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41. Microsoft PowerPoint - FINAL Feb 2021 Spotlight_Delay in Appropriate DX.pptx - Read-Only (pdf file)
    psnet.ahrq.gov/sites/default/files/2021-02/final_feb_2021_spotlight_delay_in_appropriate_dx.pdf
    January 01, 2021 - surgery are both associated with increased risk of pulmonary embolism • Compare and contrast different … surgery, a computed tomography (CT) angiogram of the chest was obtained to rule out a pulmonary embolism … surgeries, repair of Achilles tendon rupture was associated with the highest incidence of VTE, although … Case Reports in Orthopedics. 2013;2013(3):1-3. doi:10.1155/2013/401968. 5. … Deep Vein Thrombosis and Pulmonary Embolism Considerations in Orthopedic Surgery.

42. Detection and measurement of rotator cuff tears with sonography: analysis of diagnostic errors. | PSNet
    psnet.ahrq.gov/issue/detection-and-measurement-rotator-cuff-tears-sonography-analysis-diagnostic-errors
    December 31, 2014 - November 26, 2014 Diagnostic errors in orthopedic surgery: evaluation of resident documentation … of neurovascular examinations for orthopedic trauma patients. … , 2011 View More See More About The Topic Physicians Radiology Orthopedic … Surgery Diagnostic Errors Epidemiology of Errors and Adverse Events

43. Microsoft PowerPoint - FINAL SLIDES Sept_Spotlight Case_When the Lytes Go Out_SLIDES_08.25.2020-revised.pptx (pdf file)
    psnet.ahrq.gov/sites/default/files/2020-09/final_slides_sept_spotlight_case_when_the_lytes_go_out_slides_08.25.2020-revised.pdf
    January 01, 2020 - acidosis, and hyperglycemia) • Patient was admitted to the General Medicine service with a consult from Orthopedics … primary responsibility for a patient • In this case, it was unclear whether an Internal Medicine or Orthopedics … responsibility • Need to identify barriers to carrying out the Internal Medicine team’s intent • Orthopedic … surgery residents may not typically manage patients with medically complex issues; in this case, the … patient may have been better served on an internal medicine team with an orthopedics consult to streamline

44. Trial and error: learning from malpractice claims in childhood surgery. | PSNet
    psnet.ahrq.gov/issue/trial-and-error-learning-malpractice-claims-childhood-surgery
    March 09, 2022 - claims database, researchers found that a wide range of pediatric surgical specialties – including orthopedics … Operating Room Children's Hospitals Risk Managers Quality and Safety Professionals Orthopedic … Surgery View More

45. Psn-Pdf (pdf file)
    psnet.ahrq.gov/node/49860/psn-pdf
    April 01, 2019 - The patient was admitted to the orthopedic surgery service to fix the fracture; the surgery was initially … All team members involved in the patient's care (internal medicine and/or geriatrics, orthopedics, emergency … comanagement service with either geriatrics or medicine in which both the medicine/geriatrics and orthopedics … Comanagement with either medicine or geriatrics and orthopedics reduces medical complications and improves … Outcomes for older patients with hip fractures: the impact of orthopedic and geriatric medicine cocare

46. Patient safety: it takes a team. | PSNet
    psnet.ahrq.gov/issue/patient-safety-it-takes-team
    April 08, 2020 - December 24, 2014 Patient safety in orthopedic surgery: prioritizing key areas of iatrogenic … More See More About The Topic Outpatient Surgery Operating Room Patients Orthopedic … Surgery Surgical Complications View More

47. Delay in Malignancy Diagnosis Reflects Systemic Failures | PSNet
    psnet.ahrq.gov/web-mm/delay-malignancy-diagnosis-reflects-systemic-failures
    September 25, 2019 - Five days later, the bone pathologist responsible for the case contacted the orthopedic surgery service … surgery service or inform his colleagues about the status of the case or his concern for neoplasm. … the orthopedic surgery service contacted a supervising surgical pathologist, requesting a final diagnosis … surgery team that the patient’s fracture was secondary to osteosarcoma. … surgery team was longer than ideal.

48. Psn-Pdf (pdf file)
    psnet.ahrq.gov/node/37944/psn-pdf
    April 11, 2011 - Identification of adverse events at an orthopedics department in Sweden. … Identification of adverse events at an orthopedics department in Sweden. … https://psnet.ahrq.gov/issue/identification-adverse-events-orthopedics-department-sweden This study … methods of error detection to determine the incidence of adverse events in patients discharged from an orthopedics … https://psnet.ahrq.gov/issue/identification-adverse-events-orthopedics-department-sweden

49. Deficiencies in electronic medical record inpatient list capabilities negatively impact patient safety, resident education, and wellness. | PSNet
    psnet.ahrq.gov/issue/deficiencies-electronic-medical-record-inpatient-list-capabilities-negatively-impact-patient
    October 19, 2022 - Following a change in EHR vendors, residents in 1 orthopedics department were no longer able to automate … October 1, 2009 View More See More About The Topic Hospitals Orthopedic … Surgery Residents and Fellows Electronic Health Records

50. Psn-Pdf (pdf file)
    psnet.ahrq.gov/node/37469/psn-pdf
    January 16, 2008 - Towards the reduction of medication errors in orthopedics and spinal surgery: outcomes using a pharmacist-led … Towards the reduction of medication errors in orthopedics and spinal surgery: outcomes using a pharmacist-led … https://psnet.ahrq.gov/issue/towards-reduction-medication-errors-orthopedics-and-spinal-surgery- outcomes-using-pharmacist … https://psnet.ahrq.gov/issue/towards-reduction-medication-errors-orthopedics-and-spinal-surgery-outcomes-using-pharmacist … https://psnet.ahrq.gov/issue/towards-reduction-medication-errors-orthopedics-and-spinal-surgery-outcomes-using-pharmacist

