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psnet.ahrq.gov/perspective/conversation-susan-smith-md
August 01, 2019 - where is the most burdensome part of the documentation for the physicians and ask faculty what they thought … To figure out how to help offset those costs, we thought about what's the desirable level of RVU [relative … Some people are very directive and templated in their thinking and how they go through a series of questions … RW : For organizations that are thinking about implementing a program, describe how you triaged a limited … We've thought about a variety of different strategies.
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psnet.ahrq.gov/node/34868/psn-pdf
February 03, 2011 - Role of computerized physician order entry systems in
facilitating medication errors.
February 3, 2011
Koppel R, Metlay JP, Cohen A, et al. Role of computerized physician order entry systems in facilitating
medication errors. JAMA. 2005;293(10):1197-203.
https://psnet.ahrq.gov/issue/role-computerized-physician-ord…
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psnet.ahrq.gov/issue/interruptions-and-multi-tasking-moving-research-agenda-new-directions
March 23, 2011 - September 26, 2016
Momentary interruptions can derail the train of thought.
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psnet.ahrq.gov/issue/overcoming-barriers-adopting-and-implementing-computerized-physician-order-entry-systems-us
July 10, 2008 - May 8, 2017
We thought we would be perfect: medication errors before and after the initiation
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psnet.ahrq.gov/issue/catching-and-correcting-near-misses-collective-vigilance-and-individual-accountability-trade
March 24, 2012 - August 10, 2011
View More
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March 27, 2024 - It requires thinking through the right infrastructure, the right level of education. … RW : It sounds like the doctor is not even thinking about the data other than in real time. … They're not thinking about the potential learning from aggregating it and analyzing it in new ways. … RW : When you thought about how little we mine of the user's experience in health care versus in retail … Then, thinking through what an ideal solution would look like and putting it together.
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October 01, 2013 - Or was it surprising that everybody had higher doses than you thought might be necessary? … When I was a resident you wouldn't get a CT scan in a pregnant woman without really, really, really thinking … So as the doses went up, we were thinking about this problem less, and when attention came to this issue … are thrilled that it's been found, and they feel that they're saved even when you as a physician are thinking … I thought that this was a great educational opportunity but he also set the stage.
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psnet.ahrq.gov/node/33883/psn-pdf
July 01, 2019 - It requires thinking through the right
infrastructure, the right level of education. … RW: It sounds like the doctor is not even thinking about the data other than in real time. … They're not thinking about the potential learning from
aggregating it and analyzing it in new ways. … RW: When you thought about how little we mine of the user's experience in health care versus in retail … Then, thinking through what an ideal solution
would look like and putting it together.
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psnet.ahrq.gov/node/60952/psn-pdf
September 30, 2020 - polymorphic ventricular tachycardia
that has a characteristic appearance on electrocardiograms and is thought … Any offending medications that
are thought to be the cause of or contributing to the prolongation of … Patients who present with diabetic ketoacidosis are typically thought to have a total body deficiency
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psnet.ahrq.gov/node/33704/psn-pdf
December 01, 2010 - There is also the shift to systems
thinking, and away from individual blame for everything. … The whole notion of systems thinking and safety
science are huge shifts. … Is that the way they thought and no one else did, or did risk
managers not think that way either? … GA: I think many of us thought that way but didn't have the same terminology. … What is your thought about this issue?
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psnet.ahrq.gov/perspective/conversation-timothy-b-mcdonald-md-jd
February 26, 2025 - As a lawyer I saw that and thought it was crazy. The other part is we didn't learn anything. … RW : People have obviously thought about the dysfunction in practice for many decades before the IOM … And always these cases we thought were horrible, it would be 3–6 months before the trial date, and defense … I was a little naïve early on thinking that physicians would understand the numbers, and they would understand
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psnet.ahrq.gov/node/34993/psn-pdf
June 22, 2009 - Five system barriers to achieving ultrasafe health care.
June 22, 2009
Amalberti R, Auroy Y, Berwick D, et al. Five system barriers to achieving ultrasafe health care. Ann Intern
Med. 2005;142(9):756-64.
https://psnet.ahrq.gov/issue/five-system-barriers-achieving-ultrasafe-health-care
This commentary builds on the…
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psnet.ahrq.gov/issue/hospital-wide-cardiac-arrest-situ-simulation-identify-and-mitigate-latent-safety-threats
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March 18, 2020 - COVID-19 crisis, safe reopening of simulation centres and the new normal: food for thought
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June 08, 2022 - COVID-19 crisis, safe reopening of simulation centres and the new normal: food for thought
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March 09, 2022 - COVID-19 crisis, safe reopening of simulation centres and the new normal: food for thought