-
psnet.ahrq.gov/node/34716/psn-pdf
February 18, 2011 - He describes the emotional toll
of these mistakes and the difficulty processing them given the lack
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psnet.ahrq.gov/node/49812/psn-pdf
November 01, 2017 - the biopsy specimen could not be directed to the appropriate area in the
pathology laboratory for processing … However,
handoffs and ownership of various tasks related to the processing of laboratory specimens are … vignette, specimens are held for a
standard period of time if they contain inadequate information for processing … Specimen ordering and processing involves numerous handoffs and complex steps.
-
psnet.ahrq.gov/node/843079/psn-pdf
January 25, 2023 - The majority of issues were a related to providers’ cognitive processing, revealing an
important area
-
psnet.ahrq.gov/node/60621/psn-pdf
June 24, 2020 - practices, increased compliance to device guidance, increased efficiency
with the use of central sterile processing
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psnet.ahrq.gov/node/33645/psn-pdf
February 01, 2007 - Metacognition
The alternative approach is to educate physicians about subconscious processing and the … argument is that if physicians were more aware of the inherent
biases that can creep into subconscious processing … monitoring, (ii) generic skills would focus on each of the
heuristics known to affect subconscious processing … Learn how diagnoses emerge from subconscious processing and the inherent biases that can lead
to errors … Stress, fatigue, distractions,
affective factors, and the inherent
shortcomings of automatic
processing
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psnet.ahrq.gov/node/49787/psn-pdf
March 01, 2017 - Clinicians make diagnostic
decisions using two kinds of mental processes: nonanalytic processing (also … called intuitive, or System 1
reasoning) and analytic processing (also called System 2 reasoning).( … Intuitive processing is a highly efficient, rapid method to cope with the
enormous complexity of clinical … Dual processing and diagnostic errors. Adv Health Sci Educ Theory Pract. 2009;14(suppl
1):37-49. … (e.g., NEJM series)
Flash card review to build clinical knowledge base
Raising awareness of dual processing
-
psnet.ahrq.gov/node/74728/psn-pdf
February 02, 2022 - RFID technology can improve process measures in
laboratory settings, such as order tracking, specimen processing
-
psnet.ahrq.gov/node/836722/psn-pdf
March 09, 2022 - perspective/emerging-safety-issues-artificial-intelligence
https://psnet.ahrq.gov/issue/natural-language-processing-and-its-implications-future-medication-safety-narrative-review
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psnet.ahrq.gov/node/73588/psn-pdf
August 11, 2021 - the FDA's Manufacturer and User Facility Device
Experience (MAUDE), this study used natural language processing
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psnet.ahrq.gov/node/836807/psn-pdf
March 30, 2022 - This hospital used an artificial intelligence natural language processing system to identify radiology
-
psnet.ahrq.gov/web-mm/specimen-almost-lost
September 21, 2022 - , the biopsy specimen could not be directed to the appropriate area in the pathology laboratory for processing … However, handoffs and ownership of various tasks related to the processing of laboratory specimens are … vignette, specimens are held for a standard period of time if they contain inadequate information for processing … Specimen ordering and processing involves numerous handoffs and complex steps.
-
psnet.ahrq.gov/node/867845/psn-pdf
February 26, 2025 - simple spreadsheet, a SQL Server to combine fields into one searchable field, or natural language
processing … text fields, reduces cost and technology needs by avoiding the use of coding or structured language
processing … conduct cross-tabulation to see results by failure modes
Software for spreadsheets, natural language processing
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psnet.ahrq.gov/node/33601/psn-pdf
December 15, 2024 - misidentification or incorrect interpretation of
patient data
Unclear current state of
user actions in order
processing … selection of
drop-down menu items—can promote errors, especially in medication
ordering
Efficiency
Processing … time, processing capacity, and resource consumption
Delays in system response Lack of system responsiveness
-
psnet.ahrq.gov/node/40922/psn-pdf
December 21, 2014 - This study used root cause analysis to identify latent factors that contributed to near misses in processing
-
psnet.ahrq.gov/node/45747/psn-pdf
December 21, 2016 - ://psnet.ahrq.gov/issue/speaking-reduce-noise-or
https://psnet.ahrq.gov/issue/effect-noise-auditory-processing-operating-room
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psnet.ahrq.gov/node/47464/psn-pdf
October 17, 2018 - This magazine article describes how pharmacists can
address failures associated with processing, dosing
-
psnet.ahrq.gov/node/44343/psn-pdf
July 22, 2015 - ://psnet.ahrq.gov/issue/speaking-reduce-noise-or
https://psnet.ahrq.gov/issue/effect-noise-auditory-processing-operating-room
-
psnet.ahrq.gov/node/842762/psn-pdf
January 18, 2023 - medical
error; the negative impact can be compounded when workers and patients are prevented from processing
-
psnet.ahrq.gov/node/842429/psn-pdf
January 11, 2023 - including 711 patients diagnosed with lung cancer used electronic health records and natural language
processing
-
psnet.ahrq.gov/node/33823/psn-pdf
January 01, 2017 - in the operating room (OR), musculoskeletal
injuries from lifting heavy instrument kits in Central Processing … We have launched Job Safety Behavioral Observation teams in four
areas (OR, Central Processing, Environmental … surgeon requires one or more of the other three kits, they will
be brought up to the OR from Central Processing … As a result of this process change, the OR and
Central Processing staff lifts 34 kg less per case, thereby