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Showing results for "occurring".

  1. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/45190/psn-pdf
    February 15, 2017 - Biases in detection of apparent "weekend effect" on outcome with administrative coding data: population based study of stroke. February 15, 2017 Li L, Rothwell PM, Study OV. Biases in detection of apparent "weekend effect" on outcome with administrative coding data: population based study of stroke. BMJ. 2016;353:…

  2. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/42577/psn-pdf
    December 31, 2014 - Estimating the information gap between emergency department records of community medication compared to on-line access to the community-based pharmacy records. December 31, 2014 Tamblyn R, Poissant L, Huang A, et al. Estimating the information gap between emergency department records of community medication compa…

  3. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/39822/psn-pdf
    February 17, 2011 - The disclosure dilemma—large-scale adverse events. February 17, 2011 Dudzinski DM, Hébert PC, Foglia MB, et al. The disclosure dilemma--large-scale adverse events. New Engl J Med. 2010;363(10):978-986. doi:10.1056/NEJMhle1003134. https://psnet.ahrq.gov/issue/disclosure-dilemma-large-scale-adverse-events Error disc…

  4. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/39404/psn-pdf
    March 31, 2010 - Incidence and root cause analysis of wrong-site pain management procedures: a multicenter study. March 31, 2010 Cohen SP, Hayek SM, Datta S, et al. Incidence and root cause analysis of wrong-site pain management procedures: a multicenter study. Anesthesiology. 2010;112(3):711-8. doi:10.1097/ALN.0b013e3181cf892d. h…

  5. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/45814/psn-pdf
    March 22, 2017 - Emergency medical services responders' perceptions of the effect of stress and anxiety on patient safety in the out-of-hospital emergency care of children: a qualitative study. March 22, 2017 Guise J-M, Hansen M, O'Brien K, et al. Emergency medical services responders' perceptions of the effect of stress and anxi…

  6. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/37462/psn-pdf
    January 06, 2017 - Medication errors associated with code situations in U.S. hospitals: direct and collateral damage. January 6, 2017 Lipshutz AKM, Morlock LL, Shore AD, et al. Medication Errors Associated with Code Situations in U.S. Hospitals: Direct and Collateral Damage. Jt Comm J Qual Patient Saf. 2016;34(1):46-56. doi:10.1016/…

  7. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/42693/psn-pdf
    December 23, 2016 - Preventing unintended retained foreign objects. December 23, 2016 Preventing unintended retained foreign objects. Sentinel event alert. 2013;(51):1-5. https://psnet.ahrq.gov/issue/preventing-unintended-retained-foreign-objects Sentinel event alerts are issued periodically by The Joint Commission to identify common …

  8. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/42103/psn-pdf
    January 07, 2015 - Indication-based prescribing prevents wrong-patient medication errors in computerized provider order entry (CPOE). January 7, 2015 Galanter W, Falck S, Burns M, et al. Indication-based prescribing prevents wrong-patient medication errors in computerized provider order entry (CPOE). J Am Med Inform Assoc. 2013;20(3…

  9. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/46404/psn-pdf
    December 07, 2017 - Preventable and mitigable adverse events in cancer care: measuring risk and harm across the continuum. December 7, 2017 Lipitz-Snyderman A, Pfister D, Classen D, et al. Preventable and mitigable adverse events in cancer care: measuring risk and harm across the continuum. Cancer. 2017;123(23):4728-4736. doi:10.1002/…

  10. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/40726/psn-pdf
    July 03, 2014 - Automated identification of postoperative complications within an electronic medical record using natural language processing. July 3, 2014 Murff HJ, FitzHenry F, Matheny ME, et al. Automated identification of postoperative complications within an electronic medical record using natural language processing. JAMA. …

  11. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/37254/psn-pdf
    January 02, 2017 - Creating a fair and just culture: one institution's path toward organizational change. January 2, 2017 Connor M, Duncombe D, Barclay E, et al. Creating a fair and just culture: one institution's pat toward organizational change. Jt Comm J Qual Patient Saf. 2007;33(10):617-24. https://psnet.ahrq.gov/issue/creating-…

  12. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/42711/psn-pdf
    October 31, 2014 - Characterising the complexity of medication safety using a human factors approach: an observational study in two intensive care units. October 31, 2014 Carayon P, Wetterneck TB, Cartmill R, et al. Characterising the complexity of medication safety using a human factors approach: an observational study in two inten…

  13. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/46774/psn-pdf
    April 12, 2019 - Association between handover of anesthesia care and adverse postoperative outcomes among patients undergoing major surgery. April 12, 2019 Jones PM, Cherry RA, Allen BN, et al. Association Between Handover of Anesthesia Care and Adverse Postoperative Outcomes Among Patients Undergoing Major Surgery. JAMA. 2018;319…

  14. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/44831/psn-pdf
    January 27, 2016 - IHI Skilled Nursing Facility Trigger Tool for Measuring Adverse Events. January 27, 2016 Adler L, Moore J, Federico F. Cambridge, MA: Institute for Healthcare Improvement; November 2015. https://psnet.ahrq.gov/issue/ihi-skilled-nursing-facility-trigger-tool-measuring-adverse-events Prior research has shown that sa…

  15. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/45231/psn-pdf
    February 14, 2017 - 6-PACK programme to decrease fall injuries in acute hospitals: cluster randomised controlled trial. February 14, 2017 Barker AL, Morello RT, Wolfe R, et al. 6-PACK programme to decrease fall injuries in acute hospitals: cluster randomised controlled trial. BMJ. 2016;352:h6781. doi:10.1136/bmj.h6781. https://psnet.…

  16. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/37940/psn-pdf
    June 16, 2010 - Comparing patient-reported hospital adverse events with medical record review: do patients know something that hospitals do not? June 16, 2010 Weissman JS, Schneider EC, Weingart SN, et al. Comparing patient-reported hospital adverse events with medical record review: do patients know something that hospitals do n…

  17. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/47524/psn-pdf
    June 19, 2019 - Learning from patients' experiences related to diagnostic errors is essential for progress in patient safety. June 19, 2019 Giardina TD, Haskell H, Menon S, et al. Learning From Patients' Experiences Related To Diagnostic Errors Is Essential For Progress In Patient Safety. Health Aff (Millwood). 2018;37(11):1821-18…

  18. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/41568/psn-pdf
    April 05, 2013 - Preventable deaths due to problems in care in English acute hospitals: a retrospective case record review study. April 5, 2013 Hogan H, Healey F, Neale G, et al. Preventable deaths due to problems in care in English acute hospitals: a retrospective case record review study. BMJ Qual Saf. 2012;21(9):737-745. doi:10.…

  19. Critical Incident | Digital Healthcare Research

    digital.ahrq.gov/health-it-tools-and-resources/evaluation-resources/workflow-assessment-health-it-toolkit/all-workflow-tools/critical-incident
    January 01, 2023 - Critical Incident Description The critical incident method is utilized to identify a process, subprocess, or problem that can be fixed or enhanced. It can also be used to identify a source of a performance deficiency. The technique attempts to find information pertaining to organizational problems, an…

  20. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/73121/psn-pdf
    April 07, 2021 - The impact of introducing automated dispensing cabinets, barcode medication administration, and closed- loop electronic medication management systems on work processes and safety of controlled medications in hospitals: a systematic review. April 7, 2021 Zheng WY, Lichtner V, Van Dort BA, et al. The impact of intr…
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