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psnet.ahrq.gov/issue/centre-patient-safety-and-service-quality
August 01, 2024 - nature of medical harm, study its causes, and understand how to improve the safety of health care. … August 14, 2019
The rise of human factors: optimising performance of individuals and … April 10, 2019
Department of Defense (DoD) Patient Safety Program. … October 3, 2017
The inevitability of physician burnout: implications for interventions … for the quality and safety of patient care.
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psnet.ahrq.gov/issue/err-human-unless-you-are-healthcare-provider
March 22, 2023 - with reduced hospital staff burnout at military treatment facilities: findings from the 2019 Department … of Defense Patient Safety Culture Survey. … April 27, 2022
The girl who cried pain: a bias against women in the treatment of pain … under the Patient Safety and Quality Improvement Act of 2005. … The Evolution of Root Cause Analysis
February 26, 2025
The
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psnet.ahrq.gov/node/43025/psn-pdf
March 05, 2014 - Assessment of DoD Wounded Warrior Matters: Managing
Risks of Multiple Medications. … March 5, 2014
Alexandria, VA: Department of Defense, Office of the Inspector General; February 21, 2014 … assessment-dod-wounded-warrior-matters-managing-risks-multiple-
medications
Examining medication safety challenges unique to the … policy and medication reconciliation to address concerns, including accidental
overdose and misuse of
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psnet.ahrq.gov/issue/disuse-system-cited-gaps-soldiers-care
September 28, 2005 - This article reports on the inconsistent use of the Department of Defense electronic medical records … September 28, 2005
The doctor was rude, the toilets are dirty. … Utilizing 'soft signals' in the regulation of patient safety. … July 5, 2006
A physician's personal experiences as a cancer of the neck patient: errors … June 25, 2014
The drawbacks of data-driven medicine.
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psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.127_slideshow.ppt
May 01, 2006 - emergency department (ED) of another hospital. … New York State Department of Health; February 2001.
1. … Albany, NY: New York State Department of Health; February 2001. … defense has weaknesses
Adverse events occur only when all the defenses around a particular situation … First Error: Communication
Two weeks prior to admission, staff in the emergency department (ED) who
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psnet.ahrq.gov/issue/covid-19-emerging-threat-antibiotic-stewardship-emergency-department
October 21, 2020 - COVID-19: an emerging threat to antibiotic stewardship in the emergency department. … COVID-19: an emerging threat to antibiotic stewardship in the emergency department. … support the re-opening of Canadian nursing homes to family caregivers and visitors during the coronavirus … July 28, 2021
Impact of pharmacist interventions provided in the emergency department … May 13, 2020
Perioperative COVID-19 defense: an evidence-based approach for optimization
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psnet.ahrq.gov/issue/review-article-improving-hospital-clinical-handover-between-paramedics-and-emergency
February 28, 2024 - and emergency department staff in the deteriorating patient. … identification of the receiving clinical staff. … 2019 Department of Defense Patient Safety Culture Survey. … from the emergency department to the intensive care unit. … April 19, 2011
Clinical handover of patients arriving by ambulance to the emergency department
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psnet.ahrq.gov/issue/national-costs-medical-liability-system
May 20, 2015 - National costs of the medical liability system. … One key premise of cost control measures is reducing the practice of defensive medicine . … by the poor quality of the evidence available to generate it. … National costs of the medical liability system. … August 10, 2022
Nearly all thirty most frequently used emergency department drugs experienced
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psnet.ahrq.gov/issue/legislative-report-general-assembly-adverse-event-reporting
May 20, 2009 - Hartford, CT: Connecticut Department of Public Health; October 2016. … Hartford, CT: Connecticut Department of Public Health; October 2016. … This annual publication provides data on adverse events reported to the Connecticut Department of Public … Hartford, CT: Connecticut Department of Public Health; October 2016. … March 25, 2009
Department of Defense Health Care Quality.
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psnet.ahrq.gov/issue/assessing-teamwork-attitudes-healthcare-development-teamstepps-teamwork-attitudes
September 23, 2020 - Study
Assessing teamwork attitudes in healthcare: development of the TeamSTEPPS teamwork … This study describes the development and validation of the TeamSTEPPS Teamwork Attitudes Questionnaire … Research and Quality and the Department of Defense. … March 9, 2009
The role of teamwork in the professional education of physicians: current … May 25, 2011
The relationship of the emotional climate of work and threat to patient
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psnet.ahrq.gov/issue/culture-change-nhs-applying-lessons-francis-inquiries
September 09, 2015 - Department of Health. London, England: Crown Publishing; February 2015. ISBN: 9781474112116. … NHS: Applying the Lessons of the Francis Inquiries. … Department of Health. London, England: Crown Publishing; February 2015. ISBN: 9781474112116. … – the Report of the Independent Investigation. … October 15, 2008
Department of Defense Health Care Quality.
