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psnet.ahrq.gov/perspective/errors-and-near-misses-what-health-care-could-learn-aviation
September 01, 2006 - Everybody learned from a particular person or an institution—which led to, you know, this is the Penn
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psnet.ahrq.gov/node/841467/psn-pdf
December 14, 2022 - A goals-of-care discussion was led by the palliative care service;
the patient and his designated decision-makers
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psnet.ahrq.gov/perspective/making-just-culture-reality-one-organizations-approach
October 01, 2007 - November 1, 2016
Sustained impact of a pediatric resident-led patient safety council.
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psnet.ahrq.gov/perspective/becoming-certified-professional-patient-safety-pharmacists-perspective
June 01, 2016 - safety officer, it is vital that I listen to the health care team when they explain the events that led
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psnet.ahrq.gov/node/836976/psn-pdf
April 27, 2022 - Her wounds led to significant blood loss.
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psnet.ahrq.gov/web-mm/delayed-evaluation-abdominal-pain-elderly-patient
February 26, 2020 - Doing so could have expedited her transfer from the waiting room to a treatment bed and may have led
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psnet.ahrq.gov/web-mm/failure-adhere-dietary-restrictions-leading-complications-and-poor-follow
March 29, 2023 - This liability issue may have led the physicians in this case to delay the procedure, instead of proceeding
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psnet.ahrq.gov/perspective/balancing-supervision-and-autonomy-ongoing-tension
February 01, 2012 - The death of 18-year-old Libby Zion at The New York Hospital in 1984 led to the recommendation by the
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psnet.ahrq.gov/perspective/safety-and-medical-education
December 01, 2013 - commentary by two noted patient safety experts raised concern that further restriction of duty hours has led
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psnet.ahrq.gov/perspective/conversation-withdonald-m-berwick-md-mpp
November 01, 2005 - In December 2004, he announced an IHI-led "Campaign to Save 100,000 Lives"—promoting the implementation
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psnet.ahrq.gov/primer/coronavirus-disease-2019-covid-19-and-safety-older-adults
April 10, 2024 - Regulatory guidelines on PPE, testing, and visitation, for example, while necessary and important, led … commission included 25 LTC experts, consumer advocates, academics, state authorities, and residents, and was led
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psnet.ahrq.gov/web-mm/unexpected-drawbacks-electronic-order-sets
December 01, 2017 - Unexpected Drawbacks of Electronic Order Sets
Citation Text:
McGreevey JD. Unexpected Drawbacks of Electronic Order Sets. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2016.
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psnet.ahrq.gov/perspective/conversation-withmark-chassin-md-mpp-mph
April 01, 2009 - that delays in receiving dilute solutions from the pharmacy turned ICUs into de facto pharmacies and led
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psnet.ahrq.gov/perspective/conversation-gregg-s-meyer-md-msc
June 01, 2016 - safety officer, it is vital that I listen to the health care team when they explain the events that led
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psnet.ahrq.gov/perspective/conversation-withlucian-leape-md
August 01, 2006 - This focus on safety led to significant decreases in risks to patients.
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psnet.ahrq.gov/perspective/conversation-witheric-g-poon-md-mph
September 01, 2008 - In both cases, errors led to the wrong concentration of IV heparin being administered, resulting in 1000
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psnet.ahrq.gov/perspective/conversation-withthomas-h-gallagher-md
January 01, 2009 - That led to my interest in an even more challenging conversation, which is how doctors and patients talk
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psnet.ahrq.gov/node/60362/psn-pdf
April 13, 2018 - which, in turn, has
reduced complications, generated cost savings to the state Medicaid program, and led
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psnet.ahrq.gov/perspective/conversation-barbara-drew-rn-phd
May 01, 2016 - team-based approach, combined with a formal alarm management committee structure and broad-based education, led
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psnet.ahrq.gov/perspective/disclosure-medical-error
January 01, 2009 - That led to my interest in an even more challenging conversation, which is how doctors and patients talk