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Total Results: 2,150 records

Showing results for "happened".

181. 162-Example-Completed-Learning-Defects-Tool (doc file)
     www.ahrq.gov/sites/default/files/wysiwyg/hai/tools/mrsa/162-example-completed-learning-defects-tool.docx
     October 01, 2024 - Provide a clear, thorough, and objective explanation of what happened. II. … What happened? In the space below, identify the MRSA infection or other event.

182. TeamSTEPPS® Diagnosis Improvement: Diagnostic Journey of Mr. Kane (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/teamstepps/diagnosis-improvement/dx-journey-presenter-notes.pdf
     March 01, 2022 - We are still trying to make sense of everything that happened… Slide 5 Background – Joe Kane … This had happened a few times before as well and usually he would go to see Dr. … he had missed a few dialysis appointments, which resulted in the excess fluid, and that this had happened … that he had missed a few dialysis appointments, which resulted in the excess fluid, and that this had happened

183. TeamSTEPPS® Diagnosis Improvement: Diagnostic Journey of Mr. Kane (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/teamstepps-program/dx-improvement/dx-journey-presenter-notes.pdf
     March 01, 2022 - We are still trying to make sense of everything that happened… Slide 5 Background – Joe Kane … This had happened a few times before as well and usually he would go to see Dr. … he had missed a few dialysis appointments, which resulted in the excess fluid, and that this had happened … that he had missed a few dialysis appointments, which resulted in the excess fluid, and that this had happened

184. Summary of Survey Findings | Agency for Healthcare Research and Quality
     www.ahrq.gov/diagnostic-safety/resources/issue-briefs/dxsafety-culture-survey-brazil-summary.html
     August 01, 2024 - and the second related to whether the office was informed when a missed, wrong, or delayed diagnosis happened

185. Recognizing-Success-Transcript (doc file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/ambulatory-surgery/sections/sustainability/recognizing-success-transcript.docx
     May 01, 2017 - use the checklist and ask about it, we decided to put up a bulletin board in the break room, which happened

186. Understand the Science of Safety | Agency for Healthcare Research and Quality
     www.ahrq.gov/hai/cusp/modules/understand/science-safety-notes.html
     July 01, 2018 - When learning from defects, unit teams identify: What happened? Why did it happen? … Analyzing what happened and why it happened helps the team understand the contributing factors and processes … What happened? Why did it happen? How will you reduce the risk of recurrence?

187. AHRQ Safety Program for Perinatal Care: Establishing a Program of In Situ Simulations (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/perinatal-care/modules/situ/simulation_facguide.pdf
     May 01, 2017 - SAY: The debrief process usually involves four steps: introducing the process, describing what happened … Program of In Situ Simulations 11 SAY: The next step in the debrief process is to describe what happened … In discussing why things happened in the scenario as they did, the team should focus on critical aspects … They can explain how and why certain outcomes may have happened “Was the decision made right (correctly

188. 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 - the patients on the wards during the night shift meet with other members of the team to review what happened … Resident physicians indicated that something happened while they were on call for which they were not … baseline assessment, the residents indicated that in 40 of the 49 (82 percent) instances that something happened … During the baseline assessment and after the intervention, sign-outs for nights when something happened … on nearly one-third of the nights they were on call, resident physicians indicated that something happened

189. Strategy 6Q: Standards for Customer Service | Agency for Healthcare Research and Quality
     www.ahrq.gov/cahps/quality-improvement/improvement-guide/6-strategies-for-improving/customer-service/strategy6q-custservice-standards.html
     March 01, 2020 - "It's the doctor's fault and I can't believe that happened." "I'm sorry that happened.

190. Scoring Different Kinds of Health Care Quality Measures | Agency for Healthcare Research and Quality
     www.ahrq.gov/talkingquality/translate/scores/scoring.html
     June 01, 2016 - Do you want to tell people how often this event happened or how often it did not happen?

