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Total Results: 1,785 records

Showing results for "problems".

261. Right Patient, Wrong Sample | PSNet
     psnet.ahrq.gov/web-mm/right-patient-wrong-sample
     June 01, 2004 - The Commentary Background Errors in laboratory services encompass a number of problems occurring outside … physicians often attribute to errors inside the laboratory, are actually the result of preanalytic problems … Analytic errors are problems during the manual or automated specimen analysis in the laboratory. … Classifying laboratory incident reports to identify problems that jeopardize patient safety. … Errors and patient outcomes associated with problems in stat chemistry testing.

262. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/847733/psn-pdf
     March 16, 2025 - This guidance shares evidence-based steps to address problems such as wrong patient errors and lack

263. Safety In Dentistry | PSNet
     psnet.ahrq.gov/perspective/safety-dentistry
     August 01, 2016 - Bernardo Perea-Pérez : There are several potentially significant problems in dentistry. … First, there are problems with the methods of disinfection and sterilization of dental instruments, often … Maybe the fourth concern is problems related to drug interactions, especially in elderly people. … On the other hand, the main problems are dangers to the privacy of health data and the possibility that … The patient safety field in general has focused on systems that have problems rather than individual

264. University of California, Davis, Health CME/CEU Information | PSNet
     psnet.ahrq.gov/basic-page/ucd-cmeceu-trainee-certification
     November 01, 2019 - Registration How to Obtain CME/CEU How to Obtain MOC Trainee Certification Accreditation Problems … Problems, Questions?

265. Primers | PSNet
     psnet.ahrq.gov/primers-0
     March 15, 2025 - Diagnostic Test Interpretation Error (1) Discontinuities, Gaps, and Hand-Off Problems … reporting systems are ubiquitous in hospitals and are a mainstay of efforts to detect safety and quality problems … may highlight specific safety concerns, they do not provide insights into the epidemiology of safety problems

266. Accreditation and Regulation: Can They Help Improve Patient Safety? | PSNet
     psnet.ahrq.gov/perspective/accreditation-and-regulation-can-they-help-improve-patient-safety
     April 01, 2009 - Prescriptive solutions therefore work best for less complex problems where one-size-fits-all solutions … RW: On one hand, there is tremendous pressure to fix the problems of medical errors and poor quality … One of the problems is that all of the organizations have to agree on exactly the same way to manage … What we hear in the field is no longer, "There are problems, but they're not in my place." … Organizations know they have quality problems.

267. The Other Side | PSNet
     psnet.ahrq.gov/web-mm/other-side
     May 01, 2007 - almost certainly much higher than the rates quoted.( 4,5 ) Analyses of wrong site surgery suggest that problems … surgeon to identify the site, and poor communication within the operative team are the most immediate problems … The guidelines systematically address each point where problems can occur.( 7,8 ) More detailed information … In the present case, as far as one can tell, no problems occurred in the routine biopsy, labeling, and … August 13, 2013 Patient reports of preventable problems and harms in primary health care

268. Managing Complexity in Diagnosis: Life-threatening Complications after Gastric Bypass Surgery. | PSNet
     psnet.ahrq.gov/web-mm/managing-complexity-diagnosis-life-threatening-complications-after-gastric-bypass-surgery
     September 25, 2019 - Complex problems, in contrast, cannot be solved by following a series of predetermined or knowable steps … Diagnostic reasoning cannot be reduced to an equation to be solved, especially when considering new problems … We often consider side effects of treatments, but it can be very challenging when completely new problems … In this case, the patient developed new problems superimposed on old ones throughout the case, adding … Recognition of this sign could have helped steer the diagnosis toward neurological problems arising from

269. Postdischarge Follow-Up Phone Call | PSNet
     psnet.ahrq.gov/web-mm/postdischarge-follow-phone-call
     May 19, 2021 - These calls aim to identify and resolve postdischarge issues such as problems understanding discharge … instructions, problems obtaining outpatient appointments, problems filling prescriptions, issues relating … discovered she was unable to get the expected follow up in the gastrointestinal clinic due to insurance problems … Telephone follow-up, initiated by a hospital-based health professional, for postdischarge problems in

