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www.ahrq.gov/sites/default/files/wysiwyg/sops/surveys/asc/part-ii-sops-asc-database-report.pdf January 01, 2020 - respondents who indicated that near-miss incidents were “Always” or “Most of the time”
documented in an incident … When something happens that could harm the patient, 
but does not, how often is it documented in an incident … When something happens that could harm the patient, but does 
not, how often is it documented in an incident … When something happens that could harm the 
patient, but does not, how often is it 
documented in an incident … When something happens that could harm the 
patient, but does not, how often is it documented in 
an incident 
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www.ahrq.gov/diagnostic-safety/resources/issue-briefs/dxsafety-dx-stewardship8.html August 01, 2024 - For example, van Moll and colleagues described an analysis of voluntary incident reports at an academic 
- 
                                        
www.ahrq.gov/sites/default/files/wysiwyg/sops/surveys/asc/asc-resource-list.pdf April 01, 2023 - The Joint Commission proposes actions for all 
organizations to take, including developing incident reporting … Incident Decision Tree 
https://www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety … The Incident Decision Tree supports the aim of creating 
an open culture, where employees feel able to … Laboratory Testing Process: A Step-by-Step Guide for Rapid-Cycle Patient Safety and 
Quality Improvement
Incident … Incident Decision Tree 
	3. Just Culture 
	4. 
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www.ahrq.gov/patient-safety/settings/hospital/candor/modules/guide4/apd.html August 01, 2022 - EQUIPMENT DEVICE FAILURE 
 
 
 If applicable, was this incident reported to the FDA? 
 
 
   
   
   
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www.ahrq.gov/hai/tools/ambulatory-surgery/sections/sustainability/management/visual-fac-notes.html June 01, 2017 - of near misses may vary from facility to facility, but many facilities have a process for recording incident … Who accepts incident reports, for example, and who monitors them over time? 
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/ambulatory-surgery/sections/sustainability/management/visual/visual-mgmt-facnotes.docx May 01, 2017 - of near misses may vary from facility to facility, but many facilities have a process for recording incident … Who accepts incident reports, for example, and who monitors them over time? 
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www.ahrq.gov/research/findings/nhqrdr/2014chartbooks/hispanichealth/part3-nqs5.html October 01, 2015 - The cohorts include incident hemodialysis patients. 
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www.ahrq.gov/research/shuttered/acfselection/appendixa.html July 01, 2018 - The aim of this study was to analyse the prehospital and in-hospital response to the incident and identify … INTERPRETATION: Critical mortality was reduced by rapid advanced major incident management and seems … The incident command system provides an organizational structure at the agency, discipline, or jurisdiction … Incident management systems and cooperative planning processes will facilitate maximal use of available … A recognized incident command system should be used. 
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www.ahrq.gov/research/shuttered/toolkitchecklist/surgetkit1.html July 01, 2018 - Review/Replanning 
 Description:  In the unfortunate event that a terrorist incident or disaster occurs … Obtaining a license 
 X 
   
 X 
 
 
 Medical personnel credentialing 
 X 
   
 X 
 
 
 Complaints and incident 
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www.ahrq.gov/sites/default/files/wysiwyg/sops/surveys/asc/composite-measures-english.pdf January 01, 2015 - When something happens that could harm the patient, but does not, how often is it documented in an incident 
- 
                                        
www.ahrq.gov/sites/default/files/2025-