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psnet.ahrq.gov/web-mm/timely-diagnosis-esophageal-perforation
September 27, 2023 - Utter, MD MSc
Professor of Surgery
Division of Trauma, Acute Care Surgery, and Surgical Critical
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psnet.ahrq.gov/issue/abbreviation-use-decreases-effective-clinical-communication-and-can-compromise-patient-safety
October 29, 2017 - Commentary
Abbreviation use decreases effective clinical communication and can compromise patient safety.
Citation Text:
Parry D, Odedra A, Fagbohun M, et al. Abbreviation use decreases effective clinical communication and can compromise patient safety. Br J Oral Maxillofac Surg. 2023;61…
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psnet.ahrq.gov/periodic-issue/periodic-issue-445
May 29, 2024 - Study
Surgeon and surgical trainee experiences after adverse patient events. … Women and racially minoritized surgical trainees reported more negative effects than men and white trainees
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psnet.ahrq.gov/perspective/handoffs-and-transitions
February 01, 2007 - highest risk patients during care transitions, a new study by Glance and colleagues examined major surgical … This retrospective cohort study of nearly 150,000 admissions captured within the National Surgical Quality
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psnet.ahrq.gov/web-mm/too-hot-comfort
May 19, 2015 - The compress was removed, and the physician called a surgical consultant for further evaluation. … The infant was treated with topical ointment; no surgical intervention was necessary.
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psnet.ahrq.gov/node/49625/psn-pdf
May 01, 2011 - During the
closure of the surgical incision, the surgery fellow drew 12 mL of 0.25% bupivacaine (a local … At the conclusion of the surgical procedure, the attending asked the fellow
to reverse the neuromuscular
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psnet.ahrq.gov/web-mm/over-not-so-easy
April 01, 2005 - Implementation science: a neglected opportunity to accelerate improvements in the safety and quality of surgical … December 18, 2017
Surgical checklist implementation project: the impact of variable WHO
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psnet.ahrq.gov/web-mm/air-side-caution
April 21, 2015 - Surgical safety checklists: a review. ANZ J Surg. 2014;84:148-154. [go to PubMed] 10. … Related Resources From the Same Author(s)
Simulation-based trial of surgical-crisis
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psnet.ahrq.gov/web-mm/saline-flush-leads-acute-paralysis-awake-patient-risks-improper-medication-labeling
February 01, 2019 - and Recovery
January 31, 2024
Use of technology to improve the adherence to surgical … May 31, 2023
Compliance with and barriers to implementing the surgical safety checklist
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psnet.ahrq.gov/node/33651/psn-pdf
June 01, 2007 - Diane Rydrych: Our system requires that all Minnesota hospitals and ambulatory surgical centers report … to a quarterly newsletter produced by the Minnesota Hospital
Association that keeps hospitals and surgical
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psnet.ahrq.gov/perspective/african-partnerships-patient-safety-lessons-learned
December 01, 2014 - Safe surgical care
9. Medication safety
10. … the CUSP approach around bloodstream infection and are trying to adapt that for work in preventing surgical … RW : It struck me as you were describing the challenges, you mentioned Atul Gawande for the surgical … there and speak with very deep professional credentials in an area leading the essential and emergency surgical
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psnet.ahrq.gov/web-mm/under-pressure-tracheostomy-cuff-over-inflation-leading-tissue-necrosis-and-cuff-rupture
March 15, 2023 - The patient subsequently underwent surgical repair of the tracheal injury. … This cycle led to the patient’s acute decompensation, and eventually to surgical repair of the iatrogenic … Tracheostomy a Surgical Guide .
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psnet.ahrq.gov/web-mm/hidden-heparins-hit-happens
March 27, 2024 - A recent meta-analysis including 7000 medical and surgical patients who received UFH or LMWH as thromboprophylaxis … has been demonstrated in other applications.( 18 )
Take-Home Points
HIT can occur in medical or surgical … March 27, 2024
Patient Safety Primers
Retained Surgical
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psnet.ahrq.gov/web-mm/what-happened-telemetry
January 18, 2012 - Health
October 6, 2021
Sustainability and long-term effectiveness of the WHO surgical … August 2, 2015
Realistic distractions and interruptions that impair simulated surgical … Hospitals
Health Care Providers
Health Care Executives and Administrators
Cardiology
Medical/Surgical
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psnet.ahrq.gov/web-mm/unseen-perils-urinary-catheters
January 31, 2024 - Insertion procedures are detailed in medical–surgical nursing textbooks and many videos can be found … Perioperative use in selected surgical procedures. … The burden of opioid-related adverse drug events on hospitalized previously opioid-free surgical
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psnet.ahrq.gov/web-mm/be-picky-about-your-piccs-fragmented-care-and-poor-communication-discharge-leads-picc
July 19, 2023 - February 15, 2023
The timing of surgical antimicrobial prophylaxis. … March 2, 2011
Surgical glove perforation and the risk of surgical site infection.
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psnet.ahrq.gov/sites/default/files/2022-04/final_spotlight_case_and_commentatry_io_line_extravasation-04.08.2022.pdf
January 01, 2022 - Signs of compartment
syndrome eventually resolved without any surgical intervention.
7
INTRAOSSEOUS … • In the present case, the patient was promptly transferred to the OR
for surgical exploration, debridement … compartment syndrome leading to early
diagnosis, abrupt discontinuation of the IO line, avoidance of
surgical
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psnet.ahrq.gov/node/60268/psn-pdf
April 29, 2020 - Initiating ECMO involves surgical procedures to
implant cannulae in the patient’s major blood vessels … The most common complications of ECMO are bleeding from cannulation sites
(15-20%) or surgical wounds … "Team time-out" and surgical safety-
experiences in 12,390 neurosurgical patients.
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psnet.ahrq.gov/node/867805/psn-pdf
February 26, 2025 - Those are particularly likely to
be preventable among surgical patients. … those unpreventable, but it is possible that with new
approaches or the use of a different type of surgical … in most of the harm in hospitals in this
country—adverse drug events, hospital-acquired infections, surgical
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psnet.ahrq.gov/perspective/conversation-bernardo-perea-perez-md-dds-phd
August 01, 2016 - BPP : It's clear to me that our campaigns to improve safety in surgical procedures, prescription drugs … apply in dentistry the methodology that has been applied in medicine for years: reporting systems, surgical … Ambulatory Clinic or Office
Health Care Providers
Information Professionals
Dentistry
Surgical