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7621. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49548/psn-pdf
      October 01, 2007 - Thyrotoxicosis or thyroid storm may be precipitated by a number of clinical stressors including surgery

7622. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/33868/psn-pdf
      October 01, 2018 - studied safety in other health care settings such as intensive care units, emergency departments, surgery

7623. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49428/psn-pdf
      January 01, 2004 - Pronovost, MD, PhD Associate Professor, Anesthesiology and Critical Care Medicine, Surgery and Public

7624. National Patient Safety Goals | PSNet
      psnet.ahrq.gov/primer/national-patient-safety-goals
      January 16, 2025 - implemented by marking the accurate surgical site prior to the procedure and taking a pause before surgery

7625. Accountability in Patient Safety | PSNet
      psnet.ahrq.gov/perspective/accountability-patient-safety
      January 01, 2018 - Perspective The Evolution of Patient Safety in Surgery

7626. The Soil, Not the Seed: The Real Problem with Root Cause Analysis | PSNet
      psnet.ahrq.gov/perspective/soil-not-seed-real-problem-root-cause-analysis
      March 01, 2007 - known to be allergic to latex had an anaphylactic reaction to a Penrose (latex) drain inserted during surgery

7627. A Lot of Pain (Medications) | PSNet
      psnet.ahrq.gov/web-mm/lot-pain-medications
      September 23, 2020 - We are told that the patient in this case experienced a "worsening" of his pain after his surgery, but

7628. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49505/psn-pdf
      March 01, 2006 - privileges.(1) In this circumstance, such a check would have shown a surgeon still holding his vascular surgery

7629. In Conversation With... Ann Gaffey, RN, MSN, CPHRM and Bruce Spurlock, MD | PSNet
      psnet.ahrq.gov/perspective/conversation-ann-gaffey-rn-msn-cphrm-and-bruce-spurlock-md
      March 30, 2020 - For example, do we need to still look at wrong site surgery?

7630. In Conversation with…Christopher P. Landrigan, MD | PSNet
      psnet.ahrq.gov/perspective/conversation-withchristopher-p-landrigan-md
      April 01, 2005 - on preventing falls in nursing homes, or a physician interested in strategies to prevent wrong-site surgery

7631. Where Does Risk-Adjusted Mortality Fit Into a Safety Measurement Program? | PSNet
      psnet.ahrq.gov/perspective/where-does-risk-adjusted-mortality-fit-safety-measurement-program
      March 01, 2015 - In 1998, I was invited to be a part of the Bristol Royal Infirmary inquiry into children's heart surgery … I note in your recent Lancet article you said the families of the children who underwent cardiac surgery

7632. Intubation Mishap | PSNet
      psnet.ahrq.gov/web-mm/intubation-mishap
      April 26, 2023 - In anesthesia, surgery, or critical care, adequate "mental models" of the patient and the associated … , 2017 Understanding patient and clinician reported nonroutine events in ambulatory surgery

7633. Complications of ECMO During Transport | PSNet
      psnet.ahrq.gov/web-mm/complications-ecmo-during-transport
      January 27, 2021 - also be used to bridge to lung or heart transplant, or for short-term support during advanced airway surgery … WebM&M Cases Missed Connection: A Case of Inadequate ECG Oversight in Cardiac Surgery

7634. Multiple Levels Involved in Prescribing the Wrong Medication | PSNet
      psnet.ahrq.gov/web-mm/multiple-levels-involved-prescribing-wrong-medication
      December 23, 2020 - The Case A 65-year-old woman complained of some ongoing nausea two weeks after hernia repair surgery. … The surgery itself had not been complicated and on her postoperative visit, her physical examination

7635. In Conversation with Carole Stockmeier about Zero Harm: Striving to Reduce Preventable Harms – Point, Counterpoint, and Areas of Agreement | PSNet
      psnet.ahrq.gov/perspective/conversation-carole-stockmeier-about-zero-harm-striving-reduce-preventable-harms-point
      September 24, 2024 - significant downside to pursuing zero harm, argues surgeon Thomas Aloia when considering zero harm goals in surgery … contribute to the high rates of burnout that correspond temporally with an increased emphasis on safety in surgery

7636. In Conversation with...James P. Bagian, MD | PSNet
      psnet.ahrq.gov/perspective/conversation-withjames-p-bagian-md
      September 01, 2006 - increasing disclosure of adverse events; root cause analyses; and programs for preventing falls, wrong-site surgery … Application of the aviation black box principle in pediatric cardiac surgery: tracking all failures in

7637. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/853774/psn-pdf
      September 27, 2023 - Utter, MD, MSc Consulting Editor, AHRQ’s Patient Safety Network (PSNet) Professor Department of Surgery … Division of Trauma, Acute Care Surgery, and Surgical Critical Care UC Davis Health ghutter@ucdavis.edu

7638. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/60721/psn-pdf
      July 21, 2020 - The same is true for certain conditions that are being followed from either surgery or medical specialties … https://www.telehealthresourcecenter.org/ https://www.telehealthresourcecenter.org/ Department of Surgery

7639. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/848124/psn-pdf
      April 26, 2023 - For example, as an anesthesiologist, during surgery, even if the patient’s blood pressure had gone down … because they’re intensely focused on performing the surgery.

7640. Organizational Change in the Face of Highly Public Errors—II. The Duke Experience | PSNet
      psnet.ahrq.gov/perspective/organizational-change-face-highly-public-errors-ii-duke-experience
      July 20, 2010 - Health Care Providers Health Care Executives and Administrators Organizational Behaviorists Surgery