Results

Total Results: 1,922 records

Showing results for "failures".

281. Welcome Guide for Frontline Providers | Agency for Healthcare Research and Quality
     www.ahrq.gov/teamstepps-program/welcome-guides/frontline-providers.html
     July 01, 2023 - While reflecting on patient harms that resulted from systemic and teamwork failures can have value, consider

282. Welcome Guide for Administrators | Agency for Healthcare Research and Quality
     www.ahrq.gov/teamstepps-program/welcome-guides/administrators.html
     July 01, 2023 - While reflecting on patient harms that resulted from systemic and teamwork failures can have value, consider

283. Welcome Guide for Trainers of Preprofessional Students | Agency for Healthcare Research and Quality
     www.ahrq.gov/teamstepps-program/welcome-guides/preprofessional-students.html
     June 01, 2023 - While reflecting on patient harms that resulted from systemic and teamwork failures can have value, consider

284. Welcome Guide for New TeamSTEPPS Trainers | Agency for Healthcare Research and Quality
     www.ahrq.gov/teamstepps-program/welcome-guides/new-trainers.html
     July 01, 2023 - While reflecting on patient harms that resulted from systemic and teamwork failures can have value, consider

285. Selected Best Practices and Suggestions for Improvement (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/qitoolkit/combined/d4g_combo_psi10-postopmetaderangement-bestpractices.pdf
     May 20, 2016 - Selected Best Practices and Suggestions for Improvement Toolkit for Using the AHRQ Quality Indicators How To Improve Hospital Quality and Safety 1 Tool D.4g Selected Best Practices and Suggestions for Improvement PSI 10: Postoperative Physiologic and Metabolic Derangement Why Focus on Postoperative Phys…

286. Health and Economic Outcomes of Newborn Screening for Infantile-onset Pompe Disease | Agency for Healthcare Research and Quality
     www.ahrq.gov/priority-populations/publications/richardson-et-al-2020.html
     January 01, 2021 - Health and Economic Outcomes of Newborn Screening for Infantile-onset Pompe Disease Pompe disease is a rare condition that is identified in about 1 in 40,000 births. It occurs from a defect in the GAA gene leading to the accumulation of lysosomal glycogen and, depending on the form and severity, can result in c…

287. Situation Monitoring: Severe Hypertension - PowerPoint Presentation
     www.ahrq.gov/sites/default/files/wysiwyg/hai/tools/perinatal-care-2/hypertension_4-situation-monitoring.pptx
     July 01, 2023 - weaknesses in the system (Reporting & Systems Learning) E.g., inefficient work processes; technology failures … Examples of system issues include technology failures, such as alarms that are easily turned off; environmental … Debriefs are not opportunities for venting personal grievances or blaming individual team members for failures … families, and staff  Debrief regularly to establish a culture of continuous learning from successes and failures

288. Situation Monitoring: Obstetric Hemorrhage (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/hai/tools/perinatal-care-2/hemorrhage_4-situation-monitoring-speaker-notes.pdf
     July 01, 2023 - weaknesses in the system (Reporting & Systems Learning) E.g., inefficient work processes; technology failures … Examples of system issues include technology failures, such as alarms that are easily turned off; environmental … Debriefs are not opportunities for venting personal grievances or blaming individual team members for failures … families, and staff Debrief regularly to establish a culture of continuous learning from successes and failures

289. Fundamental Concepts for Understanding Cognitive Load | Agency for Healthcare Research and Quality
     www.ahrq.gov/diagnostic-safety/resources/issue-briefs/dxsafety-cognitive-load2.html
     August 01, 2024 - Cognitive Load Theory and Its Impact on Diagnostic Accuracy Fundamental Concepts for Understanding Cognitive Load Previous Page Next Page Table of Contents Cognitive Load Theory and Its Impact on Diagnostic Accuracy Introduction to Diagnostic Errors Fundamental Concepts for Understanding Cogniti…

290. Organizational Behavior Management in Health Care: Applications for Large-Scale Improvements in Patient Safety (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety-2/vol2/Advances-Cunningham_11.pdf
     January 29, 2008 - adverse events have been identified as: technical errors (44 percent); errors in diagnosis (17 percent); failures … These include technical errors during care procedures, failures in communication among caregivers and … Communication failures: An insidious contributor to medical mishaps.

