-death-conviction-and-healing
This webinar … https://psnet.ahrq.gov/issue/hospital-accident-lessons-learned-death-conviction-and-healing
https://psnet.ahrq.gov
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psnet.ahrq.gov/node/36212/psn-pdf
February 02, 2010 - SafetyNet: Lessons Learned from Close Calls in the OR. … https://psnet.ahrq.gov/issue/safetynet-lessons-learned-close-calls-or
This special issue includes a … https://psnet.ahrq.gov/issue/safetynet-lessons-learned-close-calls-or
https://psnet.ahrq.gov/issue/patient-worker-safety
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psnet.ahrq.gov/node/38393/psn-pdf
October 03, 2017 - Adverse Health Care Events Reporting System: What
Have We Learned?
October 3, 2017
St. … https://psnet.ahrq.gov/issue/adverse-health-care-events-reporting-system-what-have-we-learned
Through … https://psnet.ahrq.gov/issue/adverse-health-care-events-reporting-system-what-have-we-learned
https:/
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psnet.ahrq.gov/node/37231/psn-pdf
May 02, 2018 - Fluorouracil error ends tragically, but application of
lessons learned will save lives. … https://psnet.ahrq.gov/issue/fluorouracil-error-ends-tragically-application-lessons-learned-will-save-lives … https://psnet.ahrq.gov/issue/fluorouracil-error-ends-tragically-application-lessons-learned-will-save-lives
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www.cahps.ahrq.gov/sites/default/files/wysiwyg/policymakers/chipra/statesummaries/chipra-750-utah-state-snapshot.pdf
January 01, 2018 - Quality Demonstration Grant Program
January 2018
This brief highlights the major strategies, lessons learned … Utah and UPIQ
staff used their experiences and lessons learned to
mentor Idaho CHIPRA demonstration … Practices
learned how to implement QI projects and use data from
electronic health records to track … /highlight07.pdf
http://www.ahrq.gov/policymakers/chipra/demoeval/what-we-learned/highlight09.html
http … /chipra/demoeval/what-we-learned/highlight13.html
http://www.ahrq.gov/policymakers/chipra/demoeval/what-we-learned
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www.innovations.ahrq.gov/sites/default/files/wysiwyg/policymakers/chipra/statesummaries/chipra-750-utah-state-snapshot.pdf
January 01, 2018 - Quality Demonstration Grant Program
January 2018
This brief highlights the major strategies, lessons learned … Utah and UPIQ
staff used their experiences and lessons learned to
mentor Idaho CHIPRA demonstration … Practices
learned how to implement QI projects and use data from
electronic health records to track … /highlight07.pdf
http://www.ahrq.gov/policymakers/chipra/demoeval/what-we-learned/highlight09.html
http … /chipra/demoeval/what-we-learned/highlight13.html
http://www.ahrq.gov/policymakers/chipra/demoeval/what-we-learned
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www.healthcare411.ahrq.gov/sites/default/files/wysiwyg/policymakers/chipra/statesummaries/chipra-750-utah-state-snapshot.pdf
January 01, 2018 - Quality Demonstration Grant Program
January 2018
This brief highlights the major strategies, lessons learned … Utah and UPIQ
staff used their experiences and lessons learned to
mentor Idaho CHIPRA demonstration … Practices
learned how to implement QI projects and use data from
electronic health records to track … /highlight07.pdf
http://www.ahrq.gov/policymakers/chipra/demoeval/what-we-learned/highlight09.html
http … /chipra/demoeval/what-we-learned/highlight13.html
http://www.ahrq.gov/policymakers/chipra/demoeval/what-we-learned
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www.monahrq.ahrq.gov/sites/default/files/wysiwyg/policymakers/chipra/statesummaries/chipra-750-utah-state-snapshot.pdf
January 01, 2018 - Quality Demonstration Grant Program
January 2018
This brief highlights the major strategies, lessons learned … Utah and UPIQ
staff used their experiences and lessons learned to
mentor Idaho CHIPRA demonstration … Practices
learned how to implement QI projects and use data from
electronic health records to track … /highlight07.pdf
http://www.ahrq.gov/policymakers/chipra/demoeval/what-we-learned/highlight09.html
http … /chipra/demoeval/what-we-learned/highlight13.html
http://www.ahrq.gov/policymakers/chipra/demoeval/what-we-learned
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www.qualitymeasures.ahrq.gov/sites/default/files/wysiwyg/policymakers/chipra/statesummaries/chipra-750-utah-state-snapshot.pdf
January 01, 2018 - Quality Demonstration Grant Program
January 2018
This brief highlights the major strategies, lessons learned … Utah and UPIQ
staff used their experiences and lessons learned to
mentor Idaho CHIPRA demonstration … Practices
learned how to implement QI projects and use data from
