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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/surgery/modules/onboarding/onboarding_overview_impmodel_facnotes.docx
December 01, 2017 - Hopkins asked staff how the next patient will be harmed and what the hospital can do about it. … Slide 17
Case Study: Laparoscopic Gastrointestinal Surgery Trays
SAY:
We also know this effort of … Slide 18
Case Study: Antibiotic Irrigation
SAY:
Yet another powerful example of the benefits of tapping … They are the ones who understand how work actually gets done on a day-to-day basis. … Slide 28
Finding a Senior Executive Partner
ASK:
So, how do you start to build this relationship with
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www.ahrq.gov/sites/default/files/wysiwyg/policymakers/chipra/factsheets/chipra_14-p008-1-ef.pdf
October 01, 2014 - ● The validity of the measure’s case-mix adjustment model—assessed according to how well the model … Go to http://www.hcup-us.ahrq.gov/kidoverview.jsp. … – Readmission measures do not indicate which factors most influence readmissions for a given population … – Claims data are limited, as billing codes do not reflect certain information such as disease severity … Quality Measures
Program (PQMP) as a followup to identifying the initial core set of children’s health
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-family-engagement/pfeprimarycare/envscan-app-f.pdf
January 01, 2015 - Yes Yes Moderate Case study of having patients serve an auditing function
for hand hygiene compliance … No Yes Suggestive Case study of impact of PCMH approach to engage
patients and improve health outcomes … Explore as case study and
possible intervention. … Trust, temporality and systems: how do patients
understand patient safety in primary care? … Toolkit provides a brief how to guide for organizations
on how to better engage patients and families
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www.ahrq.gov/
June 12, 2025 - To Explore AHRQ Data Tools
Impact Case Studies
Learn how AHRQ-funded … Diagnostic Safety and Quality
Funding research to better understand how diagnostic errors happen and … how to prevent them. … Data & Analytics
Providing data and analysis to help healthcare decision makers understand how the … do about the flu.
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www.ahrq.gov/nhguide/toolkits/determine-whether-to-treat/toolkit1-suspected-uti-sbar.html
November 01, 2024 - with a suspected UTI for the prescribing clinician, who then uses the information to assess the need … simplified, one-page format ( Word ) that can be edited A Clinician Letter: A template for a letter … Care provides training modules about the form for nursing staff (tool 4) ( PDF | Word ) How Do I … A periodic refresher training is also helpful as a reminder to staff and to make sure new staff understand … how to use the tool.
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www.ahrq.gov/hai/quality/tools/cauti-ltc/modules/implementation/education-bundles/indwelling-urinary-catheter-use/catheter-care/slides.html
March 01, 2017 - don'ts of catheter care and maintenance; and
Describe the TeamSTEPPS strategy of mutual support and how … soap and water
Do keep the catheter and tubing from kinking and becoming obstructed
Do keep catheter … collection containers
Do make sure to disinfect the sampling port before obtaining a sample
2 … Slide 12: Case Study
Joe, a certified nursing assistant (CNA), is busy getting Mr. … How could Sarah and Michael, two CNAs with down time, offer task assistance in this scenario?
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www.ahrq.gov/diagnostic-safety/resources/issue-briefs/dxchecklists-6.html
September 01, 2020 - Are Not Performing as Expected
Conclusions and Next Steps
References
Checklists to … Finally, most studies that measure effects on accuracy are performed in controlled settings that do not … realistic circumstances and with a realistic case mix? … and the contexts for use, will help answer these and other critical questions and demonstrate if and how … Return to Contents
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/prevention-chronic-care/improve/coordination/ccqmpc/ccqmp-pc-development.pdf
July 01, 2016 - framework to better reflect how patients
and families think about care planning, transitions of care … The number of needed completes is an important factor in determining how many patients to
sample from … calculate the performance of each
practice and, where appropriate, shows how a practice’s performance … over dum;
if educ ne . then dum=0;
end;
do over dum2;
if age ne . then dum2=0;
end;
do over … % Sometimes
or Never
Average
(0–100)
How Does Your Practice
Compare to All Practices?
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www.ahrq.gov/sites/default/files/wysiwyg/hai/tools/mrsa-2/012-ss-decolonization-strategies.pptx
April 01, 2025 - How to reduce the likelihood of this defect from happening again? … How to know the risk is reduced?
Access the AHRQ Learning From Defects Tool. … Improved the availability of a nasal decolonization agent in the pre-op area
How to know the risk is … recommendations in this presentation are those of the authors, who are responsible for its content, and do … Effectiveness of a bundled intervention of decolonization and prophylaxis to decrease Gram positive surgical
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/cauti-tools/archived-webinars/leveraging-cultural-change-080814.pptx
January 01, 2013 - of the HSOPS results and the team check-up tool can identify opportunities for improvement
Utilize case … studies to develop strategies to overcome barriers to decreasing urinary catheter device utilization … :
Do not participate in rounds
Value:
Teamwork
Value:
Autonomy
Assumption:
Safety is a system property … it :
Is preoccupied with failure
Is sensitive to how each team member affects a process
allows those … Is there a rational reason?
