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Showing results for "failure".

  1. Diagnostic Safety Issue Brief 21 Diagnostic Stewardship as a Model To Improve the Quality and Safety of Diagnosis (pdf file)

    www.ahrq.gov/sites/default/files/publications2/files/dx-safety-21-diagnostic-stewardship.pdf
    August 01, 2024 - among the most prominent contributing factors.1,3-5 In contrast to clinical reasoning errors (e.g., failure … Error in the Testing Process Diagnostic errors include missed, delayed, and wrong diagnosis, as well as failure … The total testing process (Figure 1) is a model that can help identify and classify failure points in … While the failure to correctly interpret a diagnostic test result may reflect knowledge gaps or cognitive … Failure to assess for and monitor chronic kidney disease (CKD), particularly in people with diabetes

  2. Toolkit for Reducing CAUTI in Hospital Units: Implementation Guide (pdf file)

    www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/cauti-tools/impl-guide/implementation-guide.pdf
    September 01, 2015 - vasopressors or inotropes), and certain critical care technologies to support respiratory and cardiac failure … to monitor urine output as part of routine care when admitted for certain conditions such as heart failure … CAUTI in Hospitals Implementation Guide 11 renal failure … For patients with congestive heart failure, consider involving the patients and family members. … • Notify physician of failure of prompted or spontaneous voiding after 24 hours.

  3. VitaminD, Calcium, or Combined Supplementation for the Primary Prevention of Fractures in Community-Dwelling Adults: Evidence Report and Systematic Review for the USPSTF (pdf file)

    www.uspreventiveservicestaskforce.org/home/getfilebytoken/Yc24U4wMLXGoqE5NjwRVA6
    April 17, 2018 - 1.50]).17 Similar, nonsignificant findings were found for stroke, venous thromboembolism, and heart failure … 0.90 to 1.19]).29 Similar findings for stroke, venous thromboembolism, and hospitalization for heart failure … thrombo- embolism: ARD, −0.16% [95% CI, −0.44% to 0.12%] and HR, 0.92 [95% CI, 0.79 to 1.07]; heart failure … Venous thromboembolism: ARD, −0.16% (95% CI, −0.44% to 0.12%); HR, 0.92 (95% CI, 0.79 to 1.07) Heart failure … Risk of heart failure among postmenopausal women: a secondary analysis of the randomized trial of vitamin

  4. Toolkit for Reducing CAUTI in Hospital Units: Implementation Guide (pdf file)

    www.ahrq.gov/sites/default/files/publications/files/implementation-guide_0.pdf
    September 01, 2015 - vasopressors or inotropes), and certain critical care technologies to support respiratory and cardiac failure … to monitor urine output as part of routine care when admitted for certain conditions such as heart failure … CAUTI in Hospitals Implementation Guide 11 renal failure … For patients with congestive heart failure, consider involving the patients and family members. … • Notify physician of failure of prompted or spontaneous voiding after 24 hours.

  5. Measuring and Improving Ambulatory Patient Safety with an Electronic Dashboard - Final Report (pdf file)

    digital.ahrq.gov/sites/default/files/docs/citation/r21hs021322-sarkar-final-report-2015.pdf
    January 01, 2015 - 3 prostate cancer, and rheumatology, as well as failure … and safety of anticoagulation treatment.(43) Inadequate INR monitoring has been implicated in the failure … Frequency of Failure to Inform Patients of Clinically Significant Outpatient Test Results.

  6. The Missing Suction Tip | PSNet

    psnet.ahrq.gov/web-mm/missing-suction-tip
    January 01, 2006 - SPOTLIGHT CASE The Missing Suction Tip Citation Text: Thomas EJ, Moore FA. The Missing Suction Tip. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2003. Copy Citation Format: Google Scholar BibTeX EndNote X3 …

  7. In Conversation With… Erik Hollnagel, PhD | PSNet

    psnet.ahrq.gov/perspective/conversation-erik-hollnagel-phd
    February 26, 2025 - In Conversation With… Erik Hollnagel, PhD June 1, 2019  Citation Text: In Conversation With… Erik Hollnagel, PhD. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2019. Copy Citation Forma…

