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psnet.ahrq.gov/node/33678/psn-pdf
January 01, 2009 - Part of my interest in the topic came
from experiences when I was a resident. … As a resident I saw that, even when a clear-cut error had
happened, thoughtful people could really struggle
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psnet.ahrq.gov/node/49861/psn-pdf
May 01, 2019 - The ICU resident provided the accepting medicine team
with signout but did not explicitly discuss the … The impact of a multi-specialty team for high risk pulmonary
embolism on resident and fellow education
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psnet.ahrq.gov/web-mm/radiology-missed-intracranial-bleed-lethargic-infant
August 21, 2016 - Given limited overnight staffing, the MRI images were preliminarily read by a radiology resident. … ultrafast brain MRI was ordered for “lethargy” and was preliminarily read as unremarkable by the radiology resident
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psnet.ahrq.gov/web-mm/medication-errors-retail-pharmacies-wrong-patient-wrong-instructions
March 19, 2019 - Cynthia Li, PharmD
PGY1 Pharmacy Resident
Department of Pharmacy Services
UC Davis Health … Katrina Marquez, PharmD
PGY1 Pharmacy Resident
Department of Pharmacy Services
UC Davis Health
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psnet.ahrq.gov/web-mm/getting-diagnosis-both-right-and-wrong
May 29, 2024 - one could imagine the medical team systematically engaging in a brief diagnostic time-out, led by the resident … October 31, 2023
Education for the next frontier in patient safety: a longitudinal resident
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psnet.ahrq.gov/web-mm/weighty-mistake
September 01, 2016 - The resident and attending physician diagnosed an uncomplicated periorbital cellulitis and prescribed … The mother, a medical student, realized the potential implications of such an error and asked the resident
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psnet.ahrq.gov/node/865656/psn-pdf
April 24, 2024 - However, he agreed to a physical examination by the resident physician and intermittently answered
questions … Catherine Mueller, PharmD, CPPS
Pharmacy Resident, Medication-Use Safety & Policy
Department of Pharmacy
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psnet.ahrq.gov/node/866526/psn-pdf
August 14, 2024 - Instruments and warning signs for identifying and
evaluating the frequency of adverse events in
intermediate and long-term care centres: a narrative
systematic review.
August 14, 2024
Malgrat-Caballero S, Kannukene A, Orrego C. Instruments and warning signs for identifying and evaluating
the frequency of adverse …
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psnet.ahrq.gov/node/40634/psn-pdf
September 20, 2011 - "July Effect": impact of the academic year-end
changeover on patient outcomes. A systematic review.
September 20, 2011
Young JQ, Ranji SR, Wachter R, et al. "July effect": impact of the academic year-end changeover on
patient outcomes: a systematic review. Ann Intern Med. 2011;155(5):309-15. doi:10.7326/0003-4819-1…
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psnet.ahrq.gov/node/44904/psn-pdf
June 01, 2016 - Does time pressure have a negative effect on diagnostic
accuracy?
June 1, 2016
ALQahtani DA, Rotgans JI, Mamede S, et al. Does Time Pressure Have a Negative Effect on Diagnostic
Accuracy? Acad Med. 2016;91(5):710-716. doi:10.1097/ACM.0000000000001098.
https://psnet.ahrq.gov/issue/does-time-pressure-have-negative-e…
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psnet.ahrq.gov/node/42123/psn-pdf
June 18, 2013 - On higher ground: ethical reasoning and its relationship
with error disclosure.
June 18, 2013
Cole AP, Block L, Wu AW. On higher ground: ethical reasoning and its relationship with error disclosure.
BMJ Qual Saf. 2013;22(7):580-585. doi:10.1136/bmjqs-2012-001496.
https://psnet.ahrq.gov/issue/higher-ground-ethical-…
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psnet.ahrq.gov/node/47500/psn-pdf
October 24, 2018 - Use of a novel, electronic health record–centered,
interprofessional ICU rounding simulation to understand
latent safety issues.
October 24, 2018
Bordley J, Sakata KK, Bierman J, et al. Use of a Novel, Electronic Health Record-Centered,
Interprofessional ICU Rounding Simulation to Understand Latent Safety Issues. …
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psnet.ahrq.gov/node/60183/psn-pdf
April 01, 2020 - Elder abuse and neglect: an overlooked patient safety
issue. A focus group study of nursing home leaders'
perceptions of elder abuse and neglect.
April 1, 2020
Myhre J, Saga S, Malmedal W, et al. Elder abuse and neglect: an overlooked patient safety issue. A focus
group study of nursing home leaders’ perceptions o…
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psnet.ahrq.gov/node/46010/psn-pdf
July 12, 2017 - Changing the medical malpractice system to align with
what we know about patient safety and quality
improvement.
July 12, 2017
Sklar DP. Changing the Medical Malpractice System to Align With What We Know About Patient Safety
and Quality Improvement. Acad Med. 2017;92(7):891-894. doi:10.1097/ACM.0000000000001733.
…
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psnet.ahrq.gov/node/36006/psn-pdf
November 15, 2011 - Disclosure of medical errors: what factors influence how
patients respond?
November 15, 2011
Mazor KM, Reed G, Yood RA, et al. Disclosure of medical errors: what factors influence how patients
respond? J Gen Intern Med. 2006;21(7):704-10.
https://psnet.ahrq.gov/issue/disclosure-medical-errors-what-factors-influenc…
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psnet.ahrq.gov/node/841775/psn-pdf
April 04, 2016 - Racial bias in pain assessment and treatment
recommendations, and false beliefs about biological
differences between blacks and whites.
April 4, 2016
Hoffman KM, Trawalter S, Axt JR, et al. Racial bias in pain assessment and treatment recommendations,
and false beliefs about biological differences between blacks a…
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psnet.ahrq.gov/issue/understanding-context-specificity-effect-contextual-factors-clinical-reasoning
August 19, 2020 - Study
Understanding context specificity: the effect of contextual factors on clinical reasoning.
Citation Text:
Konopasky A, Artino AR, Battista A, et al. Understanding context specificity: the effect of contextual factors on clinical reasoning. Diagnosis (Berl). 2020;79(3):257-264. doi:…
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psnet.ahrq.gov/issue/blueprint-restructuring-department-surgery-concert-health-care-system-during-pandemic
September 27, 2017 - Commentary
Blueprint for restructuring a department of surgery in concert with the health care system during a pandemic: the University of Wisconsin Experience.
Citation Text:
Zarzaur BL, Stahl CC, Greenberg JA, et al. Blueprint for restructuring a department of surgery in concert with t…
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psnet.ahrq.gov/issue/checklist-usage-decreases-critical-task-omissions-when-training-residents-separate-simulated
July 18, 2014 - Study
Checklist usage decreases critical task omissions when training residents to separate from simulated cardiopulmonary bypass.
Citation Text:
Petrik EW, Ho D, Elahi M, et al. Checklist usage decreases critical task omissions when training residents to separate from simulated cardiopu…
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psnet.ahrq.gov/issue/multidisciplinary-medication-review-nursing-home-residents-what-are-most-significant-drug
August 04, 2021 - Study
Multidisciplinary medication review in nursing home residents: what are the most significant drug-related problems? The Bergen District Nursing Home (BEDNURS) study.
Citation Text:
Ruths S, Straand J, Nygaard HA. Multidisciplinary medication review in nursing home residents: what…