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psnet.ahrq.gov/node/49429/psn-pdf
January 01, 2004 - en route to the emergency
department (ED). … As the size of the pregnancy
increases and the size of the ovaries decreases, the extra-uterine pregnancy … If
emergency department physicians are to be the first line of defense in recognizing ectopic pregnancies … Department of Health and Human Services. … Department of Health and Human Services.
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psnet.ahrq.gov/node/49539/psn-pdf
June 01, 2007 - defense to a legal suit in battery in most jurisdictions. … Department of Health and Human Services. … necessarily represent the
views of AHRQ. … Readers should not interpret any statement in this report as an official position of AHRQ or
of the … Department of Health and Human Services.
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psnet.ahrq.gov/node/49769/psn-pdf
September 01, 2016 - to the emergency department with abdominal pain. … how best to address the concerns about the quality of the physician's care. … of instances of
unsatisfactory care below the surface. … Department of Health and Human Services. … Department of Health and Human Services.
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psnet.ahrq.gov/web-mm/ruptured-heterotopic-pregnancy
August 16, 2023 - Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services … en route to the emergency department (ED). … If emergency department physicians are to be the first line of defense in recognizing ectopic pregnancies … Department of Health and Human Services. … Department of Health and Human Services.
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psnet.ahrq.gov/perspective/conversation-richard-c-boothman-jd
March 01, 2012 - Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services … the manager, division chief, or department chair who was well aware of that problem but did nothing. … Washington, DC: US Department of Health and Human Services, Office of the Inspector General; November … Department of Health and Human Services. … Department of Health and Human Services.
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psnet.ahrq.gov/web-mm/informed-or-misled
April 24, 2018 - Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services … Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services … defense to a legal suit in battery in most jurisdictions. … Department of Health and Human Services. … Department of Health and Human Services.
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psnet.ahrq.gov/node/863649/psn-pdf
February 28, 2024 - In 2006,
AHRQ, in collaboration with the Department of Defense, developed Team Strategies and Tools … TeamSTEPPS, including several representatives currently or formerly involved with the Department of … Defense Health Agency, which played a major role in the development of TeamSTEPPS. … groups of students or colleagues
on the use of TeamSTEPPS. … The results of that evaluation could be available as early as the end of 2024.
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psnet.ahrq.gov/node/50844/psn-pdf
January 29, 2020 - issues, result in fewer interruptions during the rest of the workday, and foster a culture of empowerment … beginning of the workday in outpatient
settings, and at the beginning of each major shift in ambulatory … Agency for Healthcare Research and Quality and the Department of Defense developed
TeamSTEPPS 2.0 as … constraints in time, personnel, workload, and the possibility of
reinforcement of hierarchies if the … Factors to consider in the introduction of huddles on clinical
wards: perceptions of staff on the SAFE
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psnet.ahrq.gov/web-mm/misdiagnosis-pelvic-mass-versus-pregnancy
November 25, 2020 - The Case
A 28-year-old woman arrived at the Emergency Department (ED) complaining of back pain and … Department. … this case; and as the diagnostic errors aligned, holes in layers of defense also lined up, a situation … Department of Health and Human Services. … Department of Health and Human Services.
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psnet.ahrq.gov/web-mm/x-ray-flip
August 10, 2019 - The Case
A 19-year-old man presented to the emergency department with respiratory distress after blunt … serve as a defense barrier in all but the most emergent cases. … An analysis of critical incidents in a teaching department for quality assurance: a survey of mishaps … Department of Health and Human Services. … Department of Health and Human Services.
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psnet.ahrq.gov/periodic-issue/periodic-issue-443
May 29, 2024 - impact of unsafe care worldwide and the status of plan objective implementation in the six regions of … This qualitative study examined a wide range of perspectives on the use of locum doctors in the United … impact of unsafe care worldwide and the status of plan objective implementation in the six regions of … Emergency Department from a nursing facility, struggling to breathe. … Despite visiting an outpatient clinic and emergency department (ED) for ongoing symptoms and significant
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psnet.ahrq.gov/web-mm/techno-trip
May 01, 2005 - Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services … Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services … Department of Health and Human Services. … Department of Health and Human Services. … Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services
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psnet.ahrq.gov/node/33612/psn-pdf
May 01, 2005 - Saul Weingart, Director of the Center for Patient Safety at DFCI, to
reflect on the lessons of the past … The Massachusetts Department of Public Health; the Boards of Registration responsible for licensing … The transformation had less to do with the reorganization of clinical care than of the acceptance and … Third, we embraced the role of system design in the prevention of error and of information technology … After all, denial is a powerful
defense mechanism.
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psnet.ahrq.gov/perspective/conversation-amy-c-edmondson-phd-am
February 01, 2017 - of Defense (DoD), released Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS … King, MS Chief of Patient Safety and High Reliability Initiatives Defense Health Agency Department of … Defense
References
1. … Department of Health and Human Services. … Department of Health and Human Services.
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psnet.ahrq.gov/web-mm/check-anesthesia-machine
August 01, 2006 - Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services … The final defense that led to detection appears to have been fortuitous. … Cooper, PhD Professor of Anesthesia Department of Anesthesia, Critical Care and Pain Medicine … Department of Health and Human Services. … Department of Health and Human Services.
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psnet.ahrq.gov/node/33726/psn-pdf
March 01, 2012 - They can't control all of the risk. … It's quite common in litigation circles to see cases
that are strong defense cases as cases we should … of the quality of that
dialogue, and we're avoiding the cases that might have been brought in the past … the manager,
division chief, or department chair who was well aware of that problem but did nothing … When I
was a defense lawyer I would have welcomed a doctor to call me up and say, "Would you be on call
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psnet.ahrq.gov/node/49435/psn-pdf
February 01, 2004 - https://psnet.ahrq.gov/web-mm/x-ray-flip
The Case
A 19-year-old man presented to the emergency department … serve as a defense
barrier in all but the most emergent cases. … An analysis of critical incidents in a teaching department
for quality assurance: a survey of mishaps … Department of Health and Human Services. … Department of Health and Human Services.
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psnet.ahrq.gov/node/49475/psn-pdf
March 01, 2005 - The radiology department at the community
hospital had recently implemented an electronic picture archiving … The source of this event is not human error on the part of the surgeon. … Cook, MD Associate Professor, Department of Anesthesia and Critical Care Director, Cognitive
Technologies … Department of Health and Human Services. … Department of Health and Human Services.
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psnet.ahrq.gov/issue/2016-john-m-eisenberg-patient-safety-and-quality-award-recipients-announced
April 13, 2016 - November 21, 2007
Front Line of Defense: The Role of Nurses in Preventing Sentinel Events … December 4, 2019
Pediatric Patient Safety in the Emergency Department. … April 28, 2010
Reducing the Risks of Wrong-Site Surgery: Safety Practices from The Joint … emergency department. … November 22, 2017
The high costs of unnecessary care.
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psnet.ahrq.gov/web-mm/written-signout-it-only-works-if-you-use-right-one
April 24, 2018 - Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services … Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services … Washington, DC: Department of Defense. Rockville, MD: Agency for Healthcare Research and Quality. … Department of Health and Human Services. … Department of Health and Human Services.