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psnet.ahrq.gov/issue/impact-commercial-computerized-provider-order-entry-cpoe-and-clinical-decision-support
August 26, 2020 - July 27, 2018
Patient groups, clinicians and healthcare professionals agree—all test … May 22, 2013
The delivery of safe and effective test result communication, management … September 27, 2023
Variation in electronic test results management and its implications … 2020
The impact of health information technology on the management and follow-up of test
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psnet.ahrq.gov/node/851389/psn-pdf
July 31, 2023 - results has grown over the
last decade, as it can lead to delays in the recognition of abnormal test … delay in cancer treatment is associated with increased
mortality.4 Failure to recognize an abnormal test … Specifically, they investigated radiologist follow-up recommendations and
colonoscopy test follow-up … after abnormal test results to design a lung cancer safety net and a colon
cancer safety net.1 The … Getting Started with This Innovation
Deploying a small pilot program to test minor changes prior to
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psnet.ahrq.gov/issue/friends-and-family-test-qualitative-study-concerns-influence-willingness-english-national
May 01, 2015 - Study
The friends and family test: a qualitative study of concerns that influence … The friends and family test: a qualitative study of concerns that influence the willingness of English … The friends and family test: a qualitative study of concerns that influence the willingness of English
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psnet.ahrq.gov/issue/patient-led-training-patient-safety-pilot-study-test-feasibility-and-acceptability
April 24, 2017 - Study
Patient-led training on patient safety: a pilot study to test the feasibility … Patient-led training on patient safety: a pilot study to test the feasibility and acceptability of an … Patient-led training on patient safety: a pilot study to test the feasibility and acceptability of an
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psnet.ahrq.gov/issue/tying-loose-ends-discharging-patients-unresolved-medical-issues
February 24, 2011 - Hospitalized patients are frequently discharged with test results or diagnostic workups pending, with … No News May Not Be Good News
August 1, 2012
Follow-up of outpatient test … December 7, 2009
Timely follow-up of abnormal outpatient test results: perceived barriers
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psnet.ahrq.gov/issue/developing-and-implementing-new-safe-practices-voluntary-adoption-through-statewide
June 13, 2011 - The chosen interventions were medication reconciliation and prompt communication of critical test … hospitals successfully implemented medication reconciliation, and 65% implemented communication of critical test … February 18, 2011
Communicating critical test results: safe practice recommendations.
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psnet.ahrq.gov/node/73575/psn-pdf
August 04, 2021 - unlocking-solutions-imaging-working-together-learn-failings-nhs
https://psnet.ahrq.gov/issue/timely-follow-abnormal-diagnostic-imaging-test-results-outpatient-setting-are-electronic … https://psnet.ahrq.gov/issue/why-test-results-are-still-getting-lost-follow-qualitative-study-implementation-gaps
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psnet.ahrq.gov/curated-library/diagnostic-errors-case-studies
May 05, 2025 - WebM&Ms (10)
A Postpartum Woman with an Erroneous SARS-CoV-2 Test
Stephen … During an exercise treadmill test, she experienced another “woozy” spell and the ECG showed an elevated … A Postpartum Woman with an Erroneous SARS-CoV-2 Test
Stephen A. Martin, MD, EdM, Gordon D. … The in-house test returned as positive for SARS-CoV-2. … A root-cause analysis subsequently determined that the positive test run on the in-house platform was
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psnet.ahrq.gov/issue/error-reduction-and-prevention-surgical-pathology-2nd-edition
September 11, 2019 - September 22, 2021
Variation in electronic test results management and its implications … March 13, 2019
Patient groups, clinicians and healthcare professionals agree—all test … May 24, 2015
Communicating Critical Test Results.
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psnet.ahrq.gov/node/38090/psn-pdf
February 18, 2011 - delivered when the potential harm exceeds the potential benefit from a given
medication, diagnostic test … This study surveyed more than 2300 Medicare beneficiaries and
analyzed how frequently they wanted a test … a primary care doctor to manage their health, a significant number
wanted a specialist referral or test
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psnet.ahrq.gov/node/38282/psn-pdf
December 17, 2008 - reporting having visited a clinician who did not have access to all of their health
information (including test … information-exchange-among-physicians-caring-same-patient-community
https://psnet.ahrq.gov/issue/i-wish-i-had-seen-test-result-earlier-dissatisfaction-test-result-management-systems-primary
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psnet.ahrq.gov/node/39655/psn-pdf
July 07, 2010 - Physicians named closer follow-up and reliable test management systems as major system
improvements … medical-diagnoses-commonly-associated-pediatric-malpractice-lawsuits-united-states
https://psnet.ahrq.gov/issue/i-wish-i-had-seen-test-result-earlier-dissatisfaction-test-result-management-systems-primary
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psnet.ahrq.gov/sites/default/files/2024-11/spotlight_case_neurological_red_flags_final.pptx
January 01, 2024 - (5)
The HINTS exam, first described in 2009, includes three bedside oculomotor tests:
Head impulse test … (HIT)
Nystagmus (N)
Test of skew (TS)
A fourth component, a bedside test of hearing by finger rub, … HINTS-Plus Examination (for patients with ongoing dizziness and nystagmus)
Test Brief description … Reassuring findinga Worrisome findingb
Head impulse test Test of the VOR, only useful in patients who … of Skew Use of alternate cover test to look for a vertical correction of gaze on uncovering one eye
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psnet.ahrq.gov/issue/fumbled-handoffs-one-dropped-ball-after-another
April 10, 2024 - June 16, 2019
"I wish I had seen this test result earlier!" … : dissatisfaction with test result management systems in primary care. … Care Transition Failure
July 1, 2011
Patient safety concerns arising from test
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psnet.ahrq.gov/issue/cdc-grand-rounds-preventing-unsafe-injection-practices-us-health-care-system
February 27, 2019 - November 23, 2011
Impact of interactions between drugs and laboratory test results on … diagnostic test interpretation—a systematic review. … November 21, 2018
Diagnostic error as a result of drug-laboratory test interactions.
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psnet.ahrq.gov/issue/nonfatal-unintentional-medication-exposures-among-young-children-united-states-2001-2003
February 27, 2019 - November 23, 2011
Impact of interactions between drugs and laboratory test results on … diagnostic test interpretation—a systematic review. … November 21, 2018
Diagnostic error as a result of drug-laboratory test interactions.
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psnet.ahrq.gov/issue/when-i-saydiagnostic-error
January 26, 2022 - April 24, 2018
Impact of interactions between drugs and laboratory test results on diagnostic … test interpretation—a systematic review. … November 21, 2018
Diagnostic error as a result of drug-laboratory test interactions.
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psnet.ahrq.gov/node/60326/psn-pdf
May 13, 2020 - To fully appreciate the implications of missed test notifications
to reduce the risk of delayed diagnoses … preventing-diagnostic-errors-ambulatory-care-electronic-notification-tool-incomplete
https://psnet.ahrq.gov/issue/advancing-safety-closed-loop-communication-test-results
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psnet.ahrq.gov/node/74073/psn-pdf
November 17, 2021 - artificial intelligence for image analysis in breast
cancer screening programmes: systematic review of test … artificial intelligence for image analysis in breast cancer
screening programmes: systematic review of test
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psnet.ahrq.gov/node/46979/psn-pdf
January 01, 2021 - nine measures suitable for
tracking two high-priority safety gaps: notifying patients of actionable test … psnet.ahrq.gov/primer/ambulatory-care-safety
https://psnet.ahrq.gov/issue/notification-abnormal-lab-test-results-electronic-medical-record-do-any-safety-concerns