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psnet.ahrq.gov/node/60746/psn-pdf
July 29, 2020 - arrived at the Emergency Department (ED) complaining of back pain and bloody
vaginal discharge. … 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/issue/nature-surgical-error-cautionary-tale-and-call-reason
September 12, 2007 - Department of Veterans Affairs: a multi-state qualitative study. … March 23, 2011
Development of an emergency department trigger tool using a systematic … department. … June 3, 2020
Blueprint for restructuring a department of surgery in concert with the … May 6, 2020
Perioperative COVID-19 defense: an evidence-based approach for optimization
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psnet.ahrq.gov/web-mm/no-blood-please
January 14, 2011 - 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/49697/psn-pdf
December 01, 2013 - The final defense that led to detection appears to have been fortuitous. … Daniel Saddawi-Konefka, MD Instructor in Anesthesia Department of Anesthesia, Critical Care and Pain … Cooper, PhD Professor of Anesthesia Department of Anesthesia, Critical Care and Pain
Medicine Massachusetts … Department of Health and Human Services. … Department of Health and Human Services.
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psnet.ahrq.gov/perspective/conversation-withwilliam-b-munier-md-mba
July 01, 2011 - technology software company, a partner at Ernst & Whinney, the director of the Department of Defense … department to engage in Patient Safety Activities, reviewing the quality and safety of care. … Department of Health and Human Services as well as the Department of Defense and the Department of Veterans … Department of Health and Human Services. … Department of Health and Human Services.
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psnet.ahrq.gov/web-mm/medication-overdose
September 01, 2011 - 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 … Pharmacists are often our first line of defense against medication errors, and ward-based clinical pharmacists … Department of Health and Human Services. … Department of Health and Human Services.
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psnet.ahrq.gov/issue/collaborating-manage-vendor-interactions-and-protect-quality-care-or
October 14, 2020 - interpreter use in a clinical trial comparing telephonic and video interpretation in a pediatric emergency department … January 17, 2007
Crowding in the Emergency Department: Challenges for the Care of Children … Stigmatizing language and the transmission of bias in the medical record. … May 28, 2008
Improving the bar-coded medication administration system at the Department … March 22, 2023
Perioperative COVID-19 defense: an evidence-based approach for optimization
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psnet.ahrq.gov/node/49395/psn-pdf
April 01, 2003 - The lack of clinical consequences to the error reflected the
pharmacist’s recognition of the ambiguous … Pharmacists are often our first line of defense against medication errors, and ward-based clinical
pharmacists … Department of Health and Human Services. … necessarily represent the
views of AHRQ. … Department of Health and Human Services.
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psnet.ahrq.gov/perspective/becoming-patient-safety-organization
July 01, 2011 - technology software company, a partner at Ernst & Whinney, the director of the Department of Defense … department to engage in Patient Safety Activities, reviewing the quality and safety of care. … Department of Health and Human Services as well as the Department of Defense and the Department of Veterans … Department of Health and Human Services. … Department of Health and Human Services.
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psnet.ahrq.gov/issue/health-care-crossroads-strategies-improving-medical-liability-system-and-preventing-patient
September 07, 2005 - The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) suggests that the current medical … November 10, 2010
Pediatric Patient Safety in the Emergency Department. … January 7, 2009
Front Line of Defense: The Role of Nurses in Preventing Sentinel Events … October 31, 2012
The growing role of the Patient Safety Officer: implications for risk … May 26, 2021
Documenting a Day of Discussion: Ahead of the Crest of the Wave Creating
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psnet.ahrq.gov/web-mm/good-catch-operating-room
August 27, 2017 - Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services … Center School of Medicine Department of Surgery New Orleans, LA References 1. … Washington, DC: Department of Defense. … Department of Health and Human Services. … Department of Health and Human Services.
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psnet.ahrq.gov/issue/facts-about-patient-safety
May 30, 2012 - April 26, 2006
Pediatric Patient Safety in the Emergency Department. … January 1, 2021
Reducing the Risks of Wrong-Site Surgery: Safety Practices from The Joint … June 1, 2011
Front Line of Defense: The Role of Nurses in Preventing Sentinel Events. … August 7, 2023
The Role of Hospitalists in Patient Safety. … September 7, 2022
The Uneven Burden of Maternal Mortality in the U.S.
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psnet.ahrq.gov/primer/responding-patient-safety-events
October 18, 2023 - Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2025. … Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2025. … Department of Health and Human Services. … Department of Health and Human Services. … Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2025.
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psnet.ahrq.gov/node/49847/psn-pdf
November 01, 2018 - However, the primary intern caring for the
patient was on his first day of the rotation, as was the … to the delivery of optimal patient care. … 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.
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psnet.ahrq.gov/node/863641/psn-pdf
February 28, 2024 - Agency for Healthcare Research and Quality (AHRQ), in collaboration with the Department of Defense … A growing body of evidence shows the importance of TeamSTEPPS in improving
https://psnet.ahrq.gov/perspective … The fourth area of emphasis is active learning strategies. … of key concepts and tools, an explanation of the value of the
TeamSTEPPS curriculum, and guidance for … While previous
iterations of TeamSTEPPS featured multiple versions of the curriculum for multiple care
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psnet.ahrq.gov/web-mm/diagnostic-delay-emergency-department
September 18, 2024 - Discuss how the concept of missed diagnostic opportunities in the emergency department setting can be … Effect of emergency department crowding on outcomes of admitted patients. … Department of Health and Human Services. … Department of Health and Human Services. … emergency department: follow up of patients with minor trauma in the outpatient clinic.
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psnet.ahrq.gov/node/33733/psn-pdf
July 01, 2012 - the hundreds of billions of dollars the US government and providers have spent on it? … of products that have the potential of at least
communicating within the brand; interoperability would … I enumerate only four:
Health IT was promoted on the basis of a survey of hospital IT needs that was … complexity of
the systems, the outsized cost and time of implementation, and the ties of legacy software … Ross Koppel, PhDProfessor, Sociology Department and School of MedicineUniversity of Pennsylvania
References
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psnet.ahrq.gov/web-mm/other-side
May 01, 2007 - Using a mandatory reporting system, the New York State Department of Health identified 46 cases in 2 … defense against possible error. … Department of Veterans Affairs. Ensuring correct surgery; 2002. … Department of Health and Human Services. … Department of Health and Human Services.
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psnet.ahrq.gov/sites/default/files/2020-03/final_spotlight_case_delays_in_the_ed_powerpoint_for_cme_review_03.09.2020.pdf
January 01, 2020 - of this educational activity, participants should be able to:
• Define the emergency department triage … process
• State the root causes and dangers of emergency department crowding
• Use waiting room patient … EMERGENCY DEPARTMENT
CARE
A case in the ED that illustrates the effects of
ED crowding, limitations … WAIT: IMPROVING
TIMELINESS OF EMERGENCY DEPARTMENT
CARE
THE COMMENTARY
By David K. … Team STEPPS
• Team STEPPS
– Developed by the Department of Defense Patient Safety Program
and supported
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psnet.ahrq.gov/issue/measuring-quality
June 21, 2017 - department. … 2019 Department of Defense Patient Safety Culture Survey. … July 5, 2023
The AHRQ Report on Diagnostic Errors in the Emergency Department: the wrong … March 15, 2023
Crowding in the Emergency Department: Challenges for the Care of Children … February 22, 2023
Misdiagnosis in the emergency department: time for a system solution