  8. Research Protocol: Diabetes Medications for Adults With Type 2 Diabetes: An Update Focused on Monotherapy and Add-On Therapy to Metformin (pdf file)

    effectivehealthcare.ahrq.gov/sites/default/files/pdf/diabetes-update-2015_research-protocol.pdf
    January 01, 2015 - see Table 1) regarding liver injury, lactic acidosis, pancreatitis, hypoglycemia, congestive heart failure … see Table 1) regarding liver injury, lactic acidosis, pancreatitis, hypoglycemia, congestive heart failure … report): § Liver injury § Lactic acidosis § Pancreatitis § Hypoglycemia § Congestive heart failure … • § Gastrointestinal side effects^ § Congestive heart failure

  9. Physician Engagement (Transcript) | Agency for Healthcare Research and Quality

    www.ahrq.gov/hai/cusp/toolkit/content-calls/engagement.html
    April 01, 2013 - And if you were to ask me now nationally, what is the biggest risk of failure for improving quality and … And I suspect that’s likely your risk of failure, too. … you want solutions that work in your context, taking what’s worked at Johns Hopkins is a recipe for failure … It’s leadership failure, really.

  10. Table 5.A.1. Evidence Table (pdf file)

    www.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/acute/chipra-143-section-5a-evidence-table.pdf
    January 01, 2014 - Study associations between evidence-based care and the occurrence of adverse events (AEs) in heart failure … Emergency Departments (EDs) between September 2007 and April 2010 with a final diagnosis of heart failure … Heart failure patients who died were significantly less likely to have Y, Gagné A, Gee A, Hobden … Patient safety analysis of the ED care of patients with heart failure and COPD exacerbations: a

  11. 2018 National Healthcare Quality and Disparities Report: Introduction and Methods (pdf file)

    www.ahrq.gov/sites/default/files/wysiwyg/research/findings/nhqrdr/2018qdr-intro-methods.pdf
    September 01, 2019 - measure’s latest data year is 2013 or earlier, except for the Patients with treated chronic kidney failure … who received a transplant within 3 years of date of renal failure measure. … available data since 2015, except 2013 data were used for the Patients with treated chronic kidney failure … who received a transplant within 3 years of date of renal failure measure.

  12. 2021 National Healthcare Quality and Disparities Report Appendixes (pdf file)

    www.ahrq.gov/sites/default/files/wysiwyg/research/findings/nhqrdr/2021qdr-appendixes.pdf
    December 01, 2021 - infarction (AMI) adult hospital admissions with acute myocardial HCUP 2018 Hospital admissions for heart failure … per 100,000 population HCUP 2018 Deaths per 1,000 adult hospital admissions with heart failure HCUP … were registered on a waiting list for USRDS 2017 Patients within 3 with treated chronic kidney failure … years of date of kidney failure who received a transplant USRDS 2015 Hemodialysis patients whose

  13. Neds 2012 Maskedstats Core Weighted (pdf file)

    hcup-us.ahrq.gov/db/nation/neds/stats/NEDS_2012_MaskedStats_Core_Weighted.PDF
    January 01, 2012 - Frequency Percent 107: Cardiac arrest and ventricular fibrillation 160,262 0.12 108: Congestive heart failure … vomitus 155,808 0.12 130: Pleurisy; pneumothorax; pulmonary collapse 220,701 0.16 131: Respiratory failure … 1,603,914 1.19 156: Nephritis; nephrosis; renal sclerosis 9,055 0.01 157: Acute and unspecified renal failure … 441,164 0.33 158: Chronic renal failure 49,106 0.04 159: Urinary tract infections 3,305,616 2.46

  14. Neds 2012 Maskedstats Core (pdf file)

    hcup-us.ahrq.gov/db/nation/neds/stats/NEDS_2012_MaskedStats_Core.PDF
    January 01, 2012 - Frequency Percent 107: Cardiac arrest and ventricular fibrillation 36,931 0.12 108: Congestive heart failure … /vomitus 36,353 0.12 130: Pleurisy; pneumothorax; pulmonary collapse 50,684 0.16 131: Respiratory failure … 368,501 1.19 156: Nephritis; nephrosis; renal sclerosis 2,060 0.01 157: Acute and unspecified renal failure … 103,840 0.33 158: Chronic renal failure 11,438 0.04 159: Urinary tract infections 770,171 2.48 160