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psnet.ahrq.gov/issue/compendium-2000-2005
September 06, 2011 - Book/Report
Compendium of Reports. … Citation Text:
Compendium of Reports. Washington DC: National Quality Forum. … This website is the complete collection to date of standards, measures and reports endorsed by the National … February 7, 2019
Crossing the Quality Chasm: A New Health System for the 21st Century … July 31, 2012
Department of Defense Health Care Quality.
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psnet.ahrq.gov/issue/assessment-emergency-department-antibiotic-discharge-prescription-dosing-errors-pediatric
March 01, 2011 - Study
Assessment of emergency department antibiotic discharge prescription dosing … Assessment of Emergency Department Antibiotic Discharge Prescription Dosing Errors for Pediatric Patients … discharged from the emergency department over a 1-year period contained a dosing error. … 2019 Department of Defense Patient Safety Culture Survey. … March 14, 2022
Patient safety in the era of the 80-hour workweek.
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psnet.ahrq.gov/issue/thresholds-rules-and-defensive-strategies-how-physicians-learn-their-prior-diagnosis-related
April 15, 2020 - : development and initial evaluation of the patients' perceptions of safety culture scale. … February 28, 2018
The randomized AMBORA trial: impact of pharmacological/pharmaceutical … February 19, 2020
Risk factors for wrong-patient medication orders in the emergency department … August 21, 2019
The design and conduct of Project RedDE: a cluster-randomized trial to … December 9, 2014
The frequency of diagnostic errors in outpatient care: estimations from
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psnet.ahrq.gov/issue/retrospective-review-crisis-events-diagnostic-radiology-analysis-frequency-demographics
February 17, 2017 - The majority of clinical deteriorations occurred within 48 hours of admission, often while the patient … defense in adverse event surveillance. … January 9, 2014
Medical emergency team calls in the radiology department: patient characteristics … An analysis of the incidence and factors behind the failure of bedside clinical staff to activate the … February 6, 2012
Intrahospital transport to the radiology department: risk for adverse
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psnet.ahrq.gov/issue/gross-negligence-manslaughter-healthcare-report-rapid-policy-review
June 14, 2023 - Department of Health and Social Care. London, England: Crown Copyright; 2018. … Department of Health and Social Care. London, England: Crown Copyright; 2018. … Department of Health and Social Care. London, England: Crown Copyright; 2018. … The Report of the Gosport Independent Panel. … July 11, 2018
Defense Health Agency Should Improve Tracking of Serious Adverse Medical
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psnet.ahrq.gov/node/33827/psn-pdf
February 01, 2017 - Agency for Healthcare Research and Quality (AHRQ), in collaboration with the
Department of Defense … and the spread of simulation have mirrored the spread
of TeamSTEPPS. … In the context of teamwork, fidelity of the simulation is usually less important than how the
simulation … King, MS Chief of Patient Safety and High Reliability Initiatives Defense Health Agency
Department of … Defense
References
1.
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psnet.ahrq.gov/issue/fatal-drug-mix-exposes-hospital-flaws
March 02, 2016 - This article reports on the deaths of three infants from heparin overdoses and describes how the hospital … of Safe Care: A (Theoretically Underpinned) Cross-sectioned Examination of the Breadth and Depth of … Attitudes of emergency department care providers to INFO clinical event debriefings. … 2019 Department of Defense Patient Safety Culture Survey. … March 22, 2023
Use of administrative data to find substandard care: validation of the
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psnet.ahrq.gov/issue/advances-patient-safety-research-implementation
December 24, 2008 - With 4 volumes and 140 articles (all of which are freely available through the link below), this expansive … collection of literature illustrates the progress made since the 1999 Institute of Medicine’s report … and the Department of Defense-Health Affairs in meeting the challenge of improving patient safety knowledge … December 10, 2024
Advances in the Prevention and Control of HAIs. … July 15, 2009
Building a Culture of Patient Safety: Report of the Commission on Patient
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psnet.ahrq.gov/web-mm/central-not-epidural
August 28, 2024 - 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