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4181. Empowerment failure: how shortcomings in physician communication unwittingly undermine patient autonomy. | PSNet
      psnet.ahrq.gov/issue/empowerment-failure-how-shortcomings-physician-communication-unwittingly-undermine-patient
      January 17, 2019 - Study Empowerment failure: how shortcomings in physician communication unwittingly undermine patient autonomy. Citation Text: Ubel PA, Scherr KA, Fagerlin A. Empowerment Failure: How Shortcomings in Physician Communication Unwittingly Undermine Patient Autonomy. Am J Bioeth. 2017;17(11):…

4182. AHRQ-Funded Patient Safety Project Highlights (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/patient-safety/highlights/ps-project-highlights-hit-hie-rev-0724update.pdf
      July 01, 2024 - ■ An AHRQ Patient Safety Learning Labiv (PSLL) developed an electronic Fall TIPS Tool to help patients … Key Findings/Impact: Investigators found that implementing the Fall TIPS toolkit reduced patient fall … into both the electronic and print versions, because patients are more likely to believe they need a fall … reporter.nih.gov/search/0zBFxPu410GfTZDt4AZLvQ/projects https://www.ahrq.gov/patient-safety/settings/hospital/fall-tips

4183. Inpatient Stays and Emergency Department Visits Involving Traumatic Brain Injury, 2017 (pdf file)
      hcup-us.ahrq.gov/reports/statbriefs/sb255-Traumatic-Brain-Injury-Hospitalizations-ED-Visits-2017.pdf
      January 01, 2017 - 230,800 28.8 None 141,400 43.3 445,100 55.5 Intent and mechanism of injury Unintentional, fall … 79.9 0 20 40 60 80 100 Pe rc en ta ge o f St ay s or V is its b Unintentional, fall … 25,200 11.2 10.3 None 5.9 16,400 4.3 13.5 Intent and mechanism of injury Unintentional, fall … CM_Non-Poisoning_Cause_Matrix.xlsx 12 o Other land transport o Other transport • Unintentional, fall

4184. Interventions-Horizon-Scan-High-Impact-1306 (pdf file)
      effectivehealthcare.ahrq.gov/sites/default/files/interventions-horizon-scan-high-impact-1306.pdf
      June 01, 2013 - support rural primary care providers in developing knowledge about diseases that would typically fall … with the names of hospital and clinical staff to reduce risk of patient disorientation and delirium; fall … support rural primary care providers in developing knowledge about diseases that would typically fall … Eagle (CO): Western Eagle County Health Services District; 2011 Fall. 48 p. … Grand Forks (ND): Rural Assistance Center; 2010 Fall [accessed 2011 Oct 27]. [4 p].

4185. Discussion | Agency for Healthcare Research and Quality
      www.ahrq.gov/hai/pfp/haccost2017-discuss.html
      November 01, 2017 - Estimating the Additional Hospital Inpatient Cost and Mortality Associated With Selected Hospital-Acquired Conditions Discussion Previous Page Next Page Table of Contents Estimating the Additional Hospital Inpatient Cost and Mortality Associated With Selected Hospital-Acquired Conditions Discussio…

4186. Sustaining Zero CLABSIs | Agency for Healthcare Research and Quality
      www.ahrq.gov/hai/cusp/toolkit/content-calls/zero-clabsi/slides.html
      July 01, 2013 - for unstable ambulatory patients Stretcher-locking mechanism failure noted and prevented patient fall

4187. Strategies and Approaches for Tracking Improvements in Patient Safety | PSNet
      psnet.ahrq.gov/primer/strategies-and-approaches-tracking-improvements-patient-safety
      June 15, 2024 - Strategies and Approaches for Tracking Improvements in Patient Safety Citation Text: Shaikh U. Strategies and Approaches for Tracking Improvements in Patient Safety . PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2021. Copy Citat…

4188. Treating Binge-Eating Disorder. A Review of Evidence for Adults (pdf file)
      effectivehealthcare.ahrq.gov/sites/default/files/pdf/binge-eating_consumer.pdf
      May 01, 2016 - Treating Binge-Eating Disorder. A Review of Evidence for Adults Treating Binge-Eating Disorder A Review of the Research for Adults e Is This Information Right for Me? This information is right for you if: � Your health care professional* said you have binge-eating disorder (BED). � You are age 18 or older.…

