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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/perinatal-care/modules/teamwork/learn/learn-about-cusp-facilitator-guide.pdf
May 01, 2017 - The CUSP framework accomplishes
this through stressing the fact that patient
harm is not an acceptable … communication tools
were effective in reducing lapses in team
functioning, errors, and the likelihood of harm … should be emphasized more than the
outcome of the choices, which may or may not
have resulted in harm … Transparency is also vital in
addressing system factors that may contribute
to harm.
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www.ahrq.gov/hai/cusp/modules/apply/ac-cusp.html
December 01, 2012 - choices should be emphasized more than the outcome of the choices, which may or may not have resulted in harm … Transparency is also vital in addressing system factors that may contribute to harm. … Display statistics that show how the initiative reduces both patient harm and the average cost per occurrence … hospital staff members, which will ultimately increase patient safety and reduce unnecessary expenses and harm
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www.ahrq.gov/teamstepps-program/curriculum/implement/activity/change.html
June 01, 2023 - Regrettably, some organizations acquire a sense of urgency only when a tragic and publicized patient harm … In some cases, inconveniences are not taken seriously by healthcare organizations and harm results (e.g … Highlighting patient stories of both harms and harm avoidance that contrast a culture of safety with
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www.ahrq.gov/sites/default/files/wysiwyg/patient-safety/reports/issue-briefs/dxsafety-probabilistic-thinking.pdf
September 01, 2022 - Introduction
Errors that occur during the diagnostic process can lead to missed or wrong diagnoses and can harm … risks” and “benefits” vs. the more neutral, transparent, and
quantifiable comparison of “chance of harm … of patient benefit and harms, tests,
like all other health services, will either help patients or harm … results and subsequent missed diagnoses that are truly
causing symptoms, with potential for patient harm
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www.ahrq.gov/diagnostic-safety/resources/issue-briefs/dxsafety-patients-source-understanding-dx-error-vol1-1.html
June 01, 2023 - Patient Experience as a Source for Understanding the Origins, Impact, and Remediation of Diagnostic Errors
Executive Summary
Previous Page Next Page
Table of Contents
Patient Experience as a Source for Understanding the Origins, Impact, and Remediation of Diagnostic Errors
Executive Summary
Intr…
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www.ahrq.gov/cpi/about/otherwebsites/effectivehealthcare.ahrq.gov/index.html
March 01, 2024 - The Effective Health Care Program
Mission
The Effective Health Care (EHC) Program funds individual researchers, research centers, and academic organizations to work with AHRQ to produce patient-centered outcomes research (PCOR) for clinicians, consumers, and policymakers. PCOR is designed to inform health car…
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www.ahrq.gov/cpi/centers/ockt/kt/tools/impuspstf/impuspstf2.html
June 01, 2022 - When the potential harm of an increase in gastrointestinal hemorrhage is outweighed by a potential benefit
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/quality-resources/tools/cauti-ltc/modules/implementation/educational-bundles/urine-culturing/whento-order/urine-cultures.pptx
March 01, 2017 - Believe it or not, even a test as simple as a urine culture can cause resident harm if used incorrectly … But the bacteria in the urine may not be causing any actual harm!
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www.ahrq.gov/sites/default/files/wysiwyg/antibiotic-use/long-term-care/communication-slides.pptx
June 01, 2021 - science of safety
Improve teamwork and communication
Recognize current practices that may lead to patient harm
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/mvp/modules/vae/overview-ptsoffventilator-facguide.docx
January 01, 2017 - that allow us to see those system factors and how they influence care, we can see the risks of patient harm … medication error, ventilator associated pneumonia, or anything that can lead to preventable patient harm … What can be done to minimize this harm? How can we get the patient off of the ventilator faster?”
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www.ahrq.gov/hai/tools/mvp/modules/vae/overview-off-ventilator-fac-guide.html
February 01, 2017 - that allow us to see those system factors and how they influence care, we can see the risks of patient harm … medication error, ventilator associated pneumonia, or anything that can lead to preventable patient harm … What can be done to minimize this harm? How can we get the patient off of the ventilator faster?"
