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psnet.ahrq.gov/node/74193/psn-pdf
December 15, 2021 - Input for the TeamSTEPPS Curriculum Updates.
December 15, 2021
Rockville MD, Agency for Healthcare Quality and Research. December 7, 2021.
https://psnet.ahrq.gov/issue/input-teamstepps-curriculum-updates
The TeamSTEPPS program is an established approach for improving teamwork and communication in
health care. This…
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www.ahrq.gov/ecareplan/videos/index.html
August 01, 2024 - eCare Plan Videos
The eCare Plan project produced three videos on the following topics: Video 1: Challenges of Managing Multiple Chronic Conditions This video introduces Dorothea, who has multiple chronic conditions, and explains some of the difficulties navigating a complex health care system. Video 2: Creatin…
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www.ahrq.gov/patient-safety/settings/labor-delivery/perinatal-care/modules/teamwork/worksheet.html
July 01, 2023 - Labor and Delivery Unit Safety Issues Worksheet for Senior Executive Partnership
AHRQ Safety Program for Perinatal Care
Purpose: To enhance communication and shared problem solving between clinical staff and senior executives with respect to patient safety issues on the labor and delivery unit.
…
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psnet.ahrq.gov/node/39068/psn-pdf
October 28, 2009 - Four patients say Cedars-Sinai did not tell them they had
received a radiation overdose.
October 28, 2009
Zarembo A.
https://psnet.ahrq.gov/issue/four-patients-say-cedars-sinai-did-not-tell-them-they-had-received-radiation-
overdose
This news piece describes communication gaps following a radiation overdose incid…
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www.ahrq.gov/nursing-home/resources/osha-covid-19-standards.html
May 01, 2022 - OSHA COVID-19 Standards Webpage
Resource: OSHA COVID-19 Standards Webpage
This webpage provides additional information about Occupational Safety & Health Administration (OSHA) COVID-19 exposure standards and requirements, including requirements in states that operate their own OSHA-approved State Plans; rec…
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www.ahrq.gov/practiceimprovement/systemdesign/leancasestudies/lean-case1.html
November 01, 2014 - Improving Care Delivery Through Lean: Implementation Case Studies
Case 1. Lakeview Healthcare
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Table of Contents
Improving Care Delivery Through Lean: Implementation Case Studies
Introduction to the Case Studies
Case 1. Lakeview Healthcare
Case 2. Central Hospital
Case…
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psnet.ahrq.gov/web-mm/not-miscarriage
June 01, 2005 - Not a Miscarriage
Citation Text:
Learman LA. Not a Miscarriage. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2003.
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Format:
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…
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psnet.ahrq.gov/node/60167/psn-pdf
April 12, 2024 - Discharge Planning and Transitions of Care
March 25, 2020
Bajorek SA, McElroy V. Discharge Planning and Transitions of Care. PSNet [internet]. 2020.
https://psnet.ahrq.gov/primer/discharge-planning-and-transitions-care
Background
Transitions of care refer to the movement of patients between different healthcare se…
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psnet.ahrq.gov/web-mm/it-safe-be-direct
September 30, 2015 - Is It Safe to Be Direct?
Citation Text:
Kulkarni NS, Williams M. Is It Safe to Be Direct?. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2008.
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psnet.ahrq.gov/node/49772/psn-pdf
October 01, 2016 - Lapse in Antibiotics Leads to Sepsis
October 1, 2016
Levy MM. Lapse in Antibiotics Leads to Sepsis. PSNet [internet]. 2016.
https://psnet.ahrq.gov/web-mm/lapse-antibiotics-leads-sepsis
The Case
A 34-year-old near-term pregnant woman presented to the emergency department (ED) with abdominal
pain, fevers, and short…
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psnet.ahrq.gov/node/49686/psn-pdf
May 01, 2013 - Don't Use That Port: Insert a PICC
May 1, 2013
Ilan R. Don't Use That Port: Insert a PICC. PSNet [internet]. 2013.
https://psnet.ahrq.gov/web-mm/dont-use-port-insert-picc
The Case
A 48-year-old woman receiving neoadjuvant therapy for breast cancer was admitted to the hospital with
fever and abdominal pain. A comp…
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psnet.ahrq.gov/node/853772/psn-pdf
September 27, 2023 - Insulin Administration: Pen vs Vial – Similar, but Not
Interchangeable
September 27, 2023
Camarillo H. Insulin Administration: Pen vs Vial – Similar, but Not Interchangeable. PSNet [internet]. 2023.
https://psnet.ahrq.gov/web-mm/insulin-administration-pen-vs-vial-similar-not-interchangeable
The Case
A fourteen-ye…
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psnet.ahrq.gov/primer/strategies-improve-organizational-health-literacy
August 30, 2023 - Strategies to Improve Organizational Health Literacy.
Citation Text:
Seidel E, Cortes T, Chong C. Strategies to Improve Organizational Health Literacy.. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2023.
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psnet.ahrq.gov/web-mm/misleading-complaint
December 01, 2009 - Misleading Complaint
Citation Text:
Soni K, Dhaliwal G. Misleading Complaint. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2012.
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digital.ahrq.gov/ahrq-funded-projects/improving-population-health-through-enhanced-targeted-regional-decision-support
January 01, 2023 - Improving Population Health Through Enhanced Targeted Regional Decision Support
Project Final Report ( PDF , 1.05 MB) Disclaimer
Disclaimer
The findings and conclusions in this document are those of the author(s), who are responsible for its content, and do not necessarily repr…
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psnet.ahrq.gov/web-mm/wrong-route-nutrients
September 04, 2010 - Wrong Route for Nutrients
Citation Text:
Scott-Cawiezell JR. Wrong Route for Nutrients. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2008.
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www.ahrq.gov/patient-safety/quality-resources/tools/chtoolbx/measures/measure-2.html
November 01, 2017 - Established Child Health Care Quality Measures—CAHPS
Child Health Care Quality Toolbox
The Child Health Toolbox contains concepts, tips, and tools for evaluating the quality of health care for children.
Contents
Expanded CAHPS 3.0 Child Survey
Children with Chronic Conditions
Screener Questions
…
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digital.ahrq.gov/ahrq-funded-projects/patients-safeguards-understanding-information-needs-hospitalized-patients
January 01, 2023 - Patients as Safeguards: Understanding the Information Needs of Hospitalized Patients
Project Final Report ( PDF , 978.5 KB) Disclaimer
Disclaimer
The findings and conclusions in this document are those of the author(s), who are responsible for its content, and do not necessaril…
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www.ahrq.gov/diagnostic-safety/resources/issue-briefs/state-of-science-2.html
June 01, 2020 - Operational Measurement of Diagnostic Safety: State of the Science
Special Considerations for Measurement of Diagnostic Safety
Previous Page Next Page
Table of Contents
Operational Measurement of Diagnostic Safety: State of the Science
Introduction
Special Considerations for Measurement of Diagn…
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psnet.ahrq.gov/node/50843/psn-pdf
January 29, 2020 - Incomplete Orders for Hypertonic Saline to Treat
Hyponatremia
January 29, 2020
Wiegley N, Morfín JA. Incomplete Orders for Hypertonic Saline to Treat Hyponatremia. PSNet [internet].
2020.
https://psnet.ahrq.gov/web-mm/incomplete-orders-hypertonic-saline-treat-hyponatremia
The Case
A 54-year-old man was brought t…