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Showing results for "failure".

141. 0129References (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/policymakers/chipra/factsheets/fullreports/0129references.pdf
     October 23, 2013 - What works in chronic care management: the case of heart failure. … Transitional care of older adults hospitalized with heart failure: a randomized, controlled trial. … Impact of a standardized heart failure order set on mortality, readmission, and quality and costs of … Structured telephone support or telemonitoring programmes for patients with chronic heart failure. … Hospital strategies associated with 30-day readmission rates for patients with heart failure.

142. References (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/policymakers/chipra/factsheets/fullreports/chipra-131-references.pdf
     October 23, 2013 - Structured telephone support or telemonitoring programmes for patients with chronic heart failure. … What works in chronic care management: the case of heart failure. … Transitional care of older adults hospitalized with heart failure: a randomized, controlled trial. … Hospital strategies associated with 30-day readmission rates for patients with heart failure. … Hospital nursing and 30-day readmissions among Medicare patients with heart failure, acute myocardial

143. Conceptual Paradigms of Diagnostic Quality, Safety, and Excellence | Agency for Healthcare Research and Quality
     www.ahrq.gov/diagnostic-safety/resources/issue-briefs/dxsafety-terminology5.html
     April 01, 2025 - been defined as “freedom from accidental injury” 11  and is rooted in recognition of error  ( the failure … or expenses for patients. 17 Historically, the concept of diagnostic safety has largely focused on failure … to adequately diagnose, in which case, the harm comes from the underlying disease and is due to failure … layers of “defenses” and explains that a confluence of many circumstances often contribute to a final failure … One consequence of defining failure or problems as “errors” is a strong tendency by those unfamiliar

144. Final Progress Report: Medication Error Reduction, Technologies and Human Factors (pdf file)
     www.ahrq.gov/sites/default/files/2024-01/carayon-report.pdf
     January 01, 2024 - Failure mode and effects analysis We conducted two failure mode and effects analyses (FMEAs), one addressing … Last, actions and outcome measures were determined for failure modes that proceeded. … Failure modes were divided into two groups: failure modes that were resolved through BCMA software upgrade … Failure mode and effects analysis E3.1.1. IV Pump FMEA Over 200 failure modes were identified. … An average of 1.9 solutions was determined per failure mode (mode 1; range 1-5); 23% of failure modes

145. Presentation: Tools for Sustainability: Premortem and Scorecard
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/mvp/modules/sustainability/premortem-scorecard-slides.pptx
     January 01, 2017 - Avoid recidivism, or backsliding Respect probability of failure over time Recognize risks to sustaining … Exercise helps you– Imagine the project has failed Brainstorm contributing factors that led to this failure … Program for Mechanically Ventilated Patients 16 Premortem Exercise Step 2 Generate the reasons for this failure … to sustain improvements Spend 10 minutes recording the reasons that could cause this failure Ask your … Target the potential risks for failure to achieve sustainment goals Remember that sustainability is a

146. Table 22. Indian Health Service total treatment cost estimates a by health status. All project sites. Fiscal year 2010 | Agency for Healthcare Research and Quality
     www.ahrq.gov/practiceimprovement/delivery-initiative/ihs/chap5tab22.html
     December 01, 2017 - use disorder 0.6% 6.9 $14,181 2.7% 0.8% 6.9 $14,216 3.3% With renal disease or failure … b 1.0% 8.6 $14,340 4.8% 1.5% 8.6 $14,339 5.9% With renal failure b 0.3%

147. Defining Diagnostic Error: A Scoping Review to Assess the Impact of the National Academies’ Report Improving Diagnosis in Health Care (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/topics/defining-diagnostic-error-a-scoping-review.pdf
     April 27, 2022 - report, Improving Diagnosis in Health Care, and proposed a new definition of diagnostic error, “the failure … Finally, Dadlez et al,25 looking at diagnostic process errors (i.e., failure points and contributing … Diagnostic error was defined as failure to establish an accurate diagnosis or failure to communicate … to establish an accurate diagnosis or failure to communicate the diagnosis in medical records. … Unavoidable misdiagnosis is a diagnostic labeling failure without a diagnostic process failure.1 Singh11

148. Exhibit 4.19. Major Factors that Inhibit Lean Success | Agency for Healthcare Research and Quality
     www.ahrq.gov/practiceimprovement/systemdesign/leancasestudies/lean-exhibit4-19.html
     November 01, 2014 - Scope Failure to review the medical evidence base may lead to a focus on improving processes that … Failure to complete all steps of the improvement process can derail the effort Resources

149. Table A: Indicator Rates for the HCBS and Full Medicaid Populations (Rates of Admission per 100,000 Persons) | Agency for Healthcare Research and Quality
     www.ahrq.gov/patient-safety/settings/long-term-care/resource/hcbs/findings/oirtab.html
     December 01, 2012 - Asthma or Chronic Obstructive Pulmonary Disease (COPD) 3,689 1,424 Congestive Heart Failure

