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healthcare411.ahrq.gov/sites/default/files/wysiwyg/research/findings/ta/topicrefinement/afib_topicref.pdf
January 01, 2020 - patient-level characteristics such as age, sex, type of AF, comorbidities, risk for stroke or
bleeding events … utilization
• Reduced medication use (e.g., need for
anticoagulants, antiarrhythmic drugs)
Harms or adverse … )
• In-hospital and 30-day stroke (any, by type),
TIA
• In-hospital and 30-day embolic events … vascular
injury, infection leading to prolonged
hospitalization or sepsis, pulmonary edema])
• Adverse … studies may be considered in the evaluation
of harms if specifically designed to evaluate
harms and/or adverse
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healthcare411.ahrq.gov/patient-safety/patients-families/index.html
June 01, 2023 - Studies
Blog
AHRQ Views
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AHRQ News Now
Events … Primary Care Settings
About AHRQ's Quality & Patient Safety Work
Patient Safety News and Events … institutions and practitioners can use to respond in a timely, thorough, and just way when unexpected events … Reconciliation
Learn about the processes that help detect and prevent medication discrepancies and adverse … drug events.
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healthcare411.ahrq.gov/patient-safety/settings/hospital/candor/modules/notes8.html
August 01, 2022 - Studies
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AHRQ Views
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AHRQ News Now
Events … Over time, the organization must continue to encourage frontline staff to report CANDOR events and other … adverse patient events by promoting transparency and a fair and just culture. … Celebrating staff for reporting CANDOR (and other) events, such as near misses and unsafe conditions. … Encourage your Team Leads to discuss actual CANDOR events to drive home important lessons.
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healthcare411.ahrq.gov/news/events/nac/2019-04-nac/nacmtg0419-minutes.html
July 01, 2019 - Studies
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Events … Careers
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FAQs
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Events … reducing the use of acute and institutional care, eliminating duplication of services, and reducing adverse … events resulting from conflicting management. … https://www.ahrq.gov/news/events/nac/2019-04-nac/nacmtg0419-minutes.html
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healthcare411.ahrq.gov/patient-safety/patients-families/patient-family-engagement/index.html
April 01, 2018 - Studies
Blog
AHRQ Views
Newsletter
AHRQ News Now
Events … Primary Care Settings
About AHRQ's Quality & Patient Safety Work
Patient Safety News and Events … institutions and practitioners can use to respond in a timely, thorough, and just way when unexpected events … Reconciliation
Learn about the processes that help detect and prevent medication discrepancies and adverse … drug events.
-
healthcare411.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/perinatal-care/modules/strategies/labor-delivery-unit/ldusafety_facguide.docx
May 01, 2017 - L&D unit staff are able to focus on patient care and have confidence that untoward events (change in … Fostering a culture that supports debriefing by the clinical team immediately after a near miss, an adverse … event, or an otherwise complex episode of care.
· A unit can decide its approach to debriefing events … Having a process in place to review severe maternal or neonatal morbidity and mortality events.
· A unit … Factors to consider—
Unit and malpractice claims data suggesting adverse events or near misses related
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healthcare411.ahrq.gov/news/newsletters/e-newsletter/835.html
October 01, 2022 - Studies
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AHRQ News Now
Events … section
News
Newsroom
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Newsletter
AHRQ News Now
Events … this week include:
The effect of a system-level tiered huddle system on reporting patient safety events … Understanding hazards for adverse drug events among older adults after hospital discharge: insights from
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healthcare411.ahrq.gov/news/blog/ahrqviews/unhealthy-alcohol-use-during-covid19.html
April 01, 2021 - Studies
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AHRQ Views
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AHRQ News Now
Events … this section
News
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Events … spectrum of alcohol misuse from risky or hazardous drinking to alcohol use disorder, is associated with adverse
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healthcare411.ahrq.gov/news/newsletters/e-newsletter/index.html?page=1
April 18, 2023 - Studies
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Events … Results
News
Newsroom
Blog
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Events … and Non-Hispanic Patients
July 12, 2022
Major Study Shows Significant Drop in In-Hospital Adverse
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healthcare411.ahrq.gov/sites/default/files/wysiwyg/professionals/education/curriculum-tools/teamstepps/instructor/essentials/implguide_0.pdf
March 01, 2006 - Available organizational data, (e.g.,
adverse event and near miss reports, AHRQ Patient Safety Culture … that facilities may also use the Guide to develop TeamSTEPPS Action Plans
in response to sentinel events … You may start by doing simple counts of your target events or clinical outcomes and
displaying … event or near miss
= Rate of Labor
& Delivery
Adverse &
Near-Miss
Events Total number of patients … events or near misses)
Who will be involved in the change?
