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psnet.ahrq.gov/perspective/conversation-karl-bilimoria-md-ms-0
December 01, 2017 - RW : Back to the question before about transparency for patients versus creating a safe environment for … And then to give it back to ourselves to be able to analyze performance and identify opportunities for … The attending back-up schedule should be appropriately staffed and accessible to everyone.
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psnet.ahrq.gov/perspective/evolution-patient-safety-surgery
August 01, 2017 - The attending back-up schedule should be appropriately staffed and accessible to everyone. … RW : Back to the question before about transparency for patients versus creating a safe environment for … And then to give it back to ourselves to be able to analyze performance and identify opportunities for
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psnet.ahrq.gov/web-mm/diagnostic-overshadowing-dangers
February 12, 2020 - In the ED, the patient complained of pain in her epigastric region and back.
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psnet.ahrq.gov/perspective/wild-west-patient-safety-office-based-anesthesia
April 01, 2003 - Leape, MD Adjunct Professor of Health PolicyHarvard School of Public Health
References
Back to Top
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psnet.ahrq.gov/node/33625/psn-pdf
January 01, 2006 - References
Back to Top
1.Air France jet overran runway. CBS News. August 5, 2005.
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psnet.ahrq.gov/node/49517/psn-pdf
August 01, 2006 - miscalculated-risk
The Case
A healthy 36-year-old man was admitted to a teaching hospital for acute low back
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psnet.ahrq.gov/node/49797/psn-pdf
June 01, 2017 - In
the ED, the patient complained of pain in her epigastric region and back.
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psnet.ahrq.gov/web-mm/transition-nowhere
March 21, 2009 - Once his renal function was assessed and found to be back to baseline, his previously held antihypertensives
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psnet.ahrq.gov/web-mm/when-psychiatric-symptoms-are-not
September 20, 2011 - July 28, 2010
WebM&M Cases
Back to Basics
March 1
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psnet.ahrq.gov/web-mm/perils-cross-coverage
September 22, 2010 - outcomes remains elusive due to a lack of handoff-specific patient outcomes.( 5 ) A common way to teach … necessary to evaluate receivers on use of active listening behaviors, such as interactive questioning, read-back
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psnet.ahrq.gov/perspective/patient-safety-united-kingdom-evolution-and-progress
May 01, 2007 - Systematic data collection of the hazards of health care can be traced back at least to the time of Florence … Charles Vincent, PhD Professor of Clinical Safety Research, Imperial College London
References
Back … That's where we can go back to the lessons of the airline industry.
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psnet.ahrq.gov/perspective/conversation-withwilliam-b-weeks-md-mba
May 01, 2009 - RW: You have spent a fair amount of your time and energy trying to teach economic principles to clinicians … way: the patient may not follow through to get what has been requested; the results may not arrive back … Baron, MD CEO, Greenhouse Internists, PCChair, American Board of Internal Medicine
References
Back
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psnet.ahrq.gov/node/60858/psn-pdf
August 26, 2020 - patient
empowerment, caregivers should be trained in how to increase patients’ capacity for self-care.37 Teach … -
back is one method through which healthcare providers can ensure that they have explained medical
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psnet.ahrq.gov/web-mm/when-meds-dont-reach-bed
May 16, 2022 - empowerment, caregivers should be trained in how to increase patients’ capacity for self-care. 37 Teach-back
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psnet.ahrq.gov/perspective/conversation-withkaveh-g-shojania-md
September 01, 2011 - The VA has done a very good job with getting back to the reporter. … In fact, not only do they get back about acknowledging and personally thanking them for doing the report … part, so people get demoralized after a year or two: "I keep filling out these reports, I never hear back … not only in terms of listening and doing, creating a meaningful action plan to fix things but getting back … The actions that hospital leaders take in response to reports teach providers whether the time and risks
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psnet.ahrq.gov/perspective/incident-reporting-more-attention-safety-action-feedback-loop-please
September 01, 2011 - The actions that hospital leaders take in response to reports teach providers whether the time and risks … The VA has done a very good job with getting back to the reporter. … In fact, not only do they get back about acknowledging and personally thanking them for doing the report … part, so people get demoralized after a year or two: "I keep filling out these reports, I never hear back … not only in terms of listening and doing, creating a meaningful action plan to fix things but getting back
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psnet.ahrq.gov/node/838972/psn-pdf
October 27, 2022 - 35 minutes, she hopped down the hallway on one leg to
find assistance but was unsuccessful and went back
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psnet.ahrq.gov/perspective/what-can-rest-health-care-system-learn-vas-quality-and-safety-transformation
September 01, 2006 - The data were then fed back to each VISN and facility. … Health PolicyHarvard School of Public HealthStaff Physician, VA Boston Healthcare System
References
Back … We did our first cultural survey back in 1998 to set the benchmark.
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psnet.ahrq.gov/perspective/conversation-jessica-behrhorst-about-evolution-root-cause-analysis
February 26, 2025 - If that is not part of this organization, we could put that RCA back on the shelf and not look at it … Jessica Behrhorst: When we teach RCA 2 , we stress that it is a toolkit, not just one tool. … I often think back to my early career. … Several years back, RCA 2 got approval from The Joint Commission.
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psnet.ahrq.gov/perspective/evolution-root-cause-analysis
February 26, 2025 - If that is not part of this organization, we could put that RCA back on the shelf and not look at it … Jessica Behrhorst: When we teach RCA 2 , we stress that it is a toolkit, not just one tool. … I often think back to my early career. … Several years back, RCA 2 got approval from The Joint Commission.