  15. Neds 2010 Maskedstats Core Weighted (pdf file)

    hcup-us.ahrq.gov/db/nation/neds/stats/NEDS_2010_MaskedStats_Core_Weighted.PDF
    January 01, 2010 - Frequency Percent 107: Cardiac arrest and ventricular fibrillation 168,818 0.13 108: Congestive heart failure … vomitus 163,696 0.13 130: Pleurisy; pneumothorax; pulmonary collapse 222,877 0.17 131: Respiratory failure … 1,399,185 1.08 156: Nephritis; nephrosis; renal sclerosis 7,909 0.01 157: Acute and unspecified renal failure … 368,190 0.29 158: Chronic renal failure 51,617 0.04 159: Urinary tract infections 3,123,511 2.42

  16. Neds 2011V2 Maskedstats Core Weighted (pdf file)

    hcup-us.ahrq.gov/db/nation/neds/stats/NEDS_2011v2_MaskedStats_Core_Weighted.PDF
    November 03, 2014 - Frequency Percent 107: Cardiac arrest and ventricular fibrillation 164,736 0.13 108: Congestive heart failure … vomitus 159,508 0.12 130: Pleurisy; pneumothorax; pulmonary collapse 219,437 0.17 131: Respiratory failure … 1,506,894 1.15 156: Nephritis; nephrosis; renal sclerosis 8,848 0.01 157: Acute and unspecified renal failure … 437,618 0.33 158: Chronic renal failure 39,884 0.03 159: Urinary tract infections 3,189,122 2.43

  17. Neds 2011 Maskedstats Core Weighted (pdf file)

    hcup-us.ahrq.gov/db/nation/neds/stats/NEDS_2011_MaskedStats_Core_Weighted.PDF
    January 01, 2011 - Frequency Percent 107: Cardiac arrest and ventricular fibrillation 166,187 0.13 108: Congestive heart failure … vomitus 165,226 0.13 130: Pleurisy; pneumothorax; pulmonary collapse 220,498 0.17 131: Respiratory failure … 1,498,131 1.14 156: Nephritis; nephrosis; renal sclerosis 8,917 0.01 157: Acute and unspecified renal failure … 452,921 0.35 158: Chronic renal failure 39,807 0.03 159: Urinary tract infections 3,171,826 2.42

  18. Neds 2009 Maskedstats Core Weighted (pdf file)

    hcup-us.ahrq.gov/db/nation/neds/stats/NEDS_2009_MaskedStats_Core_Weighted.PDF
    January 01, 2009 - 1,378,579 1.07 107: Cardiac arrest and ventricular fibrillation 162,092 0.13 108: Congestive heart failure … vomitus 169,225 0.13 130: Pleurisy; pneumothorax; pulmonary collapse 222,081 0.17 131: Respiratory failure … 1,324,714 1.03 156: Nephritis; nephrosis; renal sclerosis 7,811 0.01 157: Acute and unspecified renal failure … 345,672 0.27 158: Chronic renal failure 62,188 0.05 159: Urinary tract infections 2,955,885 2.29

  19. Reducing Hospital Readmission Rates by Implementing an Inpatient Tobacco Cessation Service Driven by Interactive-Voice Recognition (IVR) Technology - Final Report (pdf file)

    digital.ahrq.gov/sites/default/files/docs/citation/r21hs023863-cartmell-final-report-2018.pdf
    January 01, 2018 - In 2018, these penalty conditions now include acute myocardial infarction (MI), heart failure, stroke … for not receiving the service included being discharged before the bedside consult was provided and failure … length of stay (dichotomized as lower or higher than median), and comorbidities (i.e., congestive heart failure … outcomes of medicare beneficiaries with worsening renal function during hospitalization for heart failure

  20. Evidence-based Practice Center Systematic Review Protocol (pdf file)

    effectivehealthcare.ahrq.gov/sites/default/files/pdf/trauma-interventions-maltreatment-child_research-protocol.pdf
    January 12, 2012 -  Child neglect (act of omission) Defined as failure to provide for a child’s basic physical … complex traumatic stress disorders, serious emotional disturbance) or other special needs (e.g., failure … or overt actions that cause harm, potential harm, or threat of harm to a child  Child neglect: failure … or overt actions that cause harm, potential harm, or threat of harm to a child) and child neglect (failure
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