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www.ahrq.gov/sites/default/files/wysiwyg/evidencenow/building-capacity/EvidenceNOW-BSC-OH-profile.pdf
September 01, 2021 - The state
has a high burden of cardiovascular disease (CVD) and substantial disparities in
CVD risk factors … Smoking rates are higher in Ohio’s geographic regions with lower
socioeconomic factors mirroring the … Determine patient, provider, clinic, and other contextual factors associated
with greater improvements … implementation,
maintenance, and efectiveness of the heart healthy QIP overall
and by subgroup; and (3) factors
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/mvp/modules/cusp/science-of-safety-slides.pptx
January 01, 2017 - After this session, you will be able to—
Understand and apply the Science of Safety
Identify how system factors … Science of Safety ‹#›
AHRQ Safety Program for Mechanically Ventilated Patients
5
Institutional
System Factors … Program for Mechanically Ventilated Patients
6
Safety
Institutional
Hospital
Departmental Factors … Work Environment
Team Factors
Individual Provider
Task Factors
Patient Characteristics
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www.ahrq.gov/research/findings/final-reports/ssi/ssiapc.html
April 01, 2018 - Initial Risk Factors
Appendix J. Additional Risk Factors
Appendix K. … Final Risk Factors
Appendix L. … Final data sheet submitted by each site that included the list of potential SSI risk factors and other … Focus Group Risk Factors
Appendix Q. Surgeon Focus Group Content Analysis
Appendix R.
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www.ahrq.gov/sites/default/files/2025-02/nishisaki2-report.pdf
January 01, 2025 - To identify
candidate factors to target for pediatric TI quality improvement by analyzing NEAR4KIDs … Risk factors included pre-existing hemodynamic instability, history of
difficult airway, and resident … Risk factors were
identified. … A preliminary QI checklist
was developed by incorporating the identified risk factors (factors associated … First, clinical variables were evaluated for
potential risk factors for TIAEs and severe TIAEs.
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www.ahrq.gov/hai/cusp/clabsi-final-companion/clabsicompapf.html
January 01, 2013 - Pediatric Units
Infections Avoided, Excess Costs Averted, and Changes in Mortality Rate
Moderating Factors … Moderating Factors Flowchart
Appendix F. Team Checkup Tools
Appendix G.
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www.ahrq.gov/sites/default/files/2024-01/daugherty-report.pdf
January 01, 2024 - science.3 Human factors related to
cognitive overload; the effects of stress, fatigue, distractions … Team factors made up 21% of the contributing factors to the total
patient safety occurrences, as reported … Team factors 1418 20.9% 1170 20.6%
2. Work environment 1646 24.3% 1326 23.4%
3. … Task factors 1995 29.5% 1608 28.3%
4. Staff factors 204 3.1% 161 2.8%
5. … : team factors, 2004-2005
Team Factors
2004
Risk
Manager
Score
Percent
2005
Risk
Manager
Score
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www.ahrq.gov/patient-safety/resources/learning-lab/idea-ll-long-desc.html
August 01, 2025 - emergency departments (EDs) by examining diagnostic decision making, identifying contributing risk factors … Through a transdisciplinary team of clinicians, engineers, human factors experts, informaticians, and … decision-making processes in the ED and identify contributing patient-, provider-, and system-level factors … Investigating Factors Influencing Diagnostic Safety in Emergency Department Patients Using Decision Trees … Mining Electronic Health Records To Identify Key Factors Influencing Diagnostic Errors in the Emergency
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www.ahrq.gov/sites/default/files/wysiwyg/patient-safety/reports/issue-briefs/dxsafety-issuebrief-maternal-morbidity.pdf
September 01, 2021 - ].15
Cognitive and system errors are major
contributing factors to diagnostic error. … delayed diagnosis.19
System errors are major contributing factors
to diagnostic error. … Explore teamwork factors associated
with prompt response to [maternal
hemorrhage]. … Explore which factors promote real-time
quantification and discussion of blood loss. … The
continuum of maternal morbidity and mortality: factors associated with severity.
-
www.ahrq.gov/sites/default/files/wysiwyg/hai/tools/mrsa-2/089-or-traffic-fg.docx
April 01, 2025 - This presentation will review components of the OR airflow, or ventilation, and explore how these factors … Slide 8
Human Factors Engineering
SAY:
Multifactorial processes can affect OR air quality, and the … Here are two examples using human factors engineering or understanding and working within the way work … Another example of applying human factors engineering comes from the Netherlands. … and examined the system factors that could have contributed to the event—in this case, increased door
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www.ahrq.gov/research/findings/final-reports/index.html?page=19
January 01, 2024 - These topics include human factors approaches to improve patient safety, patient safety measure development … Principal Investigators: Picone and Jollis Grant Number: R03 HS 013386 Topic(s): Human and Environmental Factors … 12035 Topic(s): Health Information Technology and Health Information Exchange, Human and Environmental Factors … Investigators: Linzer and Schwartz Grant Number: R01 HS 11955 Topic(s): Human and Environmental Factors
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www.ahrq.gov/patient-safety/settings/hospital/vtguide/appb2.html
January 01, 2020 - B.10 Caprini Individualized Point-Based (Quantitative) Model of VTE Risk Assessment
Factors … A large number of VTE risk factors are included, which may increase sensitivity. … It uses more common risk factors compared with the Brigham and Women's Hospital (BWH) model, but many … Fully ambulatory without multiple VTE risk factors. … He has no other known VTE risk factors.