191. Eliciting Patients’ Diagnostic Experiences Using Rigorous Methods | Agency for Healthcare Research and Quality
     www.ahrq.gov/patient-safety/reports/issue-briefs/dxsafety-patients-source-understanding-dx-error-vol2-3.html
     June 01, 2023 - their safety concerns did so through a sequence of open-ended questions 18 : Please tell us what happened … Considering only respondents for whom the diagnostic problem happened 3 or more years in the past, 28 … clinicians, scaffolding questions asked about these encounters and encouraged respondents to “explain what happened … , how it happened, and how it felt to you.”

192. Eliciting Patients’ Diagnostic Experiences Using Rigorous Methods | Agency for Healthcare Research and Quality
     www.ahrq.gov/diagnostic-safety/resources/issue-briefs/dxsafety-patients-source-understanding-dx-error-vol2-3.html
     June 01, 2023 - their safety concerns did so through a sequence of open-ended questions 18 : Please tell us what happened … Considering only respondents for whom the diagnostic problem happened 3 or more years in the past, 28 … clinicians, scaffolding questions asked about these encounters and encouraged respondents to “explain what happened … , how it happened, and how it felt to you.”

193. Engage Patients and Families for Perinatal Safety (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/perinatal-care/modules/teamwork/engage/pf-engagement-facilitator-guide.pdf
     May 01, 2017 - Providers communicate the facts of what happened and assure the patient and family that they will receive … A hospital committed to transparency offers an apology that the incident happened. … communicated to the patient and family: • An apology for any unreasonable care • An explanation of what happened

194. AHRQ Safety Program for Perinatal Care: Facilitation Instructions for Conducting In Situ Simulations
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/perinatal-care/modules/situ/simulation.pptx
     May 01, 2017 - response. 17 AHRQ Safety Program for Perinatal Care In Situ Simulations 17 Debriefing: Describe What Happened … 18 AHRQ Safety Program for Perinatal Care In Situ Simulations 18 Debriefing: Describe What Happened … What To Measure1 Processes (Measures of Performance) Explain how and why certain outcomes may have happened

195. Module 4: Teamwork and Communication: Material Use Guide | Agency for Healthcare Research and Quality
     www.ahrq.gov/hai/quality/tools/cauti-ltc/modules/implementation/long-term-modules/module4/guide.html
     March 01, 2017 - Ask staff about the best way to transparently inform the resident's family about what happened.

196. Session 1 | Agency for Healthcare Research and Quality
     www.ahrq.gov/patient-safety/settings/long-term-care/resource/facilities/ltc/mod3sess3.html
     October 01, 2014 - Most of the falls have happened at night after his private duty caregiver has gone home. … But even if you think a mistake may have happened, you must report the change.

197. Appendix A: Calculating Statistical Power with Clustering to Assess Potential for Detecting Meaningful Effects | Agency for Healthcare Research and Quality
     www.ahrq.gov/ncepcr/tools/pcmh/implement/appendix-a.html
     September 01, 2021 - Detecting Meaningful Effects Appendix B: Using a Comparison Group to Account for What Would Have Happened

198. II. What Do I Need for an Evaluation? | Agency for Healthcare Research and Quality
     www.ahrq.gov/ncepcr/tools/pcmh/implement/section-2.html
     September 01, 2021 - Detecting Meaningful Effects Appendix B: Using a Comparison Group to Account for What Would Have Happened

199. Testing the Design of a Quality Report By Getting User Feedback | Agency for Healthcare Research and Quality
     www.ahrq.gov/talkingquality/resources/design/testing.html
     September 01, 2019 - Then ask them how they happened to choose those particular ones; sometimes people get the "right" answer

200. Module 4: Event Reporting, Event Investigation and Analysis | Agency for Healthcare Research and Quality
     www.ahrq.gov/patient-safety/settings/hospital/candor/modules/notes4.html
     August 01, 2022 - To strengthen system accountability, we want to learn what happened, why it happened, what normally happens