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Showing results for "operations".

  1. Drawn curtains, muted alarms, and diverted attention lead to tragedy in the postanesthesia care unit. | PSNet

    psnet.ahrq.gov/issue/drawn-curtains-muted-alarms-and-diverted-attention-lead-tragedy-postanesthesia-care-unit
    June 10, 2018 - Newspaper/Magazine Article Drawn curtains, muted alarms, and diverted attention lead to tragedy in the postanesthesia care unit. Citation Text: Drawn curtains, muted alarms, and diverted attention lead to tragedy in the postanesthesia care unit. ISMP Medication Safety Alert! Acute Care E…

  2. Managing the Unexpected: Sustained Performance in a Complex World, Third Edition. | PSNet

    psnet.ahrq.gov/issue/managing-unexpected-sustained-performance-complex-world-3rd-edition
    November 04, 2015 - Book/Report Classic Managing the Unexpected: Sustained Performance in a Complex World, Third Edition. Citation Text: Managing the Unexpected: Sustained Performance in a Complex World, Third Edition. Weick KE, Sutcliffe KM. San Francisco, CA: Jossey-Bass; 2015. I…

  3. Leading change: why transformation efforts fail. | PSNet

    psnet.ahrq.gov/issue/leading-change-why-transformation-efforts-fail
    March 03, 2021 - Commentary Classic Leading change: why transformation efforts fail. Citation Text: Leading change: why transformation efforts fail. Kotter JP. Harvard Bus Rev  1995;73(2);59-67. Copy Citation Save Save to your library …

  4. Engineering a Learning Healthcare System: A Look at the Future: Workshop Summary. | PSNet

    psnet.ahrq.gov/issue/engineering-learning-healthcare-system-look-future-workshop-summary
    June 15, 2011 - Book/Report Engineering a Learning Healthcare System: A Look at the Future: Workshop Summary. Citation Text: Engineering a Learning Healthcare System: A Look at the Future: Workshop Summary. Grossmann C, Goolsby WA, Olsen L, McGinnis JM; Institute of Medicine and National Academy of …

  5. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. | PSNet

    psnet.ahrq.gov/issue/patient-safety-and-quality-evidence-based-handbook-nurses
    May 29, 2024 - Book/Report Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Citation Text: Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Hughes RG, ed. Rockville, MD: Agency for Healthcare Research and Quality; 2008. AHRQ Publication No. 08-0043.   Copy Ci…

  6. Patient safety in dermatology: a review of the literature. | PSNet

    psnet.ahrq.gov/issue/patient-safety-dermatology-review-literature
    May 25, 2022 - Review Patient safety in dermatology: a review of the literature. Citation Text: Cao LY, Taylor JS, Vidimos A. Patient safety in dermatology: a review of the literature. Dermatol Online J. 2010;16(1):3. Copy Citation Format: Google Scholar PubMed BibTeX EndNote X3 XML End…

  7. Using medical malpractice closed claims data to reduce surgical risk and improve patient safety. | PSNet

    psnet.ahrq.gov/issue/using-medical-malpractice-closed-claims-data-reduce-surgical-risk-and-improve-patient-safety
    December 01, 2010 - Commentary Using medical malpractice closed claims data to reduce surgical risk and improve patient safety. Citation Text: Manuel BM, Greenwald LM. Using medical malpractice closed claims data to reduce surgical risk and improve patient safety. Bull Am Coll Surg. 2007;92(3):27-30. Copy…

  8. Preventing communication errors in telephone medicine. | PSNet

    psnet.ahrq.gov/issue/preventing-communication-errors-telephone-medicine
    December 01, 2004 - Commentary Preventing communication errors in telephone medicine. Citation Text: Reisman AB, Brown KE. Preventing communication errors in telephone medicine. J Gen Intern Med. 2005;20(10):959-63. Copy Citation Format: Google Scholar PubMed BibTeX EndNote X3 XML EndNote 7 …

  9. A piece of my mind. I'm sorry. | PSNet

    psnet.ahrq.gov/issue/piece-my-mind-im-sorry
    November 22, 2017 - Commentary A piece of my mind. I'm sorry. Citation Text: Kahn JS. A PIECE OF MY MIND. I'm Sorry. JAMA. 2015;313(24):2427-8. doi:10.1001/jama.2014.6507. Copy Citation Format: DOI Google Scholar PubMed BibTeX EndNote X3 XML EndNote 7 XML Endnote tagged PubMedId RIS …

  10. Safe Practices for Better Healthcare: 2010 Update. | PSNet

    psnet.ahrq.gov/issue/safe-practices-better-healthcare-2010-update
    March 23, 2012 - Book/Report Safe Practices for Better Healthcare: 2010 Update. Citation Text: Safe Practices for Better Healthcare: 2010 Update. Washington, DC: National Quality Forum; 2010. Copy Citation Save Save to your library Print Download PDF Share …

