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Total Results: 3,178 records

Showing results for "led".

3021. Equity in Patient Safety | PSNet
      psnet.ahrq.gov/perspective/equity-patient-safety
      September 24, 2024 - For example, implicit bias about racial differences in pain tolerance has led to systematic undertreatment

3022. In Conversation With… J. Bryan Sexton, PhD, MA | PSNet
      psnet.ahrq.gov/perspective/conversation-j-bryan-sexton-phd-ma
      February 26, 2025 - Ten years from now, people will probably still say that the projects that led to checklists being the

3023. “This is the wrong patient's blood!”: Evaluating a Near-Miss Wrong Transfusion Event | PSNet
      psnet.ahrq.gov/web-mm/wrong-patients-blood-evaluating-near-miss-wrong-transfusion-event
      July 01, 2017 - errors was the wrong blood reaching the patient’s bedside, a high risk near-miss event that may have led

3024. Lack of Sepsis Recognition Leads to Delay in Care Following Cesarean Delivery. | PSNet
      psnet.ahrq.gov/web-mm/lack-sepsis-recognition-leads-delay-care-following-cesarean-delivery
      November 30, 2021 - Later, problems with data gathering and information processing led to a brief delay in recognizing emerging

3025. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49483/psn-pdf
      June 01, 2005 - Getting Started The RCA team is usually led by a member of the institution’s patient safety or quality

3026. In Conversation With… Brian Jarman, PhD | PSNet
      psnet.ahrq.gov/perspective/conversation-brian-jarman-phd
      March 01, 2015 - HSMRs for years, it was whistleblowers among staff and patients who attracted the public attention that led

3027. Monitoring Fetal Health | PSNet
      psnet.ahrq.gov/web-mm/monitoring-fetal-health
      September 08, 2010 - Although well intended, there are two fundamental differences inherent in centralized monitoring that have led

3028. Spotlight
      psnet.ahrq.gov/sites/default/files/2025-01/spotlight_case_misdiagnosis_of_small_bowel_obstruction_-_slides_-_final.pptx
      January 01, 2025 - gallbladder, should have prompted a surgical consultation for acute cholecystitis, which might have led

3029. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/849661/psn-pdf
      June 28, 2023 - intubation during general anesthesia.28 It is possible that her obesity, and perhaps other social factors, led

3030. Beeline to Spine | PSNet
      psnet.ahrq.gov/web-mm/beeline-spine
      March 01, 2014 - The impact of a consultant anaesthetist led pre-operative assessment clinic on patients undergoing major

3031. In Conversation With… Richard Platt, MD, MSc | PSNet
      psnet.ahrq.gov/perspective/conversation-richard-platt-md-msc
      October 01, 2016 - As part of that work, I was asked to develop an antimicrobial stewardship program and that led to a general

3032. In Conversation With… Shantanu Nundy, MD | PSNet
      psnet.ahrq.gov/perspective/conversation-shantanu-nundy-md
      February 26, 2025 - And that led to the name "The Human Diagnosis Project."

3033. Hidden Danger! Insidious Postpartum Bleeding After Emergency Cesarean Delivery. | PSNet
      psnet.ahrq.gov/web-mm/hidden-danger-insidious-postpartum-bleeding-after-emergency-cesarean-delivery
      November 25, 2020 - Although death was averted, it seems quite evident that earlier investigation and intervention might have led

3034. Getting to the Root of the Matter | PSNet
      psnet.ahrq.gov/web-mm/getting-root-matter
      September 01, 2005 - Getting Started The RCA team is usually led by a member of the institution’s patient safety or quality

3035. Be Picky about your PICCs—Fragmented Care and Poor Communication at Discharge Leads to a PICC without a Plan. | PSNet
      psnet.ahrq.gov/web-mm/be-picky-about-your-piccs-fragmented-care-and-poor-communication-discharge-leads-picc
      July 19, 2023 - The suitability of PICC lines for such a broad range of clinical situations has led to highly variable

3036. Haste Makes Care Unsafe | PSNet
      psnet.ahrq.gov/web-mm/haste-makes-care-unsafe
      January 07, 2015 - Haste Makes Care Unsafe Citation Text: Eichhorn JH. Haste Makes Care Unsafe. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2015. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML EndNote 7 XML Endnote tagged P…

3037. Hurried Team Huddle and Poor Communication: Unsafe Practice During Anesthesia for Emergency Cesarean Delivery | PSNet
      psnet.ahrq.gov/web-mm/hurried-team-huddle-and-poor-communication-unsafe-practice-during-anesthesia-emergency
      September 27, 2023 - intubation during general anesthesia. 28 It is possible that her obesity, and perhaps other social factors, led

3038. The Michigan Hospital Medicine Safety Consortium (HMS) Finds Infectious Diseases (ID) Physician Approval for Placement of Peripherally Inserted Central Catheters (PICCs) Prevents Unnecessary PICC Use and Reduces Complications | PSNet
      psnet.ahrq.gov/innovation/michigan-hospital-medicine-safety-consortium-hms-finds-infectious-diseases-id-physician
      July 23, 2024 - group of vascular access experts from around the world, including several HMS member hospitals, and led

3039. Delayed Symptomatic Subdural Hematoma Following an Initially Normal CT Head | PSNet
      psnet.ahrq.gov/web-mm/delayed-symptomatic-subdural-hematoma-following-initially-normal-ct-head
      March 27, 2024 - December 7, 2016 Systematic review and meta-analysis of the effectiveness of pharmacist-led

3040. Adolescent Diabetes: A Routine Visit? | PSNet
      psnet.ahrq.gov/web-mm/adolescent-diabetes-routine-visit
      November 18, 2016 - sexual history in a confidential setting may have revealed this patient's prior sexual assault and led