-
psnet.ahrq.gov/web-mm/which-line-ordering-provider-or-proceduralist
September 16, 2015 - harmed by having the incorrect catheter placed, but the error was eventually discovered and further injury … power hierarchy—individuals of lesser status in the medical hierarchy may be reluctant to check, let … Craig Blackmore, MD, MPH Director, Center for Health Care Improvement Science Virginia Mason Medical … or other relationship with the manufacturers of any commercial products discussed in this continuing medical … Physician scores on a national clinical skills examination as predictors of complaints to medical
-
psnet.ahrq.gov/web-mm/missing-large-vessel-occlusion-stroke-patient-history-seizures
August 31, 2022 - Relevant Financial Relationships: As a provider accredited by the Accreditation Council for Continuing Medical … The Accreditation Council for Continuing Medical Education (ACCME) defines a commercial interest as “ … The Case A 58-year-old man with a past medical history of seizures, meningioma, type 2 diabetes mellitus … The patient’s past medical history of seizures and his normal non-contrast cranial CT could be compatible … perform CT angiography during stroke alerts due to concerns about causing contrast-related acute kidney injury
-
psnet.ahrq.gov/node/837215/psn-pdf
July 08, 2022 - Relevant Financial Relationships: As a provider accredited by the Accreditation Council for
Continuing Medical … The Accreditation Council for Continuing Medical
Education (ACCME) defines a commercial interest as … The Case
A 58-year-old man with a past medical history of seizures, meningioma, type 2 diabetes mellitus … The
patient’s past medical history of seizures and his normal non-contrast cranial CT could be compatible … perform CT angiography during stroke alerts due to
concerns about causing contrast-related acute kidney injury
-
psnet.ahrq.gov/sites/default/files/2022-03/final_spotlight_case_mistaken_capacity.pdf
January 01, 2022 - the patient’s complete history
• Describe the strategies to strengthen psychosocial training for medical … – Laboratory tests were notable for acute kidney injury, metabolic acidosis,
hypomagnesemia, hypophosphatemia … On interview, it was determined that the
patient did not have capacity to make complex medical decisions … – Medical decision-making is the ability of a patient to understand the
benefits and risks of, and … Evaluating medical decision-making capacity in practice. Am Fam Physician. 2018;98(1):40-
49.
-
psnet.ahrq.gov/node/853080/psn-pdf
August 30, 2023 - In the initial VIC
model, patient rooms in medical-surgical units at two different community hospitals … interrupted three times.3 This finding is
consistent with other studies on the impact of interruption on medical … Quality Indicators showed low incidence of catheter-associated urinary tract infections, pressure
injuries
-
psnet.ahrq.gov/node/50949/psn-pdf
February 26, 2020 - decisions are based on some kind of pathology and/or
laboratory result.1 Medical testing consists … A study by the University
of Minnesota Medical Center (UMMC) laboratory found their facility could not … infections, such as sepsis, exponentially increases
the odds of death.13 Costs associated with iatrogenic injuries … Medical
testing error occurs most frequently during the pre-analytic phase. … A review of medical errors in laboratory diagnostics and where we are today.
-
psnet.ahrq.gov/node/49472/psn-pdf
March 01, 2005 - identifiers removed) are also submitted to the CDC, which
collects information on notifiable diseases and injuries … communication between local health departments and clincians through updates at hospital
grand rounds, medical … conferences, and through medical societies and state licensing boards. … Catherine McLean, MD Medical Epidemiologist Division of STD Prevention Centers for Disease Control
and
-
psnet.ahrq.gov/node/49779/psn-pdf
January 01, 2017 - Purchasing provides an opportunity to shape the safety and usability of medical technology. … Arlington, VA:
Association for the Advancement of Medical Instrumentation; 2010. … Issues From the AAMI/FDA Infusion Device Summit
Report (1) © 2010 Association for the Advancement of Medical … Injuries are caused by a lack of differentiation between the use of infusion devices in hospitals
and … Infusion
pump: A medical device used to deliver fluids into a patient's body in a controlled manner.
