نتایج جستجو برای: root cause analysis
تعداد نتایج: 3246267 فیلتر نتایج به سال:
In wireless sensor networks data, which get generated, is not always same; some data may be more important than others and having different priorities. As deployment sizes and data rates grow, congestion becomes a major problem in these networks. The congestion results in arbitrary dropping of data packets that reduce the overall network throughput. In this paper, we discuss the various paramet...
PREVENTABLE MISTAKES ARE COMMON IN MEDICINE. FOR example, at 1 hospital, a patient received patientcontrolled analgesia (PCA), a combination of local anesthetic and narcotic. The medication was intended to be infused into the epidural space. Instead, a nurse inadvertently connected the tubing to an intravenous catheter, delivering potentially lethal anesthetic into the patient’s bloodstream. Wh...
• dispels any misconceptions about the staff’s degree of response to the error. • helps to alleviate their feelings of isolation, helplessness, and confusion about how and why the error occurred. • reduces self-blaming and blaming of individual staff members as the system-based causes of errors are revealed and described. • minimizes their frustration and anger.1–3 • demonstrates the organizati...
Automation and computer intelligence to support complex human decisions becomes essential to manage large and distributed systems in the Cloud and IoT era. Understanding the root cause of an observed symptom in a complex system has been a major problem for decades. As industry dives into the IoT world and the amount of data generated per year grows at an amazing speed, an important question is ...
IMPORTANCE Despite the recognized value of the Joint Commission's Universal Protocol and the implementation of time-outs, incorrect surgical procedures are still among the most common types of sentinel events and can have fatal consequences. OBJECTIVES To examine a root cause analysis database for reported wrong-side thoracenteses and to determine the contributing factors associated with thei...
Which Software Reliability Engineering (SRE) methods should be applied during the various phases of the lifecycle of a product? The answer given here centres on learning from errors. The classification and evaluation of methods is strictly based on causal analyses of disasters, accidents and incidents with undesired outcome. The lifecycle model of IEC Standard 61508 has been adopted as a classi...
We discuss a Root Cause Analysis (RCA) system implementing a probabilistic approach based on Bayesian inference for adaptive reasoning under uncertainties in industrial process operation. The proposed approach is model based and accumulates the process knowledge within the problem domain, which data is gathered and stored in XML-based information server. The Bayesian networks have been created ...
After receiving in June 2007 some external, expert advice on how to prevent and control HCAIs, the trust made concerted efforts to tackle the problem. It did a root cause analysis (RCA) for the most recent bacteraemias. RCA involves a systematic review of any activity associated with the patient to try and identify causal effects. The results were used, along with best practice guidance, such a...
Recent research shows that runtime models can be used to build dynamic systems coping with changing requirements and execution environments. As software systems are getting bigger and more complex, locating malfunctioning software parts is no trivial task because of the vast amount of possible error sources and produced logging information. This information has to be traced back to faulty compo...
Using Root Cause Analysis to Handle Intrusion Detection Alarms Klaus Julisch IBM Zurich Research Laboratory Säumerstrasse 4 8803 Rüschlikon, Switzerland e-mail: [email protected] In response to attacks against enterprise networks, administrators are increasingly deploying intrusion detection systems. These systems monitor hosts, networks, and other resources for signs of security violations. U...
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