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Total Results: 3,178 records

Showing results for "led".

2901. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/863308/psn-pdf
      February 28, 2024 - #18 https://psnet.ahrq.gov//#19 patient suffered from a severe aspiration event, which most likely led

2902. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49636/psn-pdf
      October 01, 2011 - This led to a prolonged intensive care unit (ICU) stay for respiratory failure from an ischemic cardiac

2903. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49474/psn-pdf
      March 01, 2005 - extra skin punctures during catheter placement and the delayed catheter changes in obese patients led

2904. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/841305/psn-pdf
      January 27, 2023 - About 10 years ago, I was privileged to attend one of the early Resilient Health Care Network meetings led

2905. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49733/psn-pdf
      May 01, 2015 - Medical advancements over the last 50 years have led to a significant increase in the lifespan of many

2906. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49615/psn-pdf
      December 01, 2010 - , it became clear the patient had not been moved in her bed since her time in the ED, which likely led

2907. Advancing Patient Safety Through State Reporting Systems | PSNet
      psnet.ahrq.gov/perspective/advancing-patient-safety-through-state-reporting-systems
      June 01, 2007 - Analysis of wrong-patient/wrong-site surgical errors led to development of the New York preoperative

2908. Nursing and Patient Safety | PSNet
      psnet.ahrq.gov/primer/nursing-and-patient-safety
      September 15, 2024 - The strength of these data has led several states, beginning with California in 2004, to establish legislatively

2909. Bad Writing, Wrong Medication | PSNet
      psnet.ahrq.gov/web-mm/bad-writing-wrong-medication
      March 01, 2015 - In this case, the medication error, a preventable ADE, led to patient harm.

2910. In Conversation With… Shantanu Agrawal, MD, MPhil | PSNet
      psnet.ahrq.gov/perspective/conversation-shantanu-agrawal-md-mphil
      February 26, 2025 - of the  Never Events list  was AHRQ commissioning a report called  Making Health Care Safer  that I led

2911. Medication Errors in Retail Pharmacies: Wrong Patient, Wrong Instructions. | PSNet
      psnet.ahrq.gov/web-mm/medication-errors-retail-pharmacies-wrong-patient-wrong-instructions
      March 19, 2019 - meeting this Joint Commission requirement and failing to follow the patient safety safeguard of the 8 R’s led

2912. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49522/psn-pdf
      November 01, 2006 - While this has led to a gradual shift toward the use of process measures (what was done) instead of

2913. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49744/psn-pdf
      October 01, 2015 - Unfortunately, his cardiac arrest led to an anoxic brain injury, and he remained in a vegetative state

2914. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49651/psn-pdf
      May 01, 2012 - handoffs, but also created a patchwork of coverage systems, including day and night float services that led

2915. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49855/psn-pdf
      March 01, 2019 - Simple checklists used at the time of ordering for self-check might have led the oncologist to identify

2916. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49852/psn-pdf
      February 01, 2019 - of the patient was not adequately communicated to the receiving hospital prior to transfer, which led

2917. The Missing Abscess: Radiology Reads in the Digital Era | PSNet
      psnet.ahrq.gov/web-mm/missing-abscess-radiology-reads-digital-era
      January 01, 2009 - The infection led to delayed wound healing and a prolonged hospital stay.

2918. In Conversation With… Thomas J. Nasca, MD, MACP | PSNet
      psnet.ahrq.gov/perspective/conversation-thomas-j-nasca-md-macp
      July 10, 2024 - Wachter : What led you to believe that a program like CLER was needed? Dr. Thomas J.

2919. EMR Entry Error: Not So Benign | PSNet
      psnet.ahrq.gov/web-mm/emr-entry-error-not-so-benign
      July 01, 2012 - Thus, the efforts of industry-led certification groups to enhance information exchange across HIT platforms

2920. Delayed Management of Necrotizing Soft Tissue Infection – Who does the Patient Belong To? | PSNet
      psnet.ahrq.gov/web-mm/delayed-management-necrotizing-soft-tissue-infection-who-does-patient-belong
      March 31, 2021 - Identifying Risks to Patient Safety In the presented case, there were undoubtedly multiple failures that led