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  1. www.ahrq.gov/cahps/quality-improvement/improvement-guide/6-strategies-for-improving/health-promotion-education/strategy6r-reminder-systems.html
    March 01, 2020 - Failure to consider these questions is likely to undermine the success of the reminder system. … Failure to keep clinic appointments: Implications for residency education and productivity.
  2. www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/cauti-tools/archived-webinars/mindfulness-061014.pptx
    March 07, 2014 - AMP Appropriate Cure Failure 90 91 5 UP Appropriate Cure Failure 32 55 31 What is “Antibiotic Stewardship … Ceftaz Cipro Before 79 65 63 66 84 After 87 83 81 88 94 Sheet1 Appropriate Cure Failure
  3. www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/pfp/pfphac.pdf
    September 01, 2014 - Iatrogenic Pneumothorax (PSI 6) PSI Post-Op Hemorrhage or Hematoma (PSI 9) PSI Post-Op Respiratory Failure … sample, and those with a principal diagnosis of acute myocardial infarction (AMI), congestive heart failure … 0.412 PSI Post-Op Hemorrhage or Hematoma (PSI 9) 20,691 32,750,000 0.632 PSI Post-Op Respiratory Failure
  4. www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/long-term-care/resources/ontime/prevhosp/2-preventablehospitalandedvisits-samplerpts_3.pdf
    November 30, 2013 - . • High-risk diagnosis associated with transfer risk: congestive heart failure (CHF), myocardial infarction … infection, dehydration, circulatory problems (includes vascular disease, venous and arterial ulcer), renal failure … • Circulatory Problems On-Time Preventable Hospital and ED Visits Electronic Reports 4 • Renal Failure … urinary incontinence documented within 7 days of report date and two active high-risk diagnoses of renal failure … Preventable discharge diagnoses include congestive heart failure, pneumonia, urinary tract infection,
  5. www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol4/Meadows.pdf
    December 01, 2003 - the NHS to be more open in the way it deals with professional errors and “to recognize that honest failure … traveled through the Incident Decision Tree, the more likely the underlying cause is to be a systems failure … • Many cases appear to go awry from the outset because of failure to differentiate between formally
  6. www.ahrq.gov/ncepcr/tools/confid-report/research-agenda.html
    March 01, 2016 - Confidential Physician Feedback Reports: Designing for Optimal Impact on Performance Part Four: A Research Agenda To Advance the Science of Physician Feedback Reporting Systems Previous Page Next Page Table of Contents Confidential Physician Feedback Reports: Designing for Optimal Impact on Performa…
  7. www.ahrq.gov/prevention/guidelines/archive.html
    July 01, 2018 - Heart Failure Clinical Guide / Quick Reference Guide Consumer Version: English / Spanish 12
  8. www.ahrq.gov/hai/tools/surgery/modules/on-boarding/overview-slides.html
    December 01, 2017 - Postoperative hemorrhage, respiratory failure, accidental puncture/laceration. … Slide 52: Premortem Exercise Step 2 Generate the reasons for failure. … Spend 10 minutes recording the reasons you believe this failure occurred. … Slide 53: Premortem Exercise Step 3 Prioritize your list of potential reasons for failure.
  9. www.ahrq.gov/sites/default/files/wysiwyg/research/findings/nhqrdr/2014chartbooks/hispanichealth/2014nhqdr-hispanichealth-pt4.pptx
    January 01, 2014 - Severity index based on comorbidities 1.02 0.89 1.06 0.93 Amputations 1.57 1.52 0.95 0.92 Renal failure … A higher percentage of Hispanics in border counties with an inpatient stay for diabetes had renal failure … (listed as any diagnosis), compared with non-Hispanics in border counties. 44 Renal Failure Hispanic … Renal failure. Peripheral vascular disease. Paralysis. … -661 (substance use) Environmental health: Any Dx in CCS 128 (asthma), 127 (COPD), 131 (respiratory failure
  10. www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/cauti-tools/archived-webinars/cauti-sustainability.pptx
    December 01, 2015 - The Power of Measuring Results 17 If you do not measure results, you can not tell success from failure … If you can not reward success, you are probably rewarding failure. … If you can not recognize failure, you can not correct it. … It is the result of preparation, hard work, and learning from failure.” General Colin L. … On the way down, failure feeds on itself.
  11. www.ahrq.gov/sites/default/files/wysiwyg/hai/tools/mrsa-2/024-ss-cusp-learning-from-defects.pptx
    April 01, 2025 - Clinical or operational events or situations that you do not want to happen again Examples of defects Failure … Learning from failure in health care: frequent opportunities, pervasive barriers.