51. Sustained improvement in quality of patient handoffs after orthopaedic surgery I-PASS intervention. | PSNet
    psnet.ahrq.gov/issue/sustained-improvement-quality-patient-handoffs-after-orthopaedic-surgery-i-pass-intervention
    June 15, 2022 - In this study, researchers modified the I-PASS tool for use in orthopedic surgery and assessed the impact … See More About The Topic Hospitals Operating Room Quality and Safety Professionals Orthopedic … Surgery Discontinuities, Gaps, and Hand-Off Problems View More

52. Medical errors in orthopaedics. Results of an AAOS member survey. | PSNet
    psnet.ahrq.gov/issue/medical-errors-orthopaedics-results-aaos-member-survey
    August 04, 2021 - The majority of practicing orthopedic surgeons in this study had witnessed a medical error within the … More About The Topic Operating Room Risk Managers Quality and Safety Professionals Orthopedic … Surgery Medication Errors/Preventable Adverse Drug Events View More

53. Does seasonal variation in orthopaedic trauma volume correlate with adverse hospital events and burnout? | PSNet
    psnet.ahrq.gov/issue/does-seasonal-variation-orthopaedic-trauma-volume-correlate-adverse-hospital-events-and
    May 25, 2022 - This study explored seasonal variation in workload in an orthopedic trauma service at one Level 1 trauma … View More See More About The Topic Residents Operating Room Educators Orthopedic … Surgery Fatigue and Sleep Deprivation View More

54. Clinical pathway adherence and missed diagnostic opportunities among children with musculoskeletal infections. | PSNet
    psnet.ahrq.gov/issue/clinical-pathway-adherence-and-missed-diagnostic-opportunities-among-children-musculoskeletal
    November 08, 2023 - Misinterpretation of laboratory results was a critical contributor to MDO by both pediatric emergency providers and orthopedic … The Topic Emergency Departments Emergency Medicine Pathology and Laboratory Medicine Orthopedic … Surgery Diagnostic Test Interpretation Error View More

55. Psn-Pdf (pdf file)
    psnet.ahrq.gov/node/36793/psn-pdf
    August 26, 2011 - Patient safety in Taiwan: a survey on orthopedic surgeons. … Patient safety in Taiwan: a survey on orthopedic surgeons. J Formos Med Assoc. 2007;106(3):212-6. … https://psnet.ahrq.gov/issue/patient-safety-taiwan-survey-orthopedic-surgeons The researchers surveyed … Taiwanese orthopedic surgeons and found that a national campaign encouraging surgeons to mark the incision … https://psnet.ahrq.gov/issue/patient-safety-taiwan-survey-orthopedic-surgeons

56. Identifying resilience: a system safety review of trauma and orthopaedic theatres. | PSNet
    psnet.ahrq.gov/issue/identifying-resilience-system-safety-review-trauma-and-orthopaedic-theatres
    October 19, 2011 - QI handbook) to explore how work-as-done and system resilience prevent never events in trauma and orthopedic … surgery in the UK. … View More See More About The Topic Hospitals Operating Room Surgery Orthopedic … Surgery Surgical Complications View More

57. Psn-Pdf (pdf file)
    psnet.ahrq.gov/node/73873/psn-pdf
    September 29, 2021 - In August 2017, the Department of Orthopedic Surgery at Cedars Sinai Medical Center launched a web- … based, real-time complication reporting platform to encourage incident reporting among orthopedic residents

58. Psn-Pdf (pdf file)
    psnet.ahrq.gov/node/60952/psn-pdf
    September 30, 2020 - general medicine ward and managed with antibiotics, subcutaneous insulin, and intravenous fluids and the orthopedic … First, it was not clearly stated in this Case whether an Internal Medicine team or an Orthopedics team … It would be unlikely that the orthopedics team would be managing the DKA, so it would be important to … In academic settings, orthopedic surgery residents may primarily manage many patients that do not have … complex issues; however, this patient would be better served on an internal medicine team with the orthopedics

59. Round-Trip Service | PSNet
    psnet.ahrq.gov/web-mm/round-trip-service
    April 26, 2023 - He was referred by his primary care provider to an orthopedic surgeon who recommended a total knee replacement … He contacted the US-based orthopedic surgeon who originally saw him, explained the circumstances, and … March 24, 2016 Patient safety in orthopedic surgery: prioritizing key areas of iatrogenic … See More About The Topic Operating Room Health Care Providers Risk Managers Orthopedic … Surgery Discontinuities, Gaps, and Hand-Off Problems View More

60. Delay in Appropriate Diagnosis and Treatment Leading to Death from Pulmonary Embolism | PSNet
    psnet.ahrq.gov/web-mm/delay-appropriate-diagnosis-and-treatment-leading-death-pulmonary-embolism
    December 31, 2024 - surgery. … surgeries, repair of Achilles tendon rupture was associated with the highest incidence of VTE, although … surgery. … Case Reports in Orthopedics . 2013;2013(3):1-3. doi:10.1155/2013/401968. … Deep Vein Thrombosis and Pulmonary Embolism Considerations in Orthopedic Surgery.