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www.ahrq.gov/sites/default/files/wysiwyg/research/findings/making-healthcare-safer/mhs3/alarm-fatigue-1.pdf
March 01, 2020 - , but also ignoring or missing many clinically significant and actionable
alarms.3
Importance of Harm … management.10
Methods for Selecting PSPs
Initial literature searches for PSPs in the alarm fatigue harm … Results of these searches were reviewed by harm-area task leads to
identify PSPs, iterate on searches … The potential for harm due to alarms’ high frequency and low specificity was briefly discussed in the … Alarm Fatigue
Introduction
Background
Importance of Harm Area
Methods for Selecting PSPs
What’s
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www.ahrq.gov/diagnostic-safety/resources/issue-briefs/leadership-2.html
June 01, 2021 - diagnostic errors, as they have with progress made in addressing other forms of preventable patient harm
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www.ahrq.gov/downloads/pub/prevent/pdfser/cas/cases.pdf
December 01, 2007 - Does screening or CEA result in harm? … Does treatment for asymptomatic CAS 60%-99% with CEA result in
harm?............................. … Does screening or CEA for asymptomatic CAS 60%-99% result in harm? … Does treatment for asymptomatic CAS 60%-99% with CEA result in
harm? … The Kaplan-Meier curves in ACST cross from net harm to net benefit
only at about 1.5 years after CEA
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www.ahrq.gov/hai/pfp/interimhac2013-ap2.html
December 01, 2014 - Efforts To Improve Patient Safety Result in 1.3 Million Fewer Patient Harms
Interim Update on 2013 Annual Hospital-Acquired Condition Rate and Estimates of Cost Savings and Deaths Averted From 2010 to 2013
Previous Page Next Page
Table of Contents
Efforts To Improve Patient Safety Result in 1.3 Mill…
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www.ahrq.gov/sites/default/files/wysiwyg/teamstepps-program/dx-improvement/module1-presenters-notes.pdf
January 12, 2022 - Diagnostic harm, which can result from diagnostic error, is an emerging area of concern in
healthcare … safety and risk
management literature, as well as care delivery research, demonstrates that diagnostic
harm … Organizations
and providers need resources to mitigate diagnostic harm, but few tools are currently … families, and
• Provide assessment and training tools to support local efforts to reduce diagnostic harm … • These gaps can delay diagnostic processes and
in some cases result in serious harm or even
death
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www.ahrq.gov/research/findings/nhqrdr/chartbooks/careaffordability/measures.html
June 01, 2018 - Inefficient care due to use of services associated with more harm than benefit .
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www.ahrq.gov/sites/default/files/wysiwyg/nhguide/6_TK1_T6-Managing_Resident_and_Family_Expectations_Final.docx
October 01, 2016 - Tool 6. Managing Resident and Family Expectations
Nurses, prescribing clinicians, and any other staff who discuss or dispense medication may experience pressure from residents and family members to prescribe antibiotics. This is a template for discussing this topic and introducing the talking points to use with residen…
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www.ahrq.gov/sites/default/files/wysiwyg/nhguide/6_TK1_T6-Managing_Resident_and_Family_Expectations_Final.pdf
October 01, 2016 - Nursing Home
Antimicrobial Stewardship Guide
Educate & Engage Residents, Family
Toolkit To Educate and Engage Residents and Family Members
Tool 6. Managing Resident and Family Expectations
Nurses, prescribing clinicians, and any other staff who discuss or dispense medication may
experience pressure from residen…
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www.ahrq.gov/sites/default/files/wysiwyg/research/findings/ta/topicrefinement/afib_topicref.pdf
January 01, 2020 - Catheter Ablation for Atrial Fibrillation: Topic Refinement - Project ID: CRDT0913
Final Topic Refinement Document
Catheter Ablation for Atrial Fibrillation - Project ID: CRDT0913
Date: 05/29/2014
Topic: Catheter Ablation for Atrial Fibrillation – Project ID: CRDT0913
EPC: Pacific Northwest EPC
AHRQ Task …