  12. www.ahrq.gov/sites/default/files/wysiwyg/patient-safety/quality-measures/qsrs/qsrs-2021-2022-adverse-event-data-report.pdf
    January 01, 2022 - into four groups: those with a principal diagnosis of acute myocardial infarction, congestive heart failure … CI Both DVT and PE developed during stay 3 21649 0.0 0.0 – 0.0 Other AEs AE attributed to failure … Other AE attributed to failure to communicate laboratory, pathology, imaging, and physiologic test … or disruption, or graft failure Dental injury 21 Module Adverse Event (AE) Outcome High … Other Other occurrences Renal failure Unplanned transfer Ventilator support (non-OR) 8.
  13. www.ahrq.gov/sites/default/files/wysiwyg/patient-safety/quality-measures/qsrs/qsrs-2021-2022-adverse-event-data-report-nov-rev.pdf
    January 01, 2022 - into four groups: those with a principal diagnosis of acute myocardial infarction, congestive heart failure … CI Both DVT and PE developed during stay 3 21649 0.0 0.0 – 0.0 Other AEs AE attributed to failure … Other AE attributed to failure to communicate laboratory, pathology, imaging, and physiologic test … or disruption, or graft failure Dental injury 21 Module Adverse Event (AE) Outcome High … Other Other occurrences Renal failure Unplanned transfer Ventilator support (non-OR) 8.
  14. www.ahrq.gov/sites/default/files/wysiwyg/patient-safety/quality-measures/qsrs/qsrs-2021-2022-adverse-event-data-report-oct-rev.pdf
    January 01, 2022 - into four groups: those with a principal diagnosis of acute myocardial infarction, congestive heart failure … CI Both DVT and PE developed during stay 3 21649 0.0 0.0 – 0.0 Other AEs AE attributed to failure … Other AE attributed to failure to communicate laboratory, pathology, imaging, and physiologic test … or disruption, or graft failure Dental injury 21 Module Adverse Event (AE) Outcome High … Other Other occurrences Renal failure Unplanned transfer Ventilator support (non-OR) 8.
  15. www.ahrq.gov/sites/default/files/wysiwyg/cahps/quality-improvement/improvement-guide/6-strategies-for-improving/access/cahps-strategy-6c.pdf
    March 01, 2017 - For example, a patient whose chart includes an unfamiliar reference to “congestive heart failure” might … think it refers to an actual failure rather than a manageable heart condition
  16. www.ahrq.gov/takeheart/about/case-for-cardiac-rehab/index.html
    December 01, 2022 - individuals who have: Had a heart attack Stable angina Received angioplasty or stent Heart failure
  17. www.ahrq.gov/talkingquality/measures/setting/physician/examples.html
    September 01, 2019 - Education and counseling for patients with certain conditions (e.g., hepatitis, heart failure).
  18. www.ahrq.gov/patient-safety/settings/long-term-care/resource/ontime/prevhosp/ereportguide.html
    September 01, 2017 - High-risk diagnoses associated with transfer risk (congestive heart failure, myocardial infarction, … Renal failure. Diabetes. Anemia. Gastroenteritis. … Rule out congestive heart failure. Rule out deep vein thrombosis. Respiratory. … Potentially preventable discharge diagnoses follow: Congestive heart failure. Pneumonia. … Potentially preventable discharge diagnoses follow: Congestive heart failure. Pneumonia.
  19. www.ahrq.gov/sites/default/files/2024-10/glance-report.pdf
    January 01, 2024 - paraplegia by 70%, cerebrovascular disease by 70%, myocardial infarction by 65%, congestive heart failure … Twenty-five percent (congestive heart failure) to 76% (PCI) of hospitals classified as low-quality hospitals … For decubitus ulcer, failure-to-rescue, and postoperative pulmonary embolism or DVT, the intraclass- … for preoperative risk factors, transmural myocardial infarction (adj OR 7.90; p<0.001), respiratory failure … (adj OR 6.02; p<0.001), renal failure (adj OR 7.15; p<0.001), and stroke within 24 hours (adj OR 4.09
  20. www.ahrq.gov/patient-safety/settings/long-term-care/resource/hcbs/findings/tab13.html
    December 01, 2012 - Pulmonary Disease 5,029 4,037 3,180 4,196 3,954 3,070 3,401 4,560 Congestive Heart Failure

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