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Total Results: 3,006 records

Showing results for "lessons learned".

2741. The ECG Is Not Normal | PSNet
      psnet.ahrq.gov/web-mm/ecg-not-normal
      November 10, 2015 - Editorial Note: The physician (case submitter) further reflected on what he learned from this experience … These are the smaller lessons from this case.

2742. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49573/psn-pdf
      January 01, 2009 - Basic assumptions and lessons distilled from the cognitive systems engineering literature (11-14) are … Overall, they highlight a number of important lessons that can be applied to health care settings. … Assumptions and Lessons from the Literature Assumptions Lessons Human behavior in professional settings

2743. In Conversation with...Joseph Britto, MD | PSNet
      psnet.ahrq.gov/perspective/conversation-withjoseph-britto-md
      February 01, 2007 - The essential difference is that it treats the physician as the "learned intermediary" (to borrow a phrase … read about—diagnosis-specific knowledge on how does one investigate, how does one treat, what are the lessons … learned and recent advances. … Diagnosing diagnosis errors: Lessons from a multi-institutional collaborative project for the diagnostic

2744. The Role of Patient-facing Technologies to Empower Patients and Improve Safety | PSNet
      psnet.ahrq.gov/perspective/role-patient-facing-technologies-empower-patients-and-improve-safety
      November 01, 2017 - Wanda Pratt : A lot of my work brings in material that we have learned from the field of human–computer … Yet the patient has been dealing with it for a long time, read about it on their own, and learned a … February 15, 2023 Lessons learned implementing a complex and innovative patient safety

2745. Team-Developed Care Plan and Ongoing Care Management by Social Workers and Nurse Practitioners Result in Better Outcomes and Reduced Acute Care Utilization in Low-Income Seniors and other High-Risk Populations | PSNet
      psnet.ahrq.gov/innovation/team-developed-care-plan-and-ongoing-care-management-social-workers-and-nurse
      July 23, 2024 - Geriatric Resources for Assessment and Care of Elders Team Care in a Veterans Affairs Medical Center: Lessons … Learned and Effects Observed. … Geriatric Resources for Assessment and Care of Elders Team Care in a Veterans Affairs Medical Center: Lessons … Learned and Effects Observed.

2746. Statewide Telehealth Program Enhances Access to Care, Improves Outcomes for High-Risk Pregnancies in Rural Area | PSNet
      psnet.ahrq.gov/innovation/statewide-telehealth-program-enhances-access-care-improves-outcomes-high-risk
      November 13, 2024 - Over its 17 years in operation, the High-Risk Pregnancy Program has gained a number of valuable lessons … learned that are particularly advantageous when reviewing this innovation for replication in other areas … The following lessons learned offer guidance in launching and sustaining this innovation: Identify

2747. Diagnostic Errors in Medicine: What Do Doctors and Umpires Have in Common? | PSNet
      psnet.ahrq.gov/perspective/diagnostic-errors-medicine-what-do-doctors-and-umpires-have-common
      February 01, 2007 - Diagnosing diagnosis errors: Lessons from a multi-institutional collaborative project for the diagnostic … The essential difference is that it treats the physician as the "learned intermediary" (to borrow a phrase … read about—diagnosis-specific knowledge on how does one investigate, how does one treat, what are the lessons … learned and recent advances.

2748. Workplace Safety in Health Care | PSNet
      psnet.ahrq.gov/perspective/workplace-safety-health-care
      January 01, 2017 - To build a better hospital, Virginia Mason takes lessons from Toyota plants. Seattle PI. … themselves discovered that, because they had all gone to different nursing schools and thought they had learned … PO : I think there are more businesses that have learned the ideas of continuous learning and continuous … demonstrated things in my own work environments when I was Secretary of the Treasury that I had first learned … One thing I've learned in health and medical care is they have this wonderful dodge; if you hurt your

2749. In Conversation With… Paul H. O'Neill, MPA | PSNet
      psnet.ahrq.gov/perspective/conversation-paul-h-oneill-mpa
      January 01, 2017 - themselves discovered that, because they had all gone to different nursing schools and thought they had learned … PO : I think there are more businesses that have learned the ideas of continuous learning and continuous … demonstrated things in my own work environments when I was Secretary of the Treasury that I had first learned … One thing I've learned in health and medical care is they have this wonderful dodge; if you hurt your … To build a better hospital, Virginia Mason takes lessons from Toyota plants. Seattle PI.

2750. Missed CANDOR Implementation Opportunities. | PSNet
      psnet.ahrq.gov/web-mm/missed-candor-implementation-opportunities
      November 11, 2020 - was no plan or commitment made to the widow to follow up with her and further explain what was later learned … The lessons learned and improvements made in response to the adverse event should also be explained,

2751. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/840174/psn-pdf
      August 28, 2024 - was no plan or commitment made to the widow to follow up with her and further explain what was later learned … The lessons learned and improvements made in response to the adverse event should also be explained,

2752. In Conversation With... Charles A Crecelius, MD, PhD, CMD and Lori L Popejoy, PhD, RN, FAAN | PSNet
      psnet.ahrq.gov/perspective/conversation-charles-crecelius-md-phd-cmd-and-lori-l-popejoy-phd-rn-faan
      October 28, 2020 - your initiative and its intersection with the COVID-19 response – how are you using the work and the lessons … I would encourage frontline staff in hard hit areas to use forums like that to share what they’ve learned … We are not New York, so some lessons didn’t apply. … While management of the infection has improved as the pandemic has continued and facilities have learned … Hood about Remote Patient Monitoring March 15, 2023 The Lancet Commission on lessons

2753. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49604/psn-pdf
      June 01, 2010 - The Commentary While there is something to be learned about the proper care of spinal catheters from … Handoff strategies in settings with high consequences for failure: lessons for health care operations

2754. Risk Mitigation Using the Anesthesia Risk Alert Program: Applying a Proactive Approach With Data Review & Collaborating With a Second Practitioner | PSNet
      psnet.ahrq.gov/innovation/risk-mitigation-using-anesthesia-risk-alert-program-applying-proactive-approach-data
      February 26, 2025 - Anesthesia adverse events voluntarily reported in the Veterans health administration and lessons learned

2755. Triage Time Bomb | PSNet
      psnet.ahrq.gov/web-mm/triage-time-bomb
      September 01, 2008 - Failure to Latch September 1, 2008 Changing smart pump vendors: lessons … learned.

2756. Medication Reconciliation Victory After an Avoidable Error | PSNet
      psnet.ahrq.gov/web-mm/medication-reconciliation-victory-after-avoidable-error
      April 01, 2015 - August 14, 2024 Exploring the impact of safety culture on incident reporting: lessons … learned from machine learning analysis of NHS England staff survey and incident data.

2757. Diagnostic Errors Case Studies | PSNet
      psnet.ahrq.gov/curated-library/diagnostic-errors-case-studies
      November 03, 2025 - PRIDE Learning Network, diagnostic error case studies were reviewed to identify common pitfalls and lessons … learned.

2758. Reconciling Records | PSNet
      psnet.ahrq.gov/web-mm/reconciling-records
      September 01, 2017 - Initial lessons from the first national demonstration project on practice transformation to a patient-centered … Perspective Assessing the Safety of Electronic Health Records: What Have We Learned

2759. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/850678/psn-pdf
      June 14, 2023 - The lessons learned from the pilot were then applied to a staggered deployment of the innovation to

2760. Missing Trauma | PSNet
      psnet.ahrq.gov/web-mm/missing-trauma
      March 03, 2011 - Resources From the Same Author(s) Patterns of errors contributing to trauma mortality: lessons … learned from 2,594 deaths.