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psnet.ahrq.gov/node/33892/psn-pdf
May 03, 2016 - This technique, used in anesthesia to understand failures (see also Cooper et al. 1978
and Flanagan
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psnet.ahrq.gov/node/36175/psn-pdf
September 29, 2010 - The authors studied the use of cognitive artifacts (eg, schedules) in the operating room in order to
understand
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psnet.ahrq.gov/issue/handoff-not-telegram-understanding-patient-co-constructed
September 03, 2014 - Commentary
A handoff is not a telegram: an understanding of the patient is co-constructed.
Citation Text:
Cohen MD, Hilligoss B, Amaral ACK-B. A handoff is not a telegram: an understanding of the patient is co-constructed. Crit Care. 2012;16(1):303. doi:10.1186/cc10536.
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psnet.ahrq.gov/issue/functional-health-literacy-and-understanding-medications-discharge
April 24, 2018 - Study
Functional health literacy and understanding of medications at discharge.
Citation Text:
Maniaci MJ, Heckman MG, Dawson NL. Functional health literacy and understanding of medications at discharge. Mayo Clin Proc. 2008;83(5):554-8. doi:10.4065/83.5.554.
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psnet.ahrq.gov/issue/losing-moment-understanding-interruptions-nurses-work
September 19, 2012 - Study
Losing the moment: understanding interruptions to nurses' work.
Citation Text:
Hall LMG, Pedersen C, Fairley L. Losing the moment: understanding interruptions to nurses' work. J Nurs Adm. 2010;40(4):169-176. doi:10.1097/NNA.0b013e3181d41162.
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DOI …
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psnet.ahrq.gov/issue/understanding-care-transitions-patient-safety-issue
August 22, 2007 - Newspaper/Magazine Article
Understanding care transitions as a patient safety issue.
Citation Text:
Understanding care transitions as a patient safety issue. Butterfield S; Stegel C; Glock S; Tartaglia D.
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psnet.ahrq.gov/node/33682/psn-pdf
April 01, 2009 - of medical errors and poor quality; on
the other hand, there are often major gaps in what we really understand … Then, once we understand where the weak defenses are, we have imperfect analytic tools to tell us which … But knowing what happened in one is not enough information to understand what
the vulnerabilities are … RW: One of the things I hear from hospitals is that they understand they are going to be measured,
accredited … We continuously reach out to all of our
customers and other stakeholders to understand how we can do
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psnet.ahrq.gov/node/33624/psn-pdf
December 01, 2005 - RW: From your unique vantage point, what is it that doctors don't understand about the legal world, and … what don't lawyers understand about the medical world? … So, they don't take
time really to understand it. … Most of our questions were motivated by trying to understand the impact of the medical
malpractice system … went directly to
public in 2000, that people really began to get excited about funding research to understand
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psnet.ahrq.gov/node/44917/psn-pdf
November 30, 2016 - psnet.ahrq.gov/issue/canadian-incident-analysis-framework
Performing incident analysis can help organizations understand
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psnet.ahrq.gov/node/43272/psn-pdf
June 18, 2014 - This commentary recommends that research, policy, and education efforts be designed to
understand and
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psnet.ahrq.gov/node/46824/psn-pdf
June 26, 2018 - The authors recommend areas of research needed to further understand patient management
reasoning.
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psnet.ahrq.gov/node/38841/psn-pdf
August 05, 2009 - tracking-virtual-slides-tool-study-diagnostic-error-histopathology
This study used an innovative educational tool with virtual histopathology specimens to understand
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psnet.ahrq.gov/node/41742/psn-pdf
October 10, 2012 - older-veterans-and-emergency-department-discharge-information
Elderly patients and their caregivers often did not understand
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psnet.ahrq.gov/node/47678/psn-pdf
December 19, 2018 - https://psnet.ahrq.gov/issue/when-mistakes-happen
This article provides an overview of efforts to understand
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psnet.ahrq.gov/node/39412/psn-pdf
January 03, 2017 - The authors explain the difficulties in confirming such instances and recommend
strategies to understand
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psnet.ahrq.gov/node/35629/psn-pdf
June 24, 2010 - balancing-risk-my-life-politics-risk-hospital-operating-theatre-department
This study describes findings from a series of observations and interviews to better understand
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psnet.ahrq.gov/node/40065/psn-pdf
January 12, 2012 - possible-solutions-barriers-incident-reporting-residents
This study conducted focus groups of trainees to understand
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psnet.ahrq.gov/node/44007/psn-pdf
April 01, 2015 - Highlighting time pressure as a factor in diagnostic error, this magazine article describes efforts to
understand
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psnet.ahrq.gov/node/41543/psn-pdf
January 18, 2013 - This review of the evidence on nursing handoffs identifies areas where more research is needed to
understand
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psnet.ahrq.gov/node/37089/psn-pdf
July 31, 2008 - Poor health literacy has previously been linked to inability to
understand prescription drug labels.