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psnet.ahrq.gov/issue/preeminent-hospitals-penalized-over-rates-patients-injuries
January 17, 2018 - Kaiser Health News. January 30, 2020. … Kaiser Health News . January 30, 2020. … Medicare reimbursement restrictions are a controversial stimulus to motivate hospital acquired condition … Kaiser Health News. January 30, 2020. … November 9, 2022
Cost of health care-associated infections in the United States.
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psnet.ahrq.gov/issue/hearing-patient-safety-and-quality-issues-end-stage-renal-disease-treatment
December 23, 2012 - Medicare population, as well as recent research on Medicare payment and costs for patients with this condition … August 17, 2022
Examining the Status of VA’s Electronic Health Record Modernization Program … May 1, 2015
First, Do No Harm: Improving Health Quality and Patient Safety. … September 10, 2009
Health-Care–Associated Infections in Hospitals: Continuing Leadership … April 15, 2009
Health-Care-Associated Infections in Hospitals: Leadership Needed from
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psnet.ahrq.gov/issue/findings-and-lessons-enabling-patient-centered-care-through-health-it-grant-initiative
October 05, 2015 - Book/Report
Findings and Lessons From the Enabling Patient-Centered Care Through Health … Citation Text:
Findings and Lessons From the Enabling Patient-Centered Care Through Health IT Grant … Care Needs Through Health IT Grant Initiative. … Patient Safety Result in 1.3 Million Fewer Patient Harms: Interim Update on 2013 Annual Hospital-Acquired Condition … August 28, 2013
Costs and Benefits of Health Information Technology.
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psnet.ahrq.gov/issue/impact-medicares-nonpayment-program-hospital-acquired-conditions
December 21, 2014 - This observational study examined Medicare's nonpayment policy for conditions such as health care–associated … December 9, 2020
Hospital- and system-wide interventions for health care-associated infections … September 26, 2018
Complication rates, hospital size, and bias in the CMS Hospital-Acquired Condition … June 7, 2017
Health care-associated infections: a meta-analysis of costs and financial … impact on the US health care system.
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psnet.ahrq.gov/issue/patients-get-power-fast-response
March 23, 2009 - afford patients and families the right to summon an immediate clinical response to a patient's worsening condition … January 13, 2016
Health-care providers want patients to read medical records, spot errors
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psnet.ahrq.gov/issue/missing-cancer-diagnosis
November 12, 2014 - common causes and patients' experiences—and emphasizes the serious consequences of misdiagnosing this condition … She seemed trapped in a downward mental health spiral. The real cause was a profound shock.
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psnet.ahrq.gov/issue/racism-root-cause-approach-new-framework
December 17, 2020 - department and experience higher postoperative mortality rates), continues to be an important public health … article presents Racism as a Root Cause (RRC), a framework to identify and address racism in public health … Author(s)
How structural racism works - racist policies as a root cause of U.S. racial health … April 9, 2009
Anti-black racism as a chronic condition. … Care Providers
Health Care Executives and Administrators
Non-Health Care Professionals
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psnet.ahrq.gov/issue/multistate-point-prevalence-survey-health-care-associated-infections
November 14, 2018 - Study
Multistate point-prevalence survey of health care-associated infections. … Multistate point-prevalence survey of health care-associated infections. … Multistate point-prevalence survey of health care-associated infections. … February 6, 2019
Are teaching hospitals treated fairly in the Hospital-Acquired Condition … hand hygiene strategy in United States of America health care facilities.
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psnet.ahrq.gov/issue/peggy-lillis-foundation
February 05, 2020 - The website provides information for patients, families, health care providers , and advocates. … 2016
Safe Patients, Smart Hospitals: How One Doctor's Checklist Can Help Us Change Health … Patient Safety Learning Laboratories: Advancing Patient Safety through Design, Systems Engineering, and Health … September 6, 2018
Hospital-Acquired Condition Reduction Program (HACRP). … February 13, 2013
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Hospitals
Health
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psnet.ahrq.gov/web-mm/i-just-want-go-home-understanding-deliriums-impact-treatment-preferences
December 18, 2019 - They must also agree to forgo treatments directed at curing the nominal terminal condition, “waiv[ing … it is assumed that with appropriate treatments, he would recover from this treatable acute medical condition—which … Department of Health and Human Services. … Department of Health and Human Services. … November 18, 2020
Complication rates, hospital size, and bias in the CMS Hospital-Acquired Condition
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psnet.ahrq.gov/issue/inadequate-emergency-department-care-and-physician-misconduct-washington-dc-va-medical-center
September 30, 2020 - prevention policy adherence and appropriate assessment , as well as a lack concern for the patient’s condition … Deficiencies in Care Coordination and Facility Response to a Patient Suicide at the Minneapolis VA Health … May 1, 2015
The New Electronic Health Record’s Unknown Queue Caused Multiple Events of … August 25, 2021
Patient Suicide on a Locked Mental Health Unit at the West Palm Beach … Telemental Health Care at VA Clinic Locations Prior to the Pandemic.
