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psnet.ahrq.gov/sites/default/files/2021-09/Battle%20Buddy%20Pocket%20Card%20-%20final%20(1).pdf
January 01, 2021 - Having a Battle Buddy helps you to: 1) Validate your experiences; 2)
Identify and address stressors … Daily BB
conversations can also help identify specific issues that need to be addressed
locally (within … any issues
that need more support or
attention
Identify any operational
issues that need escalation … Anticipate
Plan
Deter
•Anticipate and identify the specific stressors you are likely to
encounter … •Describe your likely responses to these stressors
•Identify the stressors and responses that will
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psnet.ahrq.gov/taxonomy/term/3477
Failure Mode and Effect Analysis (FMEA)
A common process used to prospectively identify error risk … Different teams charged with analyzing the same process may identify different steps in the process,
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psnet.ahrq.gov/issue/association-postoperative-readmissions-surgical-quality-using-delphi-consensus-process
September 25, 2018 - Association of postoperative readmissions with surgical quality using a Delphi consensus process to identify … Association of Postoperative Readmissions With Surgical Quality Using a Delphi Consensus Process to Identify … Association of Postoperative Readmissions With Surgical Quality Using a Delphi Consensus Process to Identify
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psnet.ahrq.gov/node/867016/psn-pdf
October 23, 2024 - automated-dynamic-radiation-oncology-prescription-checking-system
Trigger tools, alerts, and other criteria are used to identify … this study, researchers reviewed over 24,000 radiation oncology
prescriptions and applied criteria to identify
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psnet.ahrq.gov/node/850678/psn-pdf
June 14, 2023 - A multidisciplinary team developed the AAM program to identify and respond to alerts of likely patient … The clinical team then works collaboratively with the patient and the family to identify or clarify the … Each hospital should also identify an implementation lead and define roles and
responsibilities for … Identify the team members who will be trained to monitor and review the AAM scores and facilitate
the … Review the data regularly to identify opportunities to improve the process and the outcomes and
refine
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psnet.ahrq.gov/node/43467/psn-pdf
September 09, 2015 - recognition of the importance of safety culture in preventing errors, organizations are taking
steps to identify … A past AHRQ WebM&M perspective
discusses how to identify and manage unprofessional behaviors. … disruptive-and-unprofessional-behavior
https://psnet.ahrq.gov/primer/culture-safety
https://psnet.ahrq.gov/perspective/how-identify-and-manage-problem-behaviors
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psnet.ahrq.gov/node/46538/psn-pdf
February 21, 2018 - adverse-events-patients-home-healthcare-retrospective-record-review-using-
trigger-tool
In this study, researchers used trigger tools to identify … psnet.ahrq.gov/primer/triggers-and-trigger-tools
https://psnet.ahrq.gov/issue/development-trigger-tool-identify-adverse-events-and-no-harm-incidents-affect-patients … https://psnet.ahrq.gov/issue/development-trigger-tool-identify-adverse-events-and-no-harm-incidents-affect-patients
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psnet.ahrq.gov/node/36718/psn-pdf
July 26, 2011 - In this cohort study, cardiologists re-
reviewed ECGs to identify the rate of false-positive and false-negative … A prior study also found that
the computerized ECG interpretation frequently did not identify the correct … causes-errors-electrocardiographic-diagnosis-atrial-fibrillation-physicians
https://psnet.ahrq.gov/issue/implications-failure-identify-high-risk-electrocardiogram-findings-quality-care-patients
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psnet.ahrq.gov/issue/use-interactive-telephone-based-self-management-support-program-identify-adverse-events-among
June 11, 2010 - Study
Use of an interactive, telephone-based self-management support program to identify … Use of an interactive, telephone-based self-management support program to identify adverse events among … Use of an interactive, telephone-based self-management support program to identify adverse events among
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psnet.ahrq.gov/issue/systematic-approaches-adverse-events-obstetrics-part-1-part-2
