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psnet.ahrq.gov/issue/health-care-failure-mode-and-effect-analysis-reduce-nicu-line-associated-bloodstream
April 24, 2018 - marked reduction in the incidence of central line–associated bloodstream infections in a neonatal intensive … Seroprevalence of SARS-CoV-2 among frontline health care personnel in a multistate hospital network--13 academic medical … October 2, 2013
The high-reliability pediatric intensive care unit. … June 27, 2011
Reducing catheter-associated bloodstream infections in the pediatric intensive … May 19, 2010
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Intensive Care Units
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psnet.ahrq.gov/node/44284/psn-pdf
September 09, 2015 - Operating room to intensive care unit handoffs and the
risks of patient harm. … Operating room to intensive care unit handoffs and the risks of
patient harm. … https://psnet.ahrq.gov/issue/operating-room-intensive-care-unit-handoffs-and-risks-patient-harm
This … care unit for liver transplant patients at a large academic medical center. … https://psnet.ahrq.gov/issue/operating-room-intensive-care-unit-handoffs-and-risks-patient-harm
https
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psnet.ahrq.gov/issue/root-cause-analysis-icu-adverse-events-veterans-health-administration
June 23, 2021 - analyzed root cause analysis reports regarding events related to care in Veterans Health Administration intensive … November 14, 2018
Controlled trial to improve resident sign-out in a medical intensive … the Rules
March 21, 2009
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Intensive
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psnet.ahrq.gov/issue/development-swarm-model-high-reliability-rapid-problem-solving-and-institutional-learning
November 16, 2022 - SWARM tool—a unit-based mechanism to rapidly analyze problems and develop solutions—in a pediatric intensive … October 6, 2016
Safety in the NICU: preventing medical errors. … July 6, 2011
Non-technical skills in the intensive care unit. … May 19, 2010
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Intensive Care Units … Health Care Executives and Administrators
Critical Care
Neonatology and Intensive Care
Epidemiology
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psnet.ahrq.gov/issue/wisdom-and-justice-not-paying-preventable-complications
January 22, 2014 - Author(s)
Responsibility for quality improvement and patient safety: hospital board and medical … January 22, 2014
Improving patient safety in intensive care units in Michigan. … June 16, 2011
Assessing and improving safety climate in a large cohort of intensive care … Implementing standardized operating room briefings and debriefings at a large regional medical … September 7, 2016
Criminalization of medical error: who draws the line?
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psnet.ahrq.gov/node/40673/psn-pdf
September 03, 2011 - Evaluating efforts to optimize TeamSTEPPS
implementation in surgical and pediatric intensive care
units … Evaluating efforts to optimize TeamSTEPPS implementation in surgical
and pediatric intensive care units … psnet.ahrq.gov/issue/evaluating-efforts-optimize-teamstepps-implementation-surgical-and-pediatric-
intensive-care … In this AHRQ-funded study, the TeamSTEPPS training
program was introduced in two intensive care units … psnet.ahrq.gov/primer/teamwork-training
https://psnet.ahrq.gov/issue/association-between-implementation-medical-team-training-program-and-surgical-mortality
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psnet.ahrq.gov/issue/medication-safety-neonatal-care-review-medication-errors-among-neonates
August 15, 2016 - August 15, 2016
Can the standard configuration of a cardiac monitor lead to medical errors … pharmacist-led discharge medication reconciliation on error and patient harm prevention at a large academic medical … December 4, 2024
Deficiencies in electronic medical record inpatient list capabilities … December 29, 2014
Interventions to reduce medication errors in pediatric intensive care … June 11, 2014
Improving safety throughout the medication use process in a neonatal intensive
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psnet.ahrq.gov/issue/leveraging-science-teamwork-sustain-handoff-improvements-cardiovascular-surgery
November 28, 2018 - improvement project aimed to improve handoffs between the cardiovascular (CV) operating room and CV intensive … In their own words: safety and quality perspectives from families of hospitalized children with medical … September 6, 2023
Family safety reporting in hospitalized children with medical complexity … Resources
Analyzing and mitigating the risks of patient harm during operating room to intensive … June 1, 2011
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Intensive Care Units
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psnet.ahrq.gov/issue/improving-patient-safety-icu-prospective-identification-missing-safety-barriers-using-bow-tie
February 14, 2024 - From the Same Author(s)
The effect of computerised decision support alerts tailored to intensive … Adverse drug events caused by three high-risk drug-drug interactions in patients admitted to intensive … interference from radio frequency identification inducing potentially hazardous incidents in critical care medical … Resources
Analyzing and mitigating the risks of patient harm during operating room to intensive … May 15, 2013
Assessing system failures in operating rooms and intensive care units.