4189. PowerPoint Presentation (ppt file)
      psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.320_slideshow.ppt
      January 01, 2020 - PowerPoint Presentation Spotlight A ʺReflexiveʺ Diagnosis in Primary Care 1 This presentation is based on the April 2014 AHRQ WebM&M Spotlight Case See the full article at http://webmm.ahrq.gov CME credit is available Commentary by: John Betjemann, MD, and S. Andrew Josephson, MD, University of California, San…

4190. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/33874/psn-pdf
      February 01, 2019 - these lessons for trainees in the actual clinical environment, the education will transiently rise and fall

4191. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49587/psn-pdf
      May 01, 2009 - probably tops this list, followed closely by missing a transient neurologic event that precipitates a fall

4192. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/33676/psn-pdf
      November 01, 2008 - stop-orders-reduce-inappropriate-urinary-catheterization-hospitalized-patients-randomized RW: There may be some trade-offs in terms of patients being forced out of bed and an increased fall

4193. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/37518/psn-pdf
      March 13, 2008 - Innovation in patient safety: a new task design in reducing patient falls. March 13, 2008 Tzeng H-M, Yin C-Y. Innovation in patient safety: a new task design in reducing patient falls. J Nurs Care Qual. 2008;23(1):34-42. doi:10.1097/01.NCQ.0000303803.07457.e5. https://psnet.ahrq.gov/issue/innovation-patient-safety…

4194. Information to Help Hospitals Get Started
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/engagingfamilies/howtogetstarted/How_to_Use_Guide_Ldr_Slide_508.pptx
      July 23, 2010 - patient falls during change of shift, dropping from one to two patient falls per month to one patient fall

4195. Reducing Unecessary Urinary catheter Use in the Emergency Department: How to Implement the Process (ppt file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/cauti-tools/archived-webinars/ed-catheter-insertions-091013.ppt
      January 01, 2010 - Reducing Unecessary Urinary catheter Use in the Emergency Department: How to Implement the Process The Emergency Department & Catheter Insertions * Mohamad Fakih, MD, MPH St. John Hospital and Medical Center Lisa Wolf, PhD, RN, CEN, FAEN Emergency Nurses Association (ENA) Jeremiah Schuur, MD, MHS, FACEP Brig…

4196. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/844785/psn-pdf
      September 11, 2019 - Information flow during pediatric trauma care transitions: things falling through the cracks. September 11, 2019 Hoonakker PLT, Wooldridge AR, Hose B-Z, et al. Information flow during pediatric trauma care transitions: things falling through the cracks. Intern Emerg Med. 2019;14(5):797-805. doi:10.1007/s11739-019-0…

4197. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/40454/psn-pdf
      June 01, 2012 - Influence of unit-level staffing on medication errors and falls in military hospitals. June 1, 2012 Breckenridge-Sproat S, Johantgen M, Patrician PA. Influence of unit-level staffing on medication errors and falls in military hospitals. West J Nurs Res. 2012;34(4):455-74. doi:10.1177/0193945911407090. https://psne…

4198. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/39255/psn-pdf
      February 02, 2011 - The patient who falls: "It's always a trade-off." February 2, 2011 Tinetti ME, Kumar C. The patient who falls: "It's always a trade-off". JAMA. 2010;303(3):258-66. doi:10.1001/jama.2009.2024. https://psnet.ahrq.gov/issue/patient-who-falls-its-always-trade Through a case study, this article reviews evidence on risk…

4199. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/47508/psn-pdf
      October 24, 2018 - Root cause analysis of reported patient falls in ORs in the Veterans Health Administration. October 24, 2018 Soncrant CM, Warner LJ, Neily J, et al. Root Cause Analysis of Reported Patient Falls in ORs in the Veterans Health Administration. AORN J. 2018;108(4):386-397. doi:10.1002/aorn.12372. https://psnet.ahrq.go…

4200. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/41554/psn-pdf
      January 03, 2017 - Using root cause analysis to reduce falls with injury in community settings. January 3, 2017 Lee A, Mills PD, Neily J. Using root cause analysis to reduce falls with injury in community settings. Jt Comm J Qual Patient Saf. 2012;38(8):366-374. https://psnet.ahrq.gov/issue/using-root-cause-analysis-reduce-falls-inj…