electronic health records to track … /highlight07.pdf
http://www.ahrq.gov/policymakers/chipra/demoeval/what-we-learned/highlight09.html
http … /chipra/demoeval/what-we-learned/highlight13.html
http://www.ahrq.gov/policymakers/chipra/demoeval/what-we-learned
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www.talkingquality.ahrq.gov/sites/default/files/wysiwyg/policymakers/chipra/statesummaries/chipra-750-utah-state-snapshot.pdf
January 01, 2018 - Quality Demonstration Grant Program
January 2018
This brief highlights the major strategies, lessons learned … Utah and UPIQ
staff used their experiences and lessons learned to
mentor Idaho CHIPRA demonstration … Practices
learned how to implement QI projects and use data from
electronic health records to track … /highlight07.pdf
http://www.ahrq.gov/policymakers/chipra/demoeval/what-we-learned/highlight09.html
http … /chipra/demoeval/what-we-learned/highlight13.html
http://www.ahrq.gov/policymakers/chipra/demoeval/what-we-learned
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ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/policymakers/chipra/statesummaries/chipra-750-utah-state-snapshot.pdf
January 01, 2018 - Quality Demonstration Grant Program
January 2018
This brief highlights the major strategies, lessons learned … Utah and UPIQ
staff used their experiences and lessons learned to
mentor Idaho CHIPRA demonstration … Practices
learned how to implement QI projects and use data from
electronic health records to track … /highlight07.pdf
http://www.ahrq.gov/policymakers/chipra/demoeval/what-we-learned/highlight09.html
http … /chipra/demoeval/what-we-learned/highlight13.html
http://www.ahrq.gov/policymakers/chipra/demoeval/what-we-learned
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psnet.ahrq.gov/node/37169/psn-pdf
October 06, 2011 - The safety journal: lessons learned with an error
reporting tool to stimulate systems thinking. … https://psnet.ahrq.gov/issue/safety-journal-lessons-learned-error-reporting-tool-stimulate-systems-thinking … https://psnet.ahrq.gov/issue/safety-journal-lessons-learned-error-reporting-tool-stimulate-systems-thinking
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psnet.ahrq.gov/node/36383/psn-pdf
March 03, 2011 - Patterns of errors contributing to trauma mortality:
lessons learned from 2,594 deaths. … https://psnet.ahrq.gov/issue/patterns-errors-contributing-trauma-mortality-lessons-learned-2594-deaths … https://psnet.ahrq.gov/issue/patterns-errors-contributing-trauma-mortality-lessons-learned-2594-deaths
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www.cahps.ahrq.gov/sites/default/files/wysiwyg/policymakers/chipra/statesummaries/chipra-750-idaho-state-snapshot.pdf
January 01, 2018 - Quality Demonstration Grant Program
January 2018
This brief highlights the major strategies, lessons learned … • Idaho planned to disseminate a toolkit—based on lessons
learned from the PCMH learning collaborative—to … /highlight07.pdf
http://www.ahrq.gov/policymakers/chipra/demoeval/what-we-learned/highlight09.html
http … /chipra/demoeval/what-we-learned/highlight13.html
http://www.ahrq.gov/policymakers/chipra/demoeval/what-we-learned … /highlight13.html
http://www.ahrq.gov/policymakers/chipra/demoeval/what-we-learned/implementation-guides
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www.innovations.ahrq.gov/sites/default/files/wysiwyg/policymakers/chipra/statesummaries/chipra-750-idaho-state-snapshot.pdf
January 01, 2018 - Quality Demonstration Grant Program
January 2018
This brief highlights the major strategies, lessons learned … • Idaho planned to disseminate a toolkit—based on lessons
learned from the PCMH learning collaborative—to … /highlight07.pdf
http://www.ahrq.gov/policymakers/chipra/demoeval/what-we-learned/highlight09.html
http … /chipra/demoeval/what-we-learned/highlight13.html
http://www.ahrq.gov/policymakers/chipra/demoeval/what-we-learned … /highlight13.html
http://www.ahrq.gov/policymakers/chipra/demoeval/what-we-learned/implementation-guides
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www.healthcare411.ahrq.gov/sites/default/files/wysiwyg/policymakers/chipra/statesummaries/chipra-750-idaho-state-snapshot.pdf
January 01, 2018 - Quality Demonstration Grant Program
January 2018
This brief highlights the major strategies, lessons learned … • Idaho planned to disseminate a toolkit—based on lessons
learned from the PCMH learning collaborative—to … /highlight07.pdf
http://www.ahrq.gov/policymakers/chipra/demoeval/what-we-learned/highlight09.html
http … /chipra/demoeval/what-we-learned/highlight13.html
http://www.ahrq.gov/policymakers/chipra/demoeval/what-we-learned … /highlight13.html
http://www.ahrq.gov/policymakers/chipra/demoeval/what-we-learned/implementation-guides