  11. AHRQ Health Information Technology Division's 2017 Annual Report. | PSNet

    psnet.ahrq.gov/issue/ahrq-health-information-technology-divisions-2017-annual-report
    May 02, 2018 - Book/Report AHRQ Health Information Technology Division's 2017 Annual Report. Citation Text: AHRQ Health Information Technology Division's 2017 Annual Report. Rockville, MD: Agency for Healthcare Research and Quality; April 2018. AHRQ Publication No. 18-0028-EF. Copy Citation …

  12. 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 - Audiovisual Think health care workers are tested often for the Coronavirus? Think again. Citation Text: Think health care workers are tested often for the Coronavirus? Think again. Wamsley L. National Public Radio and WBUR. December 7, 2020. Copy Citation Save …

  13. Health literacy and patient safety events. | PSNet

    psnet.ahrq.gov/issue/health-literacy-and-patient-safety-events
    January 11, 2017 - Newspaper/Magazine Article Health literacy and patient safety events. Citation Text: Gardner LA. Health literacy and patient safety events. PA-PSRS Patient Saf Advis. 2016;13(2):58-65. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML EndNote 7 XML Endnote tagged P…

  14. ACOG Committee Opinion No. 447: patient safety in obstetrics and gynecology. | PSNet

    psnet.ahrq.gov/issue/acog-committee-opinion-no-447-patient-safety-obstetrics-and-gynecology
    July 19, 2017 - Commentary ACOG Committee Opinion No. 447: patient safety in obstetrics and gynecology. Citation Text: Improvement AC of O and GCC on PS and Q. ACOG Committee Opinion No. 447: Patient safety in obstetrics and gynecology. Obstet Gynecol. 2009;114(6):1424-7. doi:10.1097/AOG.0b013e3181c6f90…

  15. Hidden danger, obvious opportunity: error and risk in the management of cancer. | PSNet

    psnet.ahrq.gov/issue/hidden-danger-obvious-opportunity-error-and-risk-management-cancer
    June 07, 2018 - Commentary Hidden danger, obvious opportunity: error and risk in the management of cancer. Citation Text: Munro AJ. Hidden danger, obvious opportunity: error and risk in the management of cancer. Br J Radiol. 2007;80(960):955-66. Copy Citation Format: Google Scholar PubMe…

  16. Maternal and Infant Health Inequality: New Evidence from Linked Administrative Data. | PSNet

    psnet.ahrq.gov/issue/maternal-and-infant-health-inequality-new-evidence-linked-administrative-data
    August 23, 2017 - Book/Report Maternal and Infant Health Inequality: New Evidence from Linked Administrative Data. Citation Text: Maternal and Infant Health Inequality: New Evidence from Linked Administrative Data. Kennedy-Moulton K, Miller S, Persson P, et al. Cambridge, MA: National Bureau of Econo…

  17. Obstacles to research on the effects of interruptions in healthcare. | PSNet

    psnet.ahrq.gov/issue/obstacles-research-effects-interruptions-healthcare
    April 19, 2017 - Commentary Obstacles to research on the effects of interruptions in healthcare. Citation Text: Grundgeiger T, Dekker SWA, Sanderson P, et al. Obstacles to research on the effects of interruptions in healthcare. BMJ Qual Saf. 2016;25(6):392-5. doi:10.1136/bmjqs-2015-004083. Copy Citatio…

  18. Zebra in the intensive care unit: a metacognitive reflection on misdiagnosis. | PSNet

    psnet.ahrq.gov/issue/zebra-intensive-care-unit-metacognitive-reflection-misdiagnosis
    October 19, 2022 - Commentary Zebra in the intensive care unit: a metacognitive reflection on misdiagnosis. Citation Text: Gillon SA, Radford ST. Zebra in the intensive care unit: a metacognitive reflection on misdiagnosis. Crit Care Resusc. 2012;14(3):216-20. Copy Citation Format: Google Sch…

  19. A concept analysis of systems thinking. | PSNet

    psnet.ahrq.gov/issue/concept-analysis-systems-thinking
    August 20, 2018 - Review A concept analysis of systems thinking. Citation Text: Stalter AM, Phillips JM, Ruggiero JS, et al. A Concept Analysis of Systems Thinking. Nurs Forum. 2017;52(4):323-330. doi:10.1111/nuf.12196. Copy Citation Format: DOI Google Scholar PubMed BibTeX EndNote X3 XML En…

  20. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/836839/psn-pdf
    March 31, 2022 - Annual Perspective: Psychological Safety of Healthcare Staff March 31, 2022 Kingston MB, Dowell P, Mossburg SE, et al. Annual Perspective: Psychological Safety of Healthcare Staff. PSNet [internet]. 2022. https://psnet.ahrq.gov/perspective/annual-perspective-psychological-safety-healthcare-staff Introduction The…
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