Physical exam shows low-grade fever.
-
www.ahrq.gov/es/patient-safety/settings/hospital/vtguide/appb2.html
January 01, 2020 - B.10 Caprini Individualized Point-Based (Quantitative) Model of VTE Risk Assessment
Factors … A large number of VTE risk factors are included, which may increase sensitivity. … It uses more common risk factors compared with the Brigham and Women's Hospital (BWH) model, but many … Fully ambulatory without multiple VTE risk factors. … He has no other known VTE risk factors.
Physical exam shows low-grade fever.
-
www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol4/Blegen.pdf
January 01, 2004 - However, systems and climate factors can be extracted from
existing work. … This final solution contained 28 items in
six patient safety factors. … Factors contributing to medication errors: a
literature review. … Workload and environmental
factors in hospital medication errors. … Hum Factors 2003;45:173–85.
36. Singer SJ, Gaba DM, Geppert JJ, et al.
-
www.ahrq.gov/sites/default/files/2025-05/bisantz-report.pdf
January 01, 2025 - and Systems Engineering, University at Buffalo, SUNY, Buffalo,
NY, USA;
2National Center for Human Factors … Methods: Human factors methodologies were used to model ED work and identify
information needs in order … Multi-day Brainstorming: A brainstorming method involving team members with both
human factors and ED … and Ergonomics in Healthcare: Advancing the
Cause, Human Factors and Ergonomics Society, March 11-13 … Poster presented at HFES 2014
11
International Symposium on Human Factors and Ergonomics in Health
-
www.ahrq.gov/sites/default/files/wysiwyg/npsd/data/spotlights/spotlight-ptsafety-and-covid-19.pdf
November 01, 2021 - ............................................................ 5
Descriptions of Other Contributing Factors … (typically categorized as Human Factors). … Analysis of 124 records for which “COVID-19” was referenced in the
Contributing Factors unstructured … Paraphrased text describing other contributing factors for a limited number of records
Type of Event … Additionally, when asked to indicate the factors contributing to the event or unsafe
condition, the
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www.ahrq.gov/sites/default/files/wysiwyg/patient-safety/settings/mcc-summit/mcc-summit-dorr-samal.pdf
May 19, 2020 - Biopsychosocial factors play a significant role
in MCC outcomes
And the factors that may predict … Internet broadband access is associated with portal use even after
controlling for sociodemographic factors … Biopsychosocial factors play a significant role in MCC outcomes
And the factors that may predict outcomes
-
www.ahrq.gov/sites/default/files/wysiwyg/evidencenow/cooperatives/evidencenow-executive-summary-nyc.pdf
November 01, 2017 - disease is the primary cause of
death in the city, and prevalence of cardiovascular disease (CVD) risk factors … Use qualitative methods to assess factors that help and hinder practices in
implementing change and … ABCS-driven
care
• Three expert webinars on topics related to evidence-
based management of CVD risk factors … practices [AcademyHealth,
2017]
• Using Practice Facilitation in primary care settings to
reduce risk factors … Conference, 2016]
• Using Practice Facilitation in primary care settings to
reduce risk factors for
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/qitoolkit/combined/d4k_combo_psi14-dehiscence-bestpractices.pdf
May 20, 2016 - Though many risk factors are non-modifiable, there are factors that can be
addressed by hospitals, such … Determine risk factors for postoperative wound dehiscence
and identify patients at risk.1-3,7
Reduce … Recommended Practice: Wound Dehiscence Risk Assessment
• Complete a preoperative assessment to identify factors … of surgery (clean vs. contaminated)
Surgical error
• When possible, eliminate or mitigate risk factors … • Educate patient about risk factors of noncompliance with postoperative instructions.
-
www.ahrq.gov/diagnostic-safety/resources/issue-briefs/dxsafety-reimagining-healthcare-teams-3.html
July 01, 2023 - In many cases, they do not individualize a patient’s risk, consider patient-specific contextual factors … For a young male patient with no other risk factors, nonvalvular atrial fibrillation confers a 0.2 percent … annual risk of stroke. 17,18 For an older female patient with all possible risk factors, the annual
-
www.ahrq.gov/healthsystemsresearch/hspc-research-study/appendix-b.html
June 01, 2020 - Social Factors. … But another study, that simply mentions measuring “individual-level HIV risk factors,” would be counted … Social Factors
Includes whether a patient has a particular insurance type. … Studies that examine patients’ social interactions will be considered to be Social Factors as well as … status, ethnicity/race, or gender will be considered both Social Factors and Equity.