How might we engage him?
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www.ahrq.gov/ncepcr/tools/obesity-kit/obtoolkit-tool12.html
March 01, 2014 - Summary
References
Appendix A. Case Studies
Appendix B. Shared Appointments
Appendix C. … One of the main purposes of the technique is to have a conversation that stimulates a patient's desire … Furthermore, much of the MI literature emphasizes how the "spirit" of MI is the driving force behind … Motivational Interviewing and Diabetes: What is it, how is it used, and does it work? … do, capturing the essence of what they have said without judgment.
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www.ahrq.gov/sites/default/files/wysiwyg/evidencenow/tools-and-materials/skills-sms-heart-health.pptx
December 01, 2010 - weight) remains a critical component of a health promotion and ASCVD risk reduction, both prior to and … activity:
3 to 4 sessions a week, lasting on average 40 minutes per session, and involving moderate-to-vigorous … Goals
Specific – what are you going to do and how often
Measurable – how will you know if you have done … it each day
Attainable – can you do it
Realistic – can you do it given … 2
Facilitate practice developing a global aim statement:
We aim to improve self-management support for
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www.ahrq.gov/hai/cauti-tools/archived-webinars/ed-catheter-insertions-transcript.html
December 01, 2017 - How does – how do nurses and physicians transmit concern back and forth? … Because whatever that looks like is really going to affect how quickly a decision is made, how completely … You know, there’s a lot of other ways to do that. … On the next slide, we’ll – one case study is trauma. … The next slide is another case study and that would be congestive heart failure.
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www.ahrq.gov/research/findings/final-reports/stpra/stpraapd2.html
April 01, 2018 - Do not flash at all. Stopped flashing a year ago. … , they might bring a lot of residents in to watch. … If podiatry case they sedate a bit before doing blocks and then they prep the site then do the drape … Instructions tell you how to lay it down so that it is in correct position. … Do not remove drapes until after most dressings are on, some dressings not 'sterile', like a brace.
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www.ahrq.gov/sites/default/files/2024-07/gallagher5-report.pdf
January 01, 2024 - Physician fear of being held publicly accountable for
adverse events that do not reflect a deficit in … bit more about how
to conduct a discussion with the family or what we could have done better or
differently … It’s easy to upload. I don’t really have any
suggestions other than we just have to do it.” … find a
way of how this is working with patients and families; it’s very difficult. … them in reviewing the documents
which they typically do with us like when we’re responding to a patient
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety-2/vol2/Advances-Shah_99.pdf
March 23, 2008 - How important a problem do you think adverse
events are in the United States today? … When people seek help from a health care
professional, how often do you think adverse events
are made … how to
proceed. … How important a problem do you think adverse events are in the United States today? … When people seek help from a health care professional, how often do you think such adverse
events are
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www.ahrq.gov/sites/default/files/wysiwyg/hai/tools/mrsa/039-mrsa-surveillance-slides.pptx
October 01, 2024 - Staphylococcus aureus (MRSA)
Understand the pros and cons of different MRSA surveillance approaches
Outline how … Wear gloves and gown to enter a patient room regardless of whether patient contact will occur. … Only a few of these patients were known to have had MRSA in the past. … recommendations in this presentation are those of the authors, who are responsible for its content, and do … Kramer A, Schwebke I, Kampf G. How long do nosocomial pathogens persist on inanimate surfaces?
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www.ahrq.gov/sites/default/files/publications/files/confidreportguide_0.pdf
March 01, 2016 - Case study illustrating the impact of clinician feedback reporting on quality of Type 2
diabetes care … and
“How has it influenced what you do in the treatment rooms? … We do not know enough about how, when, and why
some feedback reports can achieve a more significant … In particular, how often do individual
physicians receive multiple provider feedback reports from various … What do we know about how to do audit and feedback?
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www.ahrq.gov/sites/default/files/wysiwyg/hai/tools/mrsa/011-blood-culture-webinar-slides.pptx
October 01, 2024 - promote blood culture stewardship and reduce blood culture contamination
Discuss how to implement blood … evaluate for bacteremia.3
However, leukocytosis and fever do not correlate well with bacteremia.3
Blood … They share their goals and set expectations for how success will be measured and defined. … Inappropriate blood culture ordering: Records show blood cultures are often ordered for cases that do … Detection of bloodstream infections in adults: how many blood cultures are needed?.
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www.ahrq.gov/research/findings/final-reports/ptfamilyscan/ptfamily3.html
July 01, 2018 - personal life. 22 Providers do recognize the importance of communication as a component of quality, … but they also tend to be overly positive in their perceptions of how effectively they communicate. 23 … what patients themselves believe they can do, they generally believe that they have a role in health … In a qualitative pilot study, nurses expressed concern that they do not have the time to spend educating … A literature review and a mixed mode study found that patient-centered interviews do not take significantly