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Total Results: 1,954 records

Showing results for "failure".

241. Phone Call Role Play (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/patient-safety/settings/hospitals/red-toolkit/phoneroleplay.pdf
     June 02, 2025 - PATIENT: Yes, I was admitted with congestive heart failure. It was the second time this year. … CALLER: Could you tell me your understanding of congestive heart failure? … Since you left the hospital, do you feel your congestive heart failure has improved, worsened, or not

242. Phoneroleplay (doc file)
     www.ahrq.gov/sites/default/files/wysiwyg/patient-safety/settings/hospitals/red-toolkit/phoneroleplay.docx
     June 02, 2025 - PATIENT: Yes, I was admitted with congestive heart failure. It was the second time this year. … CALLER: Could you tell me your understanding of congestive heart failure? … Since you left the hospital, do you feel your congestive heart failure has improved, worsened, or not

243. AHRQ Issues Report to Congress on Burden of Sepsis in U.S. Hospital Care | Agency for Healthcare Research and Quality
     www.ahrq.gov/news/newsroom/press-releases/sepsis-report-to-congress.html
     September 01, 2024 - a dysregulated systemic inflammatory response to infection that results in tissue damage and organ failure … comorbidities, impaired immune function, and specific conditions like cancer, chronic lung disease, and heart failure

244. Chapter 3. Risk-Informed Interventions | Agency for Healthcare Research and Quality
     www.ahrq.gov/research/findings/final-reports/stpra/stpra3.html
     April 01, 2018 - fractional contribution of a risk element to the total system for all scenarios under study, based upon the failure … The most important components that comprise this failure, as indicated by their contribution to the risk … Antibiotic-related failure. Staff not well-trained in infection control practices. … If the ASC selected interventions that targeted both the failure to prepare the skin appropriately and … on the morning of surgery (e.g., blood glucose levels out of control, uncompensated congestive heart failure

245. Examples of Diagnosis Pages (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/patient-safety/settings/hospitals/red-toolkit/dxpages.pdf
     June 02, 2025 - Examples of Diagnosis Pages Congestive Heart Failure Pneumonia Chronic Obstructive Pulmonary Disease

246. Final Progress Report: Proactive Risk Reduction in Medication Prescribing in the Ambulatory Setting (pdf file)
     www.ahrq.gov/sites/default/files/2024-01/field2-report.pdf
     January 01, 2024 - accompanying prophylaxis for known side effects, excessive dosing, inadequate laboratory monitoring, failure … Team 2 held sessions on failure to provide prophylaxis for known side effects, prescribing a drug that … interacts with a drug the patient is also taking 7 inadequate monitoring of high-risk medications 36 failure … an excess dose of a drug 1 There was no evidence in the literature to allow estimates of the error “failure … a bottom-up fashion during the course of the project as the teams highlighted two areas of system failure

247. Final Progress Report: Validation of an Innovative Approach to Error Reduction (pdf file)
     www.ahrq.gov/sites/default/files/2024-11/blumenthal-report.pdf
     January 01, 2024 - Following the work of Reason and the Institute of Medicine (IOM), we defined an error as the failure … For the purpose of this study, we used the failure to comply with standards of care and the identification … further classified as serious and non-serious depending on the potential consequences of the particular failure … Accordingly, we conducted explicit chart review both for (1) failure to comply with condition-specific … is, processes that are important to the care of all ED patients, regardless of diagnosis (e.g., the failure

248. TeamSTEPPS Coaching Feedback Form (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/teamstepps-program/tools/ts-coaching-feedback-form.pdf
     June 02, 2025 - Understanding Performance Improvement Setting Performance Goals Rewarding Improvement Dealing With Failure

249. Final Progress Report: Cook County & Rush Developmental Center for Research in Patient Safety: Diagnosis Error Evaluation and Research (DEER) Project (pdf file)
     www.ahrq.gov/sites/default/files/2025-04/schiff-mcnutt-report.pdf
     January 01, 2025 - None of the 20 evidence-based AHRQ Patient Safety Indicators directly measures failure to diagnose. … It identifies what went wrong, situating where in the diagnostic process the failure occurred. … Adding this “time dimension” underscores the fact that failure to make the exact diagnosis is often … Failure to recognize and act on abnormal test results: the case of screening bone densitometry. … Risk management tips: A focused look at failure to diagnose.

