Results

Total Results: 4,038 records

Showing results for "occurs".

101. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/49562/psn-pdf
     May 01, 2008 - procedure is not started if a member of the team has concerns.(2) In some institutions, the time out occurs … If the time out occurs at the time of incision, the surgeon is already scrubbed in, leaving only the … time out is for the team to collectively discuss the case, but, given the requirements to ensure it occurs … With regard to timing, it seems that the closer to actual incision time the time out occurs, the less

102. The safety of outpatient health care: review of electronic health records. | PSNet
     psnet.ahrq.gov/issue/safety-outpatient-health-care-review-electronic-health-records
     January 25, 2023 - Although most care occurs in outpatient settings, research into adverse events (AE) in this setting

103. The fallacy of a single diagnosis. | PSNet
     psnet.ahrq.gov/issue/fallacy-single-diagnosis
     October 05, 2022 - Premature closure occurs when clinicians accept a diagnosis before it has been confirmed and alternative

104. Race differences in reported harmful patient safety events in healthcare system high reliability organizations. | PSNet
     psnet.ahrq.gov/issue/race-differences-reported-harmful-patient-safety-events-healthcare-system-high-reliability
     March 01, 2023 - The authors raise the question of whether reporting bias by race occurs in patient safety reporting and

105. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/33588/psn-pdf
     March 15, 2025 - When a medical error or patient harm occurs, the first priority is to attend to the patient and family … errors and adverse events, along with support that can be put in place to respond when such involvement occurs

106. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/33561/psn-pdf
     September 15, 2024 - reducing-preventable-patient-harm-due-retained-surgical-items-rsi-bundle Patient death or serious injury associated with intravascular air embolism that occurs … serious injury of a patient or staff member resulting from a physical assault (i.e., battery) that occurs

107. Workplace training for senior trainees: a systematic review and narrative synthesis of current approaches to promote patient safety. | PSNet
     psnet.ahrq.gov/issue/workplace-training-senior-trainees-systematic-review-and-narrative-synthesis-current
     February 07, 2024 - patient safety skills during clinical rotations, because most learning for postgraduate medical training occurs

108. The effect of computerised decision support alerts tailored to intensive care on the administration of high-risk drug combinations, and their monitoring: a cluster randomised stepped-wedge trial. | PSNet
     psnet.ahrq.gov/issue/effect-computerised-decision-support-alerts-tailored-intensive-care-administration-high-risk
     October 18, 2023 - Alert fatigue occurs when clinical decision support systems (CDSS) produce numerous low-relevance alerts

109. Just culture: the foundation of staff safety in the perioperative environment. | PSNet
     psnet.ahrq.gov/issue/just-culture-foundation-staff-safety-perioperative-environment
     June 09, 2021 - A just culture balances organizational and individual accountability when a medical error occurs

110. Grading recommendations for enhanced patient safety in sentinel event analysis: the recommendation improvement matrix. | PSNet
     psnet.ahrq.gov/issue/grading-recommendations-enhanced-patient-safety-sentinel-event-analysis-recommendation
     April 15, 2020 - The RIM consists of two elements—whether the intervention occurs before or after the event and whether

111. The patients' perspective: hematological cancer patients' experiences of adverse events as part of care. | PSNet
     psnet.ahrq.gov/issue/patients-perspective-hematological-cancer-patients-experiences-adverse-events-part-care
     December 01, 2019 - When an error or adverse event occurs, patients and families want to be informed.

112. The threat within: mitigating the risk of medical error. | PSNet
     psnet.ahrq.gov/issue/threat-within-mitigating-risk-medical-error
     July 15, 2020 - Despite efforts to protect patients, harm still occurs during the course of medical care.

113. Potentially inappropriate medication use and healthcare expenditures in the US community-dwelling elderly. | PSNet
     psnet.ahrq.gov/issue/potentially-inappropriate-medication-use-and-healthcare-expenditures-us-community-dwelling
     April 08, 2020 - cohort of noninstitutionalized elderly and found that inappropriate medication use in this population occurs

114. Early diagnosis of cancer: systems approach to support clinicians in primary care. | PSNet
     psnet.ahrq.gov/issue/early-diagnosis-cancer-systems-approach-support-clinicians-primary-care
     December 14, 2022 - This commentary examines how cancer diagnosis delay in primary care occurs.

115. Disclosure-and-resolution programs that include generous compensation offers may prompt a complex patient response. | PSNet
     psnet.ahrq.gov/issue/disclosure-and-resolution-programs-include-generous-compensation-offers-may-prompt-complex
     November 20, 2024 - Some institutions have implemented disclosure-and-resolution programs whenever an error occurs, in which

116. Why do acute healthcare staff behave unprofessionally towards each other and how can these behaviours be reduced? A realist review. | PSNet
     psnet.ahrq.gov/issue/why-do-acute-healthcare-staff-behave-unprofessionally-towards-each-other-and-how-can-these
     July 24, 2024 - This narrative review characterized how, why, and under what circumstances unprofessional behavior occurs

117. Blind Spot | PSNet
     psnet.ahrq.gov/web-mm/blind-spot
     July 30, 2020 - Specific ophthalmologic findings determine the diagnosis.( 5 ) AION occurs at the optic nerve head as … PION occurs anywhere posterior to the optic nerve head to the optic nerve chiasm. … Figure 2 ) with their eyes free from external pressure.( 6 ) These data clearly demonstrate that ION occurs … Cortical blindness is usually associated with embolic events or profound hypotension and most commonly occurs

118. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/49581/psn-pdf
     March 21, 2009 - operationalized; however, the far-reaching effects of these decisions often go undetected until an error occurs … The error occurs when individuals fall victim to the flaws within the system and mistakes are made. … Standardize patient-centric handoff communication, and mandate that it occurs at the time of nursing

119. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/49628/psn-pdf
     June 01, 2011 - The most commonly cited preoperative risk is bleeding, which occurs in up to 3% of patients. … The highest risk of return to the operating room to control hemorrhage occurs one week postoperatively … The most common complication is postoperative bleeding, which occurs in less than 10% of patients.

120. Addressing the Loss of Trust in Safety Culture. | PSNet
     psnet.ahrq.gov/issue/addressing-loss-trust-safety-culture
     February 08, 2017 - needed to ensure that patients can trust the health care system to hold those accountable when error occurs