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Low on the Totem Pole | PSNet

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October 01, 2003 - These medical personnel are exceptionally important to the care of patients. … My test, however, is much simpler. … I recently posed this test to an audience of 1000 at the National Patient Safety Foundation’s annual … conference in Orlando, asking how many worked in institutions that would pass my test. … WebM&M Cases A Postpartum Woman with an Erroneous SARS-CoV-2 Test

Patient safety incidents in home hospice care: the experiences of hospice interdisciplinary team members. | PSNet

psnet.ahrq.gov/issue/patient-safety-incidents-home-hospice-care-experiences-hospice-interdisciplinary-team-members

February 15, 2011 - January 10, 2011 Rural community members' perceptions of harm from medical mistakes: … August 9, 2011 The management of test results in primary care: does an electronic medical … July 14, 2010 Management of test results in family medicine offices. … Home Care Health Care Providers Quality and Safety Professionals Palliative Care Medical

Application of a digital quality measure for cancer diagnosis in Epic Cosmos. | PSNet

psnet.ahrq.gov/issue/application-digital-quality-measure-cancer-diagnosis-epic-cosmos

November 13, 2024 - Resources From the Same Author(s) A virtual breakthrough series collaborative for missed test … November 13, 2024 Why test results are still getting "lost" to follow-up: a qualitative … April 27, 2022 Provider bias in prescribing opioid analgesics: a study of electronic medical … View More See More About The Topic Emergency Departments Emergency Medicine Medical

Allocation of physician time in ambulatory practice: a time and motion study in four specialties. | PSNet

psnet.ahrq.gov/issue/allocation-physician-time-ambulatory-practice-time-and-motion-study-four-specialties

August 26, 2020 - April 26, 2017 Patient groups, clinicians and healthcare professionals agree—all test … June 19, 2024 View More Related Resources Embedded bias: how medical … November 23, 2016 Medical errors: disclosure styles, interpersonal forgiveness, and outcomes … January 7, 2015 Health-care providers want patients to read medical records, spot errors … , 2014 Frequency of failure to inform patients of clinically significant outpatient test

Delays in care during the COVID-19 pandemic in the Veterans Health Administration. | PSNet

psnet.ahrq.gov/issue/delays-care-during-covid-19-pandemic-veterans-health-administration

May 17, 2023 - May 22, 2024 Multiple Failures in Test Results Follow-up for a Patient Diagnosed with … Prostate Cancer at the Hampton VA Medical Center in Virginia. … March 13, 2019 Understanding test results follow-up in the ambulatory setting: analysis … Ambulatory Clinic or Office Health Care Executives and Administrators Public Health Diagnostic Test

Patient Safety in the Ambulatory Care Setting | PSNet

psnet.ahrq.gov/perspective/patient-safety-ambulatory-care-setting

April 27, 2022 - ambulatory care setting, diagnostic-related errors are among the most problematic and the most common medical … benefited from the input and insights of Gordon Schiff, MD, the Quality and Safety Director for the Harvard Medical … result of turnover, may be more prone to missed and delayed diagnoses, outright diagnostic errors, and medical … Follow-up failures (i.e., incomplete or delayed communication of test results) have been documented … across a wide spectrum of abnormal test results.

Artificial intelligence in clinical diagnosis: opportunities, challenges, and hype. | PSNet

psnet.ahrq.gov/issue/artificial-intelligence-clinical-diagnosis-opportunities-challenges-and-hype

December 21, 2022 - August 7, 2024 A virtual breakthrough series collaborative for missed test results: a … November 1, 2023 Why test results are still getting "lost" to follow-up: a qualitative … September 16, 2020 Amid COVID-19, discipline against bad doctors plummets; more medical … diagnostic process framework to teach clinical reasoning in computerized case presentations to 251 medical

Problem list completeness in electronic health records: a multi-site study and assessment of success factors. | PSNet

psnet.ahrq.gov/issue/problem-list-completeness-electronic-health-records-multi-site-study-and-assessment-success

April 29, 2018 - Using the test case example of a diabetes diagnosis for any patient that had a recorded hemoglobin A1c … value of greater than 7% (a test result that is diagnostic for diabetes), problem list completeness … June 24, 2020 Electronic health record–related events in medical malpractice claims. … January 23, 2019 IT-CARES: an interactive tool for case-crossover analyses of electronic medical

The impact of prescribing safety alerts for elderly persons in an electronic medical record: an interrupted time series evaluation. | PSNet

psnet.ahrq.gov/issue/impact-prescribing-safety-alerts-elderly-persons-electronic-medical-record-interrupted-time

July 10, 2008 - Study The impact of prescribing safety alerts for elderly persons in an electronic medical … The impact of prescribing safety alerts for elderly persons in an electronic medical record: an interrupted … This AHRQ–funded study discovered that the use of alerts within an electronic medical record system can … The impact of prescribing safety alerts for elderly persons in an electronic medical record: an interrupted … 2022 Application of human factors methods to understand missed follow-up of abnormal test

In Conversation With... David Gruen, MD | PSNet

psnet.ahrq.gov/perspective/conversation-david-gruen-md

January 31, 2020 - and content expert for artificial intelligence in medical imaging. … The question becomes how do we test on an ongoing basis the accuracy of AI, particularly when we get … not going to be reimbursed because they didn’t have that information two days later and repeated the test … Artificial intelligence in medical imaging: threat or opportunity? … November 17, 2021 Variation in electronic test results management and its implications

Measuring and improving diagnostic safety in primary care: addressing the “twin” pandemics of diagnostic error and clinician burnout. | PSNet

psnet.ahrq.gov/issue/measuring-and-improving-diagnostic-safety-primary-care-addressing-twin-pandemics-diagnostic