250. Tool 5 (continued) | Agency for Healthcare Research and Quality
     www.ahrq.gov/es/patient-safety/settings/hospital/red/toolkit/phone-roleplay.html
     March 01, 2025 - PATIENT: Yes, I was admitted with congestive heart failure. It was the second time this year. … CALLER: Could you tell me your understanding of congestive heart failure? … Since you left the hospital, do you feel your congestive heart failure has improved, worsened, or not

251. Tool 5 (continued) | Agency for Healthcare Research and Quality
     www.ahrq.gov/patient-safety/settings/hospital/red/toolkit/phone-roleplay.html
     March 01, 2025 - PATIENT: Yes, I was admitted with congestive heart failure. It was the second time this year. … CALLER: Could you tell me your understanding of congestive heart failure? … Since you left the hospital, do you feel your congestive heart failure has improved, worsened, or not

252. 170-Cusp-Science-Safety-Notes (doc file)
     www.ahrq.gov/sites/default/files/wysiwyg/hai/tools/mrsa/170-cusp-science-safety-notes.docx
     October 01, 2024 - Cultivate a preoccupation with failure. … Failure to install the software that prevents infusions from running too fast is an example of a latent … failure that enabled the defect to happen. … Latent failures are the “holes in the system”—the weaknesses that could allow an active failure to happen … The Swiss cheese model helps us to understand that defects are not the result of a single failure, but

253. National Healthcare Quality and Disparities Report (QDR): Care Coordination Chartbook (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/research/findings/nhqrdr/chartbooks/carecoordination/qdr2015-chartbook-carecoordination.pdf
     June 16, 2016 - Patients With Heart Failure Who Received Written Discharge Instructions  Importance: Heart failure … ■ In all years, the percentage of hospitalized adult patients with heart failure who were given … For heart failure and COPD, low share is defined as ≤7% and high as ≥29%. … For heart failure and COPD, low share is defined as ≤7% and high as ≥29%. … Rehospitalization for heart failure. Circulation 2012;126:501-6.

254. NPSD Dashboards | Agency for Healthcare Research and Quality
     www.ahrq.gov/npsd/data/dashboard/index.html
     September 01, 2025 - Dashboard Details the type of device; type of device by residual harm to the patient; device defect, failure … , or user error; device defect, failure, or user error by residual harm to the patient; type of health

255. AHRQ’s Portrait of Sepsis Reveals Its Alarming Human Toll | Agency for Healthcare Research and Quality
     www.ahrq.gov/news/blog/ahrqviews/portrait-of-sepsis.html
     September 01, 2024 - reaction to an untreated infection, causing the body to attack itself, leading to tissue damage, organ failure … individuals with weakened immune systems or conditions like cancer, chronic lung disease, and heart failure

256. Final Progress Report: Cardio-HIT Phase II (pdf file)
     www.ahrq.gov/sites/default/files/2024-12/kmetik-otoole-report.pdf
     January 01, 2024 - recognized, ambulatory care physician performance measures for coronary artery disease and heart failure … practices submitted clinical performance data to a data warehouse for coronary artery disease and heart failure … separate analyses: an exception sample for validation of exception criteria and an apparent quality failure … Electronic medical records for patients in the exception, apparent quality failure, and measure met … Automated review of electronic health records to assess quality of care for outpatients with heart failure

257. Module 8—Injection Safety | Agency for Healthcare Research and Quality
     www.ahrq.gov/nursing-home/resources/module-8-injection-safety.html
     May 01, 2022 - overview of injection safety, along with a review of recommended practices and the consequences of failure

258. TeamSTEPPS Video-Based Simulation: Facilitator Guide Module 4 (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/teamstepps-program/video/module-4-mutual-support-facilitator-guide.pdf
     June 02, 2025 - Discuss the causes of reluctance or failure to seek support when needed. 3. … ● What might cause reluctance or failure to seek support when it is needed? … Discuss the causes of reluctance or failure to seek support when needed. 3. … What might cause reluctance or failure to seek support when it is needed? … Discuss the causes of reluctance or failure to seek support when needed. 3.

259. Tool 1: Readmission Data Analysis and Interpretation (xls file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/medicaidreadmitguide/mcaidread_tool1_data_analysis_final.xlsx
     June 02, 2025 - 120 500 24% 5% Sepsis 100 500 20% 4% Psychosis 80 400 20% 3% COPD 70 300 23% 3% Renal Failure … Cellulitis w/o MCC 20 150 13% 1% Total, Top 10 550 Total, All Readmissions 2550 22% Heart Failure … 200 1300 15% 8% COPD 30 300 10% 1% Intracranial hemorrhage 25 50 50% 1% Renal failure with CC … with MCC 15 80 19% 1% Psychosis 15 100 15% 1% UTI 15 80 19% 1% Sepsis 10 145 7% 0% Respiratory failure … 0% Medicaid Cellulitis 10 100 10% 0% COPD with MCC 5 30 17% 0% Chest pain 5 35 14% 0% Renal failure

260. Slide 1
     www.ahrq.gov/sites/default/files/wysiwyg/research/findings/nhqrdr/chartbooks/carecoordination/qdr2015-chartbook-carecoordination.pptx
     June 16, 2016 - Importance: Heart failure is the most frequent hospital discharge diagnosis in the older adults. … Trends: From 2005 to 2013, the percentage of hospitalized adult patients with heart failure who were … In all years, the percentage of hospitalized adult patients with heart failure who were given complete … For heart failure and COPD, low share is defined as ≤7% and high as ≥29%. … Rehospitalization for heart failure. Circulation 2012;126:501-6.