02061oam 2200457I 450 991015488330332120230809233545.01-315-38090-01-4987-8117-910.1201/9781315380902 (CKB)4340000000018641(MiAaPQ)EBC4751229(OCoLC)964697910(EXLCZ)99434000000001864120180706h20172017 uy 0engurcnu||||||||rdacontentrdamediardacarrierPatient safety investigating and reporting serious clinical incidents /Russell Kelsey, MB.BS MRCGP General Practitioner. Worcestershire, UKBoca Raton :CRC Press,[2017]©20171 online resource (225 pages) color illustrationsIncludes index.1-4987-8116-0 Introduction : why do we still miss appendicitis? -- RCA : background and context -- How do we recognise serious clinical incidents? -- Recognising serious incidents using the SIRT : case studies -- A culture of complaint : openness, candour, and blame -- Root cause analysis : what happened? : the evidence -- Root cause analysis : what happened? : care and service delivery problems -- Root cause analysis : understanding why -- Understanding why : system factors -- Human factors part 1 : the key to enhanced learning -- Human factors part 2 : situational awareness and high pressure environments -- Root cause -- Learning and recommendations -- Solutions design and changing cultures -- Writing reports.Medical errorsPreventionRoot cause analysisSafety regulationsMedical errorsPrevention.Root cause analysis.Safety regulations.610.28/9Kelsey Russell1241394FlBoTFGFlBoTFGBOOK9910154883303321Patient safety2879774UNINA