270. Airway Obstruction during Anterior Cervical Spine Surgery | PSNet
     psnet.ahrq.gov/web-mm/airway-obstruction-during-anterior-cervical-spine-surgery
     January 29, 2021 - drugs should be avoided when monitoring motor potentials, although avoiding these drugs can lead to problems … Anesthesia clinicians need to review algorithms for troubleshooting problems with ventilation frequently … clinicians therefore need to regularly review and practice their algorithms for solving ventilation problems … Some crises occur infrequently, and checklists are particularly helpful when dealing with uncommon problems … Coexisting health problems need to be identified and treated Obese patients like the patient in this

271. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/855425/psn-pdf
     January 01, 2024 - hospitalisation-medication-misadventures-among-older-adults-and-without-dementia-5-year https://psnet.ahrq.gov/issue/drug-related-problems-among-older-people-dementia-systematic-review

272. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/60990/psn-pdf
     October 07, 2020 - The tiered huddle structure uses six tiers to share information and address problems at all levels of

273. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/865872/psn-pdf
     May 15, 2024 - association of psychological safety and joint-problem- solving orientation (JPS; e.g., addressing problems

274. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/33569/psn-pdf
     June 15, 2024 - Systematic problems in care transitions are at the root of most adverse events that arise after discharge … families) must understand their diagnosis, their follow-up needs, and whom to contact with questions or problems

275. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/33568/psn-pdf
     June 15, 2024 - A central tenet of RCA is to identify underlying problems that increase the likelihood of errors while … errors occurring at the interface between humans and a complex system) and latent errors (the hidden problems

276. The Different Count Contributions to Retention (pdf file)
     psnet.ahrq.gov/sites/default/files/2024-10/The%20Different%20Count%20Contributions%20to%20Retention.pdf
     January 01, 2024 - NoThing Left Behind® tenet is that Retained Surgical Item (RSI) cases are surgical patient safety problems … and safety problems, in a simplistic view, are the result of failed practice and/or communication processes … It turns out that the predominate problem with retained sponge cases are practice problems NOT communication … problems.

277. PSNet Curated Library (pdf file)
     psnet.ahrq.gov/print/pdf/node/854855
     January 01, 2024 - Encouraging patients to speak up about problems in cancer care. … frequency-and-types-patient-reported-errors-electronic-health-record-ambulatory-care-notes https://psnet.ahrq.gov/issue/encouraging-patients-speak-about-problems-cancer-care … Encouraging patients to speak up about problems in cancer care. … towards-conceptualizing-patients-partners-health-systems-systematic-review-and-descriptive https://psnet.ahrq.gov/issue/encouraging-patients-speak-about-problems-cancer-care

278. Swiss Cheese Model | PSNet
     psnet.ahrq.gov/taxonomy/term/3460
     April 10, 2025 - In fact, many of the systems problems discussed by Reason and others—poorly designed work schedules,

279. Transition Coaches® Reduce Readmissions for Medicare Patients With Complex Postdischarge Needs | PSNet
     psnet.ahrq.gov/innovation/transition-coachesr-reduce-readmissions-medicare-patients-complex-postdischarge-needs
     March 27, 2024 - Many of these problems are the result of a failure to understand and manage postdischarge care needs, … difficulty in accessing providers for their followup needs because of transportation issues and other problems … inadequate followup care make patients vulnerable to medication errors, exacerbations of symptoms, and other problems … The coach does not provide skilled care or fix problems.  … A Medication Discrepancy Tool is used to identify medication problems and errors and facilitate appropriate

280. In Conversation With… Tejal K. Gandhi, MD, MPH | PSNet
     psnet.ahrq.gov/perspective/conversation-tejal-k-gandhi-md-mph
     February 26, 2025 - RW : Are there areas in which it creates new problems or challenges for the field or for NPSF specifically … who understands patient safety and can be in the trenches doing continuous improvement, identifying problems … , reporting problems, and even working to fix problems. … difficult for that local person to solve it, you need some of these specialists who can do the more complex problems