-
psnet.ahrq.gov/node/33717/psn-pdf
September 01, 2011 - Risk
managers developed these systems to identify injuries that might lead to litigation and to reduce … actual
incidence of safety events, other detection methods are more sensitive, including reviewing medical … hospital staff and physicians through multiple means,
such as through electronic newsletters, continuing medical … Palermo, MD, MMM, FACS, VP, Chief Medical Officer, Chief Quality Officer, Health First, Inc.;
and Ellen … Effectiveness of patient safety training in equipping medical students
to recognise safety hazards and
-
psnet.ahrq.gov/node/846170/psn-pdf
March 15, 2023 - psnet.ahrq.gov/web-mm/duplicate-therapies-retail-pharmacy
The Cases
Case 1: A middle-aged man with a past medical … errors have the potential to be serious and may result in adverse drug events (ADE),
which are patient injuries … teach-back, it is important to speak slowly, make eye contact,
use relaxed body language, avoid complex medical … Patients' memory for medical information. J R Soc Med. 2003 May;96(5):219-22. [Free
full text]
5. … Reducing Medical Admissions and Presentations Into
Hospital through Optimising Medicines (REMAIN HOME
-
psnet.ahrq.gov/web-mm/preventable-rash
October 01, 2012 - identifiers removed) are also submitted to the CDC, which collects information on notifiable diseases and injuries … communication between local health departments and clincians through updates at hospital grand rounds, medical … conferences, and through medical societies and state licensing boards. … Catherine McLean, MD Medical Epidemiologist Division of STD Prevention Centers for Disease Control and … April 29, 2020
Differences in safety report event types submitted by graduate medical
-
psnet.ahrq.gov/perspective/wild-west-patient-safety-office-based-anesthesia
April 01, 2003 - Reports of several patient injuries following early discharge suggest that postoperative complications … , Division of General Internal MedicineBrigham and Women's HospitalAdjunct Assistant ProfessorWeill Medical
-
psnet.ahrq.gov/node/865413/psn-pdf
March 27, 2024 - Barbara Pelletreau: My background is in patient safety and employee injury prevention. … encryption of data or networks that lead to the disruption and loss of the availability of critical medical … In many cases, these outages—the loss of medical
technology—after a ransomware attack can last 30 days … There will be a loss of all this medical technology and operational
technology. … Provide Medical Care Is in Critical Condition: Analysis
and Stakeholder Decision Support to Minimize
-
psnet.ahrq.gov/node/846169/psn-pdf
March 15, 2023 - Succinylcholine is
contraindicated in patients with stroke, spinal cord injury, burns, or myotonic dystrophy … inadequate resources such as the broken drug refrigerator otherwise could have led to irreversible injury … Risk of respiratory complications and wound infection in
patients undergoing ambulatory surgery: smokers
-
psnet.ahrq.gov/node/33712/psn-pdf
June 01, 2011 - analysts who see this
behavior as a universal law: automobile seat belts actually do reduce deaths and injuries … I know that in the current medical system that is very
hard to do given the workloads and systems … is true in
government, and it would be true in industry, and I suspect it would also be true in a medical … On the other side, there is the widely discussed ability of
medical professionals, much more than other
-
psnet.ahrq.gov/web-mm/hold-tpa
July 29, 2020 - Same Author(s)
A randomized trial of a multifactorial strategy to prevent serious fall injuries
-
psnet.ahrq.gov/web-mm/hypoxemia-after-emergency-intubation
March 24, 2019 - Per emergency medical services (EMS) report, the patient went into cardiorespiratory arrest and cardiopulmonary … significant reduction in the number of unrecognized esophageal intubations and cases of hypoxic brain injury … P stands for pneumothorax, which typically occurs in trauma patients with rib fractures or patients … J Trauma Inj . 2019;32(3):136-142. [ Free full text ] Xuan Q, Lyu Z, Chen Q, et al. … WebM&M Cases
Weight and Height Juxtaposition in the Electronic Medical
-
psnet.ahrq.gov/web-mm/not-all-headaches-are-due-migraine-red-flags-dont-miss-diagnoses-and-diagnostic-pitfalls
February 17, 2021 - Approximately five years after the first hospitalization, the patient suffered a head injury at work. … Olson, MD Professor of Medicine and Pediatrics University of Minnesota Medical School apjolson@umn.edu
-
psnet.ahrq.gov/node/49519/psn-pdf
September 01, 2006 - injuries.(16)
Although electronic mechanisms for written signout can facilitate the standardization … Center, and Graduate Medical Education (GME)
leadership.
3. & 4. … Ideally, these structures will be integrated into an electronic
medical record. … London, England: British Medical Association; August 2004. … Effect of reducing interns' work hours on serious
medical errors in intensive care units.
-
psnet.ahrq.gov/web-mm/one-bronchoscopy-two-errors
December 09, 2020 - When reviewing the medical literature, we did not find any statistical overview nor any case reports … directly concerning medical errors in bronchoscopy. … Analysis of incidents resulting in patient injuries in a web-based system in Swedish health care. … September 13, 2023
Using simulation to identify sources of medical diagnostic error in