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healthcare411.ahrq.gov/news/newsletters/e-newsletter/896.html
January 01, 2024 - Studies
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Events … section
News
Newsroom
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AHRQ News Now
Events … Changes in hospital adverse events and patient outcomes associated with private equity acquisition .
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healthcare411.ahrq.gov/patient-safety/settings/hospital/candor/modules/guide5/scenarios.html
August 01, 2022 - Studies
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Events … Patients and Families
About AHRQ's Quality & Patient Safety Work
Patient Safety News and Events … , and surgeon, along with a lack of familiarity with the new equipment as an important cause of the adverse
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healthcare411.ahrq.gov/news/newsletters/e-newsletter/901.html
February 01, 2024 - Studies
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Events … section
News
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Events … comment): Documentation Burden
AHRQ in the Professional Literature
Decision-making during high-risk events … Guideline concordance and antibiotic-associated adverse events between Veterans Administration and non-Veterans
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healthcare411.ahrq.gov/news/newsletters/e-newsletter/873.html
July 01, 2023 - Studies
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AHRQ News Now
Events … section
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Events … the Society of Thoracic Surgeons’ (STS) postoperative cardiac surgery guidelines is associated with adverse … events, according to an AHRQ-funded study in the Journal of Thoracic and Cardiovascular Surgery .
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healthcare411.ahrq.gov/news/newsletters/e-newsletter/877.html
August 01, 2023 - Studies
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AHRQ Views
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AHRQ News Now
Events … section
News
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AHRQ News Now
Events … Comparing rates of adverse events detected in incident reporting and the Global Trigger Tool: a systematic
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healthcare411.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/candor/candor-acknowledgments.pdf
September 14, 2017 - advance the implementation of a transparent and just response to those who have been
injured due to an adverse … team at every phase of CANDOR development, including during tool synthesis, training,
and stakeholder events
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healthcare411.ahrq.gov/research/findings/studies/index.html?page=485
January 01, 2024 - Studies
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Events … 1279)
2015
(1430)
2014
(662)
2013
(195)
Topics
Access to Care
(417)
Adverse … Drug Events (ADE)
(321)
Adverse Events
(737)
Alcohol Use
(61)
Ambulatory Care and Surgery
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healthcare411.ahrq.gov/ncepcr/communities/pbrn/registry/dartmouth-practice-based-research-network.html
January 01, 2012 - Studies
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AHRQ Views
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AHRQ News Now
Events … health or disease related issues: Use of Benzodiazephines/Benzodiazepine Agonists in Chronic Insomnia, Adverse
-
healthcare411.ahrq.gov/hai/hai-carb-funding.html
November 01, 2021 - Studies
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AHRQ Views
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Events … determine the clinical efficacy and effectiveness of preventive interventions including unintended adverse
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healthcare411.ahrq.gov/sites/default/files/wysiwyg/teamstepps/webinars/2017-materials/teamstepps-webinar-071217.pptx
January 01, 2017 - TEAMSTEPPS 05.2
Slide ‹#›
2
Upcoming TeamSTEPPS Events
Master Training Courses
Registration for … TEAMSTEPPS 05.2
Slide ‹#›
A table shows the Most Frequently Identified Root Causes of Sentinel Events … Communication, and Leadership are in the top three positions for 2013, 2014, and 2015, totaling 79% of adverse … events.
13
TEAMSTEPPS 05.2
Slide ‹#›
A team of experts becomes an Expert Team.
14
TeamSTEPPS … Situation: She’s having a lot of ABD events that are now requiring stimulation.