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psnet.ahrq.gov/node/43773/psn-pdf
May 01, 2015 - Safety Result in 1.3 Million
Fewer Patient Harms: Interim Update on 2013 Annual
Hospital-Acquired Condition … Research and Quality provides estimates on hospital-acquired
conditions (HACs)—including never events and health … efforts-improve-patient-safety-result-13-million-fewer-patient-harms-interim-update-2013
https://psnet.ahrq.gov/primer/health-care-associated-infections … https://psnet.ahrq.gov/primer/health-care-associated-infections
https://psnet.ahrq.gov/primer/never-events
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psnet.ahrq.gov/issue/quality-improvement-organizations
October 19, 2022 - Related Resources From the Same Author(s)
An asset-based quality improvement tool for health … care organizations: cultivating organization wide quality improvement and health care professional engagement … June 1, 2022
Commentary on Sentinel & Serious Events Reported by District Health Boards … July 1, 2020
Hospital-Acquired Condition Reduction Program (HACRP). … August 14, 2013
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Health Care Providers
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psnet.ahrq.gov/node/35571/psn-pdf
April 06, 2011 - Qual Saf Health Care. 2005;14(6):408-13. … overestimation-clinical-diagnostic-performance-caused-low-necropsy-rates
Assessing how well clinicians or diagnostic tests perform in detecting a given condition
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psnet.ahrq.gov/node/44779/psn-pdf
May 20, 2016 - project and other efforts that substantially decreased rates of this
preventable hospital-acquired condition … fifteen-years-after-err-human-success-story-learn
https://psnet.ahrq.gov/issue/err-human-building-safer-health-system
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psnet.ahrq.gov/innovation/transition-coachesr-reduce-readmissions-medicare-patients-complex-postdischarge-needs
March 27, 2024 - Knowledge of “red flags”: The patient is knowledgeable of indicators that his or her condition is worsening … their providers; and assisting patients and families in playing a more active role in managing their condition … Review of warning signs: The Transitions Coach reviews a list of red flags that indicate a worsening condition … were approximately 50 percent less likely to be rehospitalized at 30, 90, and 180 days for the same condition … Knowledge of red flags: Patients need to understand signs that their condition is worsening and know
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psnet.ahrq.gov/node/60066/psn-pdf
March 25, 2020 - of a condition
requiring time-sensitive treatment” or “who has a potential threat to life, limb, or … It is possible that staff would have identified the patient’s condition or deterioration earlier had … However, the staff failed to follow the policy and the patient’s condition worsened unnoticed. … Department of Health and Human Services. … Department of Health and Human Services.
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psnet.ahrq.gov/issue/accuracy-preliminary-diagnoses-made-paramedics-cross-sectional-comparative-study
September 16, 2020 - between the preliminary diagnosis and the hospital diagnosis was 70% and varied depending on the medical condition … September 16, 2020
The safety of health care for ethnic minority patients: a systematic … September 2, 2020
Peer support by interprofessional health care providers in aftermath … July 13, 2022
Transformational improvement in quality care and health systems: the next … View More
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Patient Transport
Educators
Allied Health
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psnet.ahrq.gov/issue/notes-healing-after-missed-diagnosis
May 18, 2022 - essay shares the experience of one physician who missed signs of a heart attack , mislabeling the condition … December 19, 2018
Hospital-acquired SARS-CoV-2 infection: lessons for public health. … Evaluating a patient safety learning laboratory to create an interdisciplinary ecosystem for health
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psnet.ahrq.gov/issue/workarounds-workplace-second-look
December 08, 2021 - Workarounds are prevalent in health care and create opportunities for unintended consequences. … This commentary discusses how poor design of health information technology can lead to more nurse … administrative claims data using Symptom-Disease Pair Analysis of Diagnostic Error methodology in an integrated health … Changes in hospital-acquired conditions and mortality associated with the hospital-acquired condition … May 20, 2009
Health IT implementation stories: HANDS care plan tool seeks to improve