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5701. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/43006/psn-pdf
      April 02, 2014 - Hamilton Acute Pain Service Safety Study: using root cause analysis to reduce the incidence of adverse … Hamilton acute pain service safety study: using root cause analysis to reduce the incidence of adverse … https://psnet.ahrq.gov/issue/hamilton-acute-pain-service-safety-study-using-root-cause-analysis-reduce … - incidence-adverse The implementation of formal root cause analysis was associated with substantial … https://psnet.ahrq.gov/primer/root-cause-analysis

5702. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/38779/psn-pdf
      July 15, 2009 - Prospective risk analysis of health care processes: a systematic evaluation of the use of HFMEA in Dutch … Prospective risk analysis of health care processes: a systematic evaluation of the use of HFMEA in Dutch … https://psnet.ahrq.gov/issue/prospective-risk-analysis-health-care-processes-systematic-evaluation-use … - hfmea-dutch-health This study analyzed 13 failure mode and effect analysis (FMEA) efforts to understand … https://psnet.ahrq.gov/issue/prospective-risk-analysis-health-care-processes-systematic-evaluation-use-hfmea-dutch-health

5703. Defining an Optimal Format for Presenting Research Needs (pdf file)
      effectivehealthcare.ahrq.gov/sites/default/files/pdf/methods-future-presentation-format_research.pdf
      January 01, 2019 - Search Flow for Systematic Reviews with Meta-Analysis 22T ........................................... … EVPI is an analysis that places an upper bound to this opportunity cost, or equivalently, an upper … Our literature search identified 414 systematic reviews with meta-analysis. … Table 1 summarizes our findings from systematic reviews with meta-analysis. 7 Table 1. … Searches for systematic reviews with meta-analysis (("meta-analysis"[Publication Type] OR "meta-analysis

5704. The health information infrastructure in America today . . . . (pdf file)
      hcup-us.ahrq.gov/datainnovations/clinicaldata/AHRQHCUPfinalNov09BDiefenbach.pdf
      November 01, 2009 - Agency for Health Care Administration Florida Center for Health Information and Policy Analysis HCUP … Learned Agency for Health Care Administration Florida Center for Health Information and Policy Analysis … Hospital Agency for Health Care Administration Florida Center for Health Information and Policy Analysis … Agency for Health Care Administration Florida Center for Health Information and Policy Analysis Data … Agency for Health Care Administration Florida Center for Health Information and Policy Analysis LOINC

5705. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/36689/psn-pdf
      June 14, 2011 - Root cause analysis. June 14, 2011 Stecker MS. Root cause analysis. … https://psnet.ahrq.gov/issue/root-cause-analysis The author provides an introduction to root cause analysis … https://psnet.ahrq.gov/issue/root-cause-analysis https://psnet.ahrq.gov/primer/root-cause-analysis

5706. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/43207/psn-pdf
      April 25, 2016 - Root cause analysis of serious adverse events among older patients in the Veterans Health Administration … Root cause analysis of serious adverse events among older patients in the Veterans Health Administration … https://psnet.ahrq.gov/issue/root-cause-analysis-serious-adverse-events-among-older-patients-veterans … Compared to previous research, this study highlights robust use of root cause analysis while emphasizing … https://psnet.ahrq.gov/issue/root-cause-analysis-serious-adverse-events-among-older-patients-veterans-health

5707. Wrong drug and wrong dose dispensing errors identified in pharmacist professional liability claims. | PSNet
      psnet.ahrq.gov/issue/wrong-drug-and-wrong-dose-dispensing-errors-identified-pharmacist-professional-liability
      August 31, 2016 - June 16, 2019 ISMP medication error report analysis. … June 16, 2019 ISMP medication error report analysis. … June 16, 2019 ISMP medication error report analysis. … June 16, 2019 ISMP medication error report analysis. … June 16, 2019 ISMP medication error report analysis.

5708. S89 (pdf file)
      effectivehealthcare.ahrq.gov/sites/default/files/s89.pdf
      October 01, 2007 - Two forms of maxSPRT were implemented: an analysis using concurrent matched controls, and an analysis … Analysis Using Matched Controls We used 2 forms of maxSPRT in this study. … Meningococcal Vaccinations in the Analysis for This Outcome* Cumulative No. … The x-axis shows how the LLR changes each week during the analysis. … However, analysis using matched controls has important limitations.

5709. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/35703/psn-pdf
      July 13, 2010 - Injury and liability associated with monitored anesthesia care: a closed claims analysis. … Injury and liability associated with monitored anesthesia care: a closed claims analysis. … https://psnet.ahrq.gov/issue/injury-and-liability-associated-monitored-anesthesia-care-closed-claims- analysis … Investigators performed a detailed analysis of more than 120 MAC claims, compared them with those of … https://psnet.ahrq.gov/issue/adverse-respiratory-events-anesthesia-closed-claims-analysis

5710. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/38697/psn-pdf
      June 10, 2009 - A report card system using error profile analysis and concurrent morbidity and mortality review: surgical … outcome analysis, part II. … A report card system using error profile analysis and concurrent morbidity and mortality review: surgical … outcome analysis, part II. … https://psnet.ahrq.gov/issue/report-card-system-using-error-profile-analysis-and-concurrent-morbidity-and