150. Interplay Between Cognitive Load and Diagnostic Accuracy | Agency for Healthcare Research and Quality
     www.ahrq.gov/diagnostic-safety/resources/issue-briefs/dxsafety-cognitive-load3.html
     May 01, 2024 - be explored by returning to the example of a hospitalist admitting a patient with congestive heart failure … The hospitalist diagnoses the patient with congestive heart failure. … switch into type 2 thinking and miss that this patient has multifocal pneumonia in addition to heart failure … lack of treatment for pneumonia, which can progress to more serious conditions, including respiratory failure

151. Executive Summary | Agency for Healthcare Research and Quality
     www.ahrq.gov/es/patient-safety/settings/hospital/vtguide/guidesum.html
     March 01, 2016 - This guide targets these failure modes in the process of preventing VTE in the inpatient setting and … Throughout this guide, multiple failure modes are described, as are strategies to address potential lapses

152. Executive Summary | Agency for Healthcare Research and Quality
     www.ahrq.gov/patient-safety/settings/hospital/vtguide/guidesum.html
     March 01, 2016 - This guide targets these failure modes in the process of preventing VTE in the inpatient setting and … Throughout this guide, multiple failure modes are described, as are strategies to address potential lapses

153. Identify Defects Through Sensemaking | Agency for Healthcare Research and Quality
     www.ahrq.gov/hai/cusp/modules/identify/identify.html
     December 01, 2012 - Worksheet Learn from Defects Form Sensemaking Tools Discovery Form Root Cause Analysis Failure … Relationship Between CUSP and Sensemaking 1 , 2 , 3 Concept CUSP Sensemaking Defect or failure … identification Defects Human/active failure Latent/system conditions Ways to identify … defects or failure Staff Safety Assessment Status of Safety Issues Worksheet Discovery … Form Root Cause Analysis Failure Mode and Effects Analysis Probabilistic Risk Assessment

154. Neonatal Intensive Care All-Condition Readmissions Without Gestational Age: ICD-9 codes of the chronic conditions included (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/acute/chipra-208-icd-9codes.pdf
     June 02, 2025 - hemolytic anemias (inc. sickle) 283 Acquired hemolytic anemias 284 Aplastic anemia and other bone marrow failure … Chronic glomerulonephritis 583 Nephritis & nephropathy, NOS 585 Chronic kidney disease 586 Renal failure

155. CHIPRA 155: Section 7.B, ICD-9 Codes Used in this Analysis (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/duration/chipra-155-section-7-b-icd-9-codes.pdf
     June 02, 2025 - hemolytic anemias (inc. sickle) 283 Acquired hemolytic anemias 284 Aplastic anemia and other bone marrow failure … Chronic glomerulonephritis 583 Nephritis & nephropathy, NOS 585 Chronic kidney disease 586 Renal failure

156. CHIPRA 207: Section 7, ICD Codes Use in the Analysis (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/acute/chipra-207-section-7-icd-codes.pdf
     June 02, 2025 - hemolytic anemias (inc. sickle) 283 Acquired hemolytic anemias 284 Aplastic anemia and other bone marrow failure … Chronic glomerulonephritis 583 Nephritis & nephropathy, NOS 585 Chronic kidney disease 586 Renal failure

157. CHIPRA 157, Section 7.B, ICD-9 Codes for Chronic Conditions Used in this Analysis (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/duration/chipra-157-icd-9-codes.pdf
     June 02, 2025 - hemolytic anemias (inc. sickle) 283 Acquired hemolytic anemias 284 Aplastic anemia and other bone marrow failure … Chronic glomerulonephritis 583 Nephritis & nephropathy, NOS 585 Chronic kidney disease 586 Renal failure

158. Section 7.B, Table 4 ICD-9 Codes Used in this Analysis (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/duration/chipra-153-section-7b-table-4.pdf
     June 02, 2025 - anemias (inc. sickle) 283 Acquired hemolytic anemias 284 Aplastic anemia and other bone marrow failure … Chronic glomerulonephritis 583 Nephritis & nephropathy, NOS 585 Chronic kidney disease 586 Renal failure

159. Contemporary Emergency Medical Treatment and Labor Act (EMTALA) Clinical Issues Involving Pregnant Patients (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/topics/contemporary-EMTALA-clinical-issues-pregnantpts.pdf
     December 01, 2024 - Common elements identified in cases resulting in CMS EMTALA citations: • Failure to fully assess the … • Failure to make use of available on-call physician specialists to participate in screening and … • Failure to escalate questions or concerns (such as to department chair, hospital administrators … Common elements identified in cases resulting in CMS EMTALA citations: • Failure to provide a complete … • Failure to provide timely transfer for stabilizing treatment, such as surgery for complications

160. Major Study Finds Significant National Patient Safety Improvement | Agency for Healthcare Research and Quality
     www.ahrq.gov/news/newsroom/press-releases/significant-patient-safety-improvement.html
     July 01, 2022 - Researchers found significant decreases in in-hospital adverse event rates for heart attack, heart failure … 2010 and 2019, adverse event rates fell 36 percent for heart attack patients, 31 percent for heart failure … for all five patient groups, as follows: 41percent for heart attack patients, 27 percent for heart failure