May 18, 2022 - The first commentary in this series describes strategies to identify and classify events in obstetric … December 21, 2017
Validity of 16 AHRQ Patient Safety Indicators to identify in-hospital
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psnet.ahrq.gov/node/44953/psn-pdf
March 09, 2016 - safety room of horrors: a novel method to assess
medical students and entering residents' ability to identify … safety room of horrors: a novel method to assess medical
students and entering residents' ability to identify … patient-safety-room-horrors-novel-method-assess-medical-students-and-
entering-residents
This simulation study challenged medical students to identify
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psnet.ahrq.gov/issue/2011-annual-benchmarking-report-malpractice-risks-emergency-medicine
July 18, 2018 - This report analyzes malpractice claims from 90 hospitals across the United States to identify risks … May 1, 2011
Implications of the failure to identify high-risk electrocardiogram
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psnet.ahrq.gov/node/867179/psn-pdf
January 01, 2025 - implementation-standardized-tool-root-cause-analysis-selection
The root cause analysis or RCA2 framework is a standardized approach to identify … In this study, researchers used an RCA2 algorithm to identify
high-risk events for root cause analysis
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psnet.ahrq.gov/node/73901/psn-pdf
September 29, 2021 - electronic health record
(EHR) data for HS-ASP “Great Catches” from October 2014 through May 2018 to identify … additional interpretation
of laboratory results), which suggests that the HS-ASP model can be leveraged to identify … using-good-catches-promote-just-culture-and-perioperative-patient-safety
https://psnet.ahrq.gov/issue/accuracy-safer-dx-instrument-identify-diagnostic-errors-primary-care
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psnet.ahrq.gov/innovation/let-us-twisst-plan-simulate-study-and-act
October 12, 2018 - In situ simulation can identify latent safety threats (LSTs) before they result in patient harm. … combines simulation-based clinical systems testing (SbCST) and simulation-based training (SbT) to identify … simulated medical emergency, participants engaged in a facilitator-led debriefing process and were asked to identify … May 15, 2024
Using in situ simulation to identify latent safety threats in emergency … August 9, 2023
In situ simulation as a quality improvement tool to identify and mitigate
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psnet.ahrq.gov/periodic-issue/periodic-issue-412
October 31, 2023 - Simulations are routinely used to identify latent safety threats. … Trigger tools are commonly used to detect adverse events and identify areas for safety improvement. … This study found that trigger tools using electronic health record-based data can accurately identify … Trigger tools are commonly used to detect adverse events and identify areas for safety improvement. … Simulations are routinely used to identify latent safety threats.
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psnet.ahrq.gov/node/45872/psn-pdf
April 13, 2017 - A prior study showed that application of the Safer Dx Instrument—a
structured tool to help identify … In this study, researchers tested the ability of the
instrument to identify diagnostic errors in high-risk … challenges-defining-and-measuring-diagnostic-error
https://psnet.ahrq.gov/issue/accuracy-safer-dx-instrument-identify-diagnostic-errors-primary-care
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psnet.ahrq.gov/issue/when-diagnostic-testing-leads-harm-new-outcomes-based-approach-laboratory-medicine
September 12, 2018 - This commentary recommends an approach to examine laboratory testing and identify weaknesses that may … October 9, 2013
Root cause analysis reports help identify common factors in delayed diagnosis
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psnet.ahrq.gov/node/74133/psn-pdf
January 01, 2022 - coordination resources in primary care, this study
utilized Medicare fee-for-service claims data to identify … risk factors to identify individuals at risk of future
avoidable hospital events.
-
psnet.ahrq.gov/node/838194/psn-pdf
September 28, 2022 - This commentary introduces Measure Dx, a tool
providing guidance for health care organizations to identify … improving-diagnostic-performance-through-feedback-diagnosis-learning-cycle
https://psnet.ahrq.gov/issue/measure-dx-resource-identify-analyze-and-learn-diagnostic-safety-events