September 07, 2022 - February 24, 2021 Why test results are still getting "lost" to follow-up: a qualitative … September 12, 2018 Clinical reasoning education at US medical schools: results from a … 2023 Implementation of patient safety structures and processes in the patient-centered medical … December 9, 2020 Clinical decision support improves the appropriateness of laboratory test

Primary Care and Patient Safety: Opportunities at the Interface | PSNet

psnet.ahrq.gov/perspective/primary-care-and-patient-safety-opportunities-interface

September 28, 2022 - They said, “Oh you mean like take a test?” … a different test or it’s not quite the one I wanted; it was a second test. … We did the blood test, and the blood test had a result. … , (2) getting the blood test, (3) the laboratory doing the test, (4) the laboratory reporting the test … mistakes, and medical errors.

Comparison and interpretation of urinalysis performed by a nephrologist versus a hospital-based clinical laboratory. | PSNet

psnet.ahrq.gov/issue/comparison-and-interpretation-urinalysis-performed-nephrologist-versus-hospital-based

March 14, 2016 - mechanism in preventing infection caused by accompanying caregivers during COVID-19-experience of a city medical … August 3, 2016 Communicating Critical Test Results. … September 9, 2011 Improving Papanicolaou test quality and reducing medical errors by … June 24, 2010 Medical error identification, disclosure, and reporting: do emergency medicine

Think health care workers are tested often for the Coronavirus? Think again. | PSNet

psnet.ahrq.gov/issue/think-health-care-workers-are-tested-often-coronavirus-think-again

July 29, 2020 - volume, and availability of health care workers to provide care during the pandemic should clinicians test … 2021 The psychological and mental impact of coronavirus disease 2019 (COVID-19) on medical … May 27, 2020 People with disabilities fear pandemic will worsen medical biases.

Patient Suicide on a Locked Mental Health Unit at the West Palm Beach VA Medical Center, Florida. | PSNet

psnet.ahrq.gov/issue/patient-suicide-locked-mental-health-unit-west-palm-beach-va-medical-center-florida

January 24, 2024 - Report Patient Suicide on a Locked Mental Health Unit at the West Palm Beach VA Medical … Citation Text: Patient Suicide on a Locked Mental Health Unit at the West Palm Beach VA Medical Center … 2024 Deficiencies in Quality Management Processes and Delays in the Communication of Test … March 1, 2023 Quality of Care Concerns and the Facility Response Following a Medical … Unexpected Death of a Patient During Treatment With Multiple Medications, Tomah VA Medical

Misplaced Nasogastric Tube Resulting in Aspiration | PSNet

psnet.ahrq.gov/web-mm/misplaced-nasogastric-tube-resulting-aspiration

August 01, 2009 - level in the lung is 0.08 mg/dl versus 1.28 mg/dl in the stomach. 1 However, this approach requires a test … Development of a reliable and valid bedside test for bilirubin and its utility for improving prediction … Closed Loop Communication Training in Medical Simulation. In: StatPearls . … Automated critical test result notification system: architecture, design, and assessment of provider … Changes in medical errors after implementation of a handoff program.

Disclosure of Adverse Events to Patients. | PSNet

psnet.ahrq.gov/issue/disclosure-adverse-events-patients

November 29, 2023 - This Veterans Health Administration (VHA) directive provides direction for disclosing medical mistakes … Author(s) Deficiencies in Quality Management Processes and Delays in the Communication of Test … DeBakey VA Medical Center in Houston, Texas. … Haley VA Medical Center, Tampa, Florida. … Johnson VA Medical Center in Clarksburg, West Virginia.

The Risks of Absent Interoperability: Medication-Induced Hemolysis in a Patient With a Known Allergy | PSNet

psnet.ahrq.gov/web-mm/risks-absent-interoperability-medication-induced-hemolysis-patient-known-allergy

April 08, 2019 - record system is no substitute for good medical practice. … Test Procedure for ?170.314 (a)(2) Drug-drug, drug-allergy interaction checks. … Test Procedure for ?170.314(a)(1) Computerized provider order entry. … Test Procedure for ? … 7 Smoking status 8 Problems 9 Medications 10 Medication allergies 11 Laboratory test

Care Deficiencies and Leaders' Inadequate Reviews of a Patient Who Died at the Lt. Col. Luke Weathers, Jr. VA Medical Center in Memphis, Tennessee. | PSNet

psnet.ahrq.gov/issue/care-deficiencies-and-leaders-inadequate-reviews-patient-who-died-lt-col-luke-weathers-jr-va

April 10, 2024 - VA Medical Center in Memphis, Tennessee. … VA Medical Center in Memphis, Tennessee. … VA Medical Center in Memphis, Tennessee. … Haley VA Medical Center, Tampa, Florida. … 2023 Deficiencies in Quality Management Processes and Delays in the Communication of Test

Deficient Care of a Patient Who Died by Suicide and Facility Leaders' Response at the Charlie Norwood VA Medical Center in Augusta, Georgia. | PSNet

psnet.ahrq.gov/issue/deficient-care-patient-who-died-suicide-and-facility-leaders-response-charlie-norwood-va

November 29, 2023 - Deficient Care of a Patient Who Died by Suicide and Facility Leaders' Response at the Charlie Norwood VA Medical … Author(s) Deficiencies in Quality Management Processes and Delays in the Communication of Test … Haley VA Medical Center, Tampa, Florida. … Roudebush VA Medical Center in Indianapolis, Indiana. … Roudebush VA Medical Center in Indianapolis, Indiana.

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