5711. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/45827/psn-pdf
      January 24, 2018 - Using failure mode and effects analysis to reduce patient safety risks related to the dispensing process … Using Failure mode and Effects Analysis to reduce patient safety risks related to the dispensing process … https://psnet.ahrq.gov/issue/using-failure-mode-and-effects-analysis-reduce-patient-safety-risks-related … - dispensing Failure mode and effect analysis is a tool commonly used to proactively assess the reliability … The authors describe the application of failure mode and effect analysis to identify failure modes in

5712. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/34803/psn-pdf
      January 05, 2017 - Systematic root cause analysis of adverse drug events in a tertiary referral hospital. … Systematic Root Cause Analysis of Adverse Drug Events in a Tertiary Referral Hospital. … This study examines the utility of root cause analysis (RCA) to identify, investigate, and address … The authors conclude that systematic application of root cause analysis, coupled with implementation … https://psnet.ahrq.gov/primer/root-cause-analysis https://psnet.ahrq.gov//#adversedrugevent

5713. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/38861/psn-pdf
      August 26, 2009 - Survey evaluation of the National Patient Safety Agency’s Root Cause Analysis training programme in … Survey evaluation of the National Patient Safety Agency's Root Cause Analysis training programme in … https://psnet.ahrq.gov/issue/survey-evaluation-national-patient-safety-agencys-root-cause-analysis- … training-programme Formal root cause analysis (RCA) training conducted by the United Kingdom's National … https://psnet.ahrq.gov/primer/root-cause-analysis https://psnet.ahrq.gov/issue/national-patient-safety-agency-npsa

5714. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/42590/psn-pdf
      August 02, 2015 - Health care-associated infections: a meta-analysis of costs and financial impact on the US health care … Health care-associated infections: a meta-analysis of costs and financial impact on the US health care … https://psnet.ahrq.gov/issue/health-care-associated-infections-meta-analysis-costs-and-financial-impact-us … This economic analysis combined a systematic review of estimates of costs attributable to HAIs with … https://psnet.ahrq.gov/issue/business-case-quality-case-studies-and-analysis

5715. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/35435/psn-pdf
      June 14, 2011 - Drill down with root cause analysis. June 14, 2011 McDonald A, Leyhane T. … Drill down with root cause analysis. Nurs Manage. 2005;36(10):26-32. … https://psnet.ahrq.gov/issue/drill-down-root-cause-analysis The authors outline a six-step process for … root cause analysis and highlight the importance of understanding state disclosure and discovery laws … https://psnet.ahrq.gov/issue/drill-down-root-cause-analysis https://psnet.ahrq.gov/primer/root-cause-analysis

5716. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/44754/psn-pdf
      March 23, 2016 - Use of failure mode and effects analysis to improve emergency department handoff processes. … Use of Failure Mode and Effects Analysis to Improve Emergency Department Handoff Processes. … https://psnet.ahrq.gov/issue/use-failure-mode-and-effects-analysis-improve-emergency-department- handoff-processes … This commentary describes a project that used failure mode and effects analysis to identify weaknesses … https://psnet.ahrq.gov/issue/use-failure-mode-and-effects-analysis-improve-emergency-department-handoff-processes

5717. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/46188/psn-pdf
      June 21, 2017 - Death by suicide within 1 week of hospital discharge: a retrospective study of root cause analysis reports … Death by Suicide Within 1 Week of Hospital Discharge: A Retrospective Study of Root Cause Analysis Reports … psnet.ahrq.gov/issue/death-suicide-within-1-week-hospital-discharge-retrospective-study-root- cause-analysis … This review of root cause analysis reports about suicide within 7 days of discharge from inpatient … /psnet.ahrq.gov/issue/death-suicide-within-1-week-hospital-discharge-retrospective-study-root-cause-analysis

5718. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/43595/psn-pdf
      November 19, 2014 - Patient safety in external beam radiotherapy—guidelines on risk assessment and analysis of adverse error-events … Patient safety in external beam radiotherapy - guidelines on risk assessment and analysis of adverse … https://psnet.ahrq.gov/issue/patient-safety-external-beam-radiotherapy-guidelines-risk-assessment-and- analysis-adverse … other safety concerns, adverse events are under-reported to voluntary reporting systems and root cause analysis … https://psnet.ahrq.gov/primer/reporting-patient-safety-events https://psnet.ahrq.gov/primer/root-cause-analysis

5719. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/37784/psn-pdf
      May 27, 2011 - A risk analysis method to evaluate the impact of a Computerized Provider Order Entry system on patient … A risk analysis method to evaluate the impact of a computerized provider order entry system on patient … https://psnet.ahrq.gov/issue/risk-analysis-method-evaluate-impact-computerized-provider-order-entry- … This study conducted a detailed quantitative analysis, following a failure mode and effect analysis … https://psnet.ahrq.gov/issue/risk-analysis-method-evaluate-impact-computerized-provider-order-entry-system-patient-safety

5720. Predictors of warfarin-associated adverse events in hospitalized patients: opportunities to prevent patient harm. | PSNet
      psnet.ahrq.gov/issue/predictors-warfarin-associated-adverse-events-hospitalized-patients-opportunities-prevent
      August 03, 2016 - June 16, 2019 ISMP medication error report analysis. … June 16, 2019 ISMP medication error report analysis. … June 16, 2019 ISMP medication error report analysis. … June 16, 2019 ISMP medication error report analysis. … June 16, 2019 ISMP medication error report analysis.