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psnet.ahrq.gov/issue/lost-opportunities-how-physicians-communicate-about-medical-errors
July 10, 2008 - Study
Lost opportunities: how physicians communicate about medical errors. … Lost Opportunities: How Physicians Communicate About Medical Errors. … Lost Opportunities: How Physicians Communicate About Medical Errors. … attitudes and beliefs of healthcare professionals on the causes and reporting of medication errors in a UK intensive … 2011
A new safety event reporting system improves physician reporting in the surgical intensive
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psnet.ahrq.gov/issue/risk-management-or-just-different-risk-national-survey-newborn-units-following-patient-safety
April 12, 2011 - August 21, 2019
Association of surgical resident wellness with medical errors and patient … September 6, 2016
Adverse drug events in a paediatric intensive care unit: a prospective … March 6, 2013
Ferrari's Formula One handovers and handovers from surgery to intensive … June 9, 2011
Adverse events in the neonatal intensive care unit: development, testing … June 21, 2006
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Intensive Care Units
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psnet.ahrq.gov/issue/using-learning-system-approach-improve-safety-prone-position-ventilation-patients
January 10, 2024 - Issues identified included medical device-related pressure injuries and device dislodgement, concerns … September 13, 2023
Factors influencing the reporting of adverse medical device events … March 15, 2023
AHRQ Safety Program for Intensive Care Units: Preventing CLABSI and CAUTI … February 2, 2022
Supervision, interprofessional collaboration, and patient safety in intensive … March 17, 2021
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Intensive Care Units
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psnet.ahrq.gov/issue/do-hospitals-support-second-victims-collective-insights-patient-safety-leaders-maryland
May 11, 2016 - Clinicians who experience adverse emotional consequences after being involved in medical errors are considered … March 3, 2019
Health care workers as second victims of medical errors. … January 12, 2011
Integrating the intensive care unit safety reporting system with existing … January 2, 2017
A system factors analysis of "line, tube, and drain" incidents in the intensive … June 29, 2009
Intensive care unit safety incidents for medical versus surgical patients
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psnet.ahrq.gov/issue/were-not-ready-i-dont-think-youre-ever-ready-clinician-perspectives-implementation-crisis
September 23, 2020 - emergence of COVID-19, the National Academy of Medicine had provided guidance on the reallocation of scarce medical … 16, 2022
Pilot implementation of a perioperative protocol to guide operating room-to-intensive … Related Resources
Understanding teamwork in rapidly deployed interprofessional teams in intensive … May 20, 2020
Psychological impact and coping strategies of frontline medical staff in … April 8, 2020
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Intensive Care Units
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psnet.ahrq.gov/issue/operating-room-icu-patient-handovers-multidisciplinary-human-centered-design-approach
June 27, 2012 - about handoffs , specifically for postsurgical patients transferred from the operating room to the intensive … October 19, 2022
Changes in medical errors after implementation of a handoff program. … February 18, 2019
Often overlooked problems with handoffs: from the intensive care unit … February 29, 2012
Patient handover from surgery to intensive care: using Formula 1 pit-stop … June 9, 2010
Identification of patient information corruption in the intensive care unit
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psnet.ahrq.gov/issue/safe-implementation-standard-concentration-infusions-paediatric-intensive-care
June 17, 2014 - Study
Safe implementation of standard concentration infusions in paediatric intensive … Safe implementation of standard concentration infusions in paediatric intensive care. … According to a retrospective study in a pediatric intensive care unit, most morphine-related medication … Safe implementation of standard concentration infusions in paediatric intensive care. … September 6, 2016
The morbidity and mortality conference in pediatric intensive care
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psnet.ahrq.gov/issue/strategies-enhance-adoption-ventilator-associated-pneumonia-prevention-interventions
July 10, 2017 - Ventilator-associated pneumonia is one of the most common health care–associated infections in intensive … July 10, 2017
Improving patient safety in intensive care units in Michigan. … June 16, 2011
Assessing and improving safety climate in a large cohort of intensive care … Surfacing safety hazards using standardized operating room briefings and debriefings at a large regional medical … April 2, 2014
As she lay dying: how I fought to stop medical errors from killing my mom
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psnet.ahrq.gov/web-mm/miscommunication-during-interhospital-transport-critically-ill-child
March 27, 2024 - Specifically, the local facility did not have a pediatric intensive care unit. … errors. 16 Standardized handoff processes can effectively decrease adverse events and medical errors … Changes in medical errors after implementation of a handoff program. … Integrating research, quality improvement, and medical education for better handoffs and safer care: … Financial benefits of a pediatric intensive care unit-based telemedicine program to a rural adult intensive
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psnet.ahrq.gov/issue/medical-residents-and-burnout
June 01, 2022 - Special or Theme Issue
Medical Residents and Burnout
Citation Text:
Medical … Medical training is a demanding experience that impacts a learner’s ability to provide safe care, cope … errors in intensive care. … April 23, 2008
Bipartisan Consensus: The Public Wants Well-Rested Medical Residents to … August 14, 2019
The hidden curricula of medical education: a scoping review.
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psnet.ahrq.gov/issue/medication-dosing-safety-pediatric-patients-recognizing-gaps-safety-threats-and-best
March 01, 2023 - safety for pediatric patients: recognizing gaps, safety threats, and best practices in the emergency medical … safety for pediatric patients: recognizing gaps, safety threats, and best practices in the emergency medical … safety for pediatric patients: recognizing gaps, safety threats, and best practices in the emergency medical … 'Doing the best we can': Registered nurses' experiences and perceptions of patient safety in intensive … Prompting rounding teams to address a daily best practice checklist in a pediatric intensive