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  1. www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol3/Flink.pdf
    April 09, 2004 - Malpractice Prevention Program.1 This program was created by the legislature to capture preventable events caused
  2. www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/nicu_toolkit/nicupacket.pdf
    December 01, 2013 - Short Bowel Syndrome Pathophysiology ■ Functional disorder caused by alterations of normal intestinal … – Caused by: immature sleep-wake cycles, disruptions in sleep patterns caused by the need to give … ■ Subglottic stenosis may be caused by intraoperative damage to cricoid, tracheostomy placed too
  3. www.ahrq.gov/sites/default/files/wysiwyg/patient-safety/settings/hospitals/nicupacket.pdf
    December 01, 2013 - Short Bowel Syndrome Pathophysiology ■ Functional disorder caused by alterations of normal intestinal … – Caused by: immature sleep-wake cycles, disruptions in sleep patterns caused by the need to give … ■ Subglottic stenosis may be caused by intraoperative damage to cricoid, tracheostomy placed too
  4. www.ahrq.gov/hai/quality/tools/cauti-ltc/modules/resources/tools/reduce/4-things.html
    March 01, 2017 - 4 Things You Should Know About Urine Cultures AHRQ Safety Program for Long-Term Care: HAIs/CAUTI 1. Bacteria in the urine does not necessarily mean a catheter-associated urinary tract infection (CAUTI) is present. Bacteriuria is the term used to describe a positive urine culture, the presenc…
  5. www.ahrq.gov/patient-safety/settings/hospital/candor/modules/guide4/apa.html
    August 01, 2022 - Event Investigation and Analysis Guide: Appendix A Five Whys In this example, there is only one path shown, but answers can create multiple paths and more questions. Event Summary:   The wrong concentration of potassium (K+) was used in the compounding of TPN. This was discovered almost 2 months later. 1s…
  6. www.ahrq.gov/es/patient-safety/settings/hospital/red/toolkit/redtool6.html
    March 01, 2025 - Re-Engineered Discharge (RED) Toolkit Tool 6: How To Monitor RED Implementation and Outcomes Previous Page Next Page Table of Contents Re-Engineered Discharge (RED) Toolkit Tool 1: Overview Tool 2: How To Begin the Re-engineered Discharge Implementation at Your Hospital How CMS Measures the "3…
  7. www.ahrq.gov/patient-safety/settings/hospital/red/toolkit/redtool6.html
    March 01, 2025 - Re-Engineered Discharge (RED) Toolkit Tool 6: How To Monitor RED Implementation and Outcomes Previous Page Next Page Table of Contents Re-Engineered Discharge (RED) Toolkit Tool 1: Overview Tool 2: How To Begin the Re-engineered Discharge Implementation at Your Hospital How CMS Measures the "3…
  8. www.ahrq.gov/patient-safety/settings/hospital/resource/guide/web1.html
    December 01, 2017 - Webinar 1: Introduction & Overview: Slide Presentation Designing & Delivering Whole-Person Transitional Care: The Hospital Guide to Reducing Medicaid Readmissions Text version of Webinar slide presentation. Slide 1: Designing & Delivering Whole-Person Transitional Care The Hospital Guide to Reducing Med…
  9. www.ahrq.gov/sites/default/files/wysiwyg/cahps/news-and-events/events/webinars/data-analysis-webcast-advancing-methods-4.pdf
    March 03, 2021 - Improving Patient Experience: Data Analysis Methods webcast - Wellstar Advancing Methods of Implementing and Evaluating Patient Experience Improvement Using CAHPS® Surveys March 3, 2021 Natalie McNeal, MBA, MHA Wellstar Community Hospice Our state-of-the-art facilities include: 11 HOSPITALS 300+ MEDICAL O…
  10. www.ahrq.gov/hai/pfp/haccost2017-discuss.html
    November 01, 2017 - Estimating the Additional Hospital Inpatient Cost and Mortality Associated With Selected Hospital-Acquired Conditions Discussion Previous Page Next Page Table of Contents Estimating the Additional Hospital Inpatient Cost and Mortality Associated With Selected Hospital-Acquired Conditions Discussio…
  11. www.ahrq.gov/sites/default/files/wysiwyg/hai/tools/mrsa-2/047-ss-faqs-staff-safety-side-effects.docx
    April 01, 2025 - AHRQ Safety Program for MRSA Prevention: Targeting SSI Preoperative Decolonization Staff – Frequently Asked Questions: Safety and Side Effects Surgical Services For: Cardiac, Hip and Knee Joint Replacement, and Spinal Fusion Surgeries​ The products we are recommending for surgical site infection (SSI) preven…
  12. www.ahrq.gov/policy/foia/foiafy09.html
    October 01, 2014 - Documents requested were protected by an exemption and release would have caused harm to the interest
  13. www.ahrq.gov/policy/foia/foiafy08.html
    October 01, 2014 - Documents requested were protected by an exemption and release would have caused harm to the interest
  14. www.ahrq.gov/sites/default/files/wysiwyg/antibiotic-use/best-practices/sepsis-facilitator-guide.pdf
    November 01, 2019 - Improving Antibiotic Use – Acute Care Moment 1: Diagnosing Sepsis SAY: Sepsis is a syndrome caused … community-acquired pneumonia and community-acquired intra- abdominal and urinary tract infections are not caused
  15. www.ahrq.gov/sites/default/files/wysiwyg/data/infographics/adverse-drug-events.pdf
    June 02, 2025 - Adverse Drug Events occurring in U.S. Hospitals 0 10 20 30 40 50 60 70 80 Adverse Drug Events Occurring in U.S. Hospitals Adverse drug events (ADEs) are the most common nonsurgical adverse events that occur in hospitals. New data from all payers in 32 States in HCUP show characteristics of the four most frequent …
  16. www.ahrq.gov/sites/default/files/2024-11/sarkar2-report.pdf
    January 01, 2024 - Final Progress Report: Investigating Failures of Notification and Monitoring in Outpatient Care: the Safety Promotion Action Research and Knowledge Network AHRQ Final Progress Report: Investigating Failures of Notification and Monitoring in Outpatient Care: the Safety Promotion Action Resea…
  17. www.ahrq.gov/sites/default/files/wysiwyg/antibiotic-use/best-practices/HAP-facilitator-guide.pdf
    November 01, 2019 - Title and Commentary Slide Number and Slide Moment 2: Diagnostic Tests for HAP SAY: HAP can be caused
  18. www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/candor/module4/mod4-system-focused-event-guide.pdf
    April 01, 2016 - the system (other than the involved individual) that might have contributed to, facilitated, or even caused … employees feel comfortable sharing openly, as that will lead to a more accurate assessment of what caused … Causal factor: the suspected or confirmed factors that caused the adverse event.
  19. www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/long-term-care/resources/ontime/fallsprev/fallspximpl-handouts.docx
    June 02, 2025 - Assessment will make it easier to understand the circumstances of the fall and will help us determine what caused
  20. www.ahrq.gov/sites/default/files/2024-12/moyer-report.pdf
    January 01, 2024 - Final Progress Report: Crossing an Invisible Quality Chasm: From NICU to Ambulatory Care AHRQ Grant Final Progress Report Title: Crossing An Invisible Quality Chasm: From NICU to Ambulatory Care Principal Investigator: Virginia A. Moyer, MD, MPH Team Members: Papile, Lucille A., MD, Co-Investigator Guillory, Char…

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