291. Labor and Delivery Unit Safety: Facilitator Guide | Agency for Healthcare Research and Quality
     www.ahrq.gov/patient-safety/settings/labor-delivery/perinatal-care/modules/strategies/labor-delivery-unit/ldusafety-fac-guide.html
     July 01, 2023 - The types of failures resulting from these behaviors are different. … Errors associated with failures of attentional behavior are labeled "mistakes" and often occur because

292. Cardiovascular Disease | Agency for Healthcare Research and Quality
     www.ahrq.gov/research/findings/nhqrdr/chartbooks/effectivetreatment/cvd.html
     June 01, 2018 - Chartbook on Effective Treatment Cardiovascular Disease Previous Page Next Page Table of Contents Chartbook on Effective Treatment Acknowledgments Effective Treatment Effective Treatment Trends and Measures Cardiovascular Disease Cancer Chronic Kidney Disease Diabetes HIV and AIDS …

293. Event Investigation and Analysis Guide: Appendix D | Agency for Healthcare Research and Quality
     www.ahrq.gov/patient-safety/settings/hospital/candor/modules/guide4/apd.html
     August 01, 2022 - Event Investigation and Analysis Guide: Appendix D CANDOR Tool PROCESS QUESTIONS TO REVIEW Y/N CONTRIBUTING OR CAUSAL FACTOR Y/N FINDINGS / COMMENTS COMMUNICATION Did all caregivers have access to all pertinent information needed to make the best decisions for the patient? (e.g.,…

294. Appendix B: Patient age, health status, and IHS total treatment costs by diabetes stage. Fiscal year 2010 | Agency for Healthcare Research and Quality
     www.ahrq.gov/practiceimprovement/delivery-initiative/ihs/appendixb.html
     December 01, 2017 - ARRA ACTION: Comparative Effectiveness of Health Care Delivery Systems for American Indians and Alaska Natives Using Enhanced Data Infrastructure Appendix B: Patient age, health status, and IHS total treatment costs by diabetes stage. Fiscal year 2010 Previous Page   Table of Contents ARRA ACTION: C…

295. Clinical Inertia and Outpatient Medical Errors (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol2/OConnor.pdf
     January 01, 2003 - To assess the failures of thinking underlying these patterns, we draw on research conducted to explain … failures of decisionmaking more generally. … In such work there is evidence to suggest that failures of decisionmaking of the sort that we have

296. Resident Sign-Out: A Precarious Exchange of Critical Information in a Fast-Paced World (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety-2/vol2/Advances-Borowitz_4.pdf
     January 22, 2008 - More than 60 percent of root causes of sentinel events reported to the Joint Commission are due to failures … percent of root causes of sentinel events reported to the Joint Commission have been judged to be due to failures … Communication failures in patient sign-out and suggestions for improvement: A critical incident analysis … Communication failures: An insidious contributor to medical mishaps.

297. Engage the Team and Applying CUSP in the ICU Setting Facilitator Guide
     www.ahrq.gov/sites/default/files/wysiwyg/hai/tools/clabsi-cauti-icu/cusp-icu-slides.pptx
     April 01, 2022 - AHRQ Safety Program for ICUs: Preventing CLABSI and CAUTI Applying CUSP ׀ 15 Examples of Defects of Failures

298. Central Venous Catheter Insertion
     www.ahrq.gov/sites/default/files/wysiwyg/hai/tools/clabsi-cauti-icu/central-catheter-insertion.pptx
     April 01, 2022 - Improves compliance with aseptic insertion Eliminates some barriers to safe care Reduces communication failures

299. Strategy 6R: Reminder Systems for Immunizations and Preventive Services | Agency for Healthcare Research and Quality
     www.ahrq.gov/cahps/quality-improvement/improvement-guide/6-strategies-for-improving/health-promotion-education/strategy6r-reminder-systems.html
     March 01, 2020 - Does the reminder system meet physicians' needs while also incorporating safeguards against process failures

300. Quality Improvement Strategies | Agency for Healthcare Research and Quality
     www.ahrq.gov/pqmp/implementation-qi/toolkit/child-hcahps/qi-strategies.html
     August 01, 2021 - Following the intervention, there were lower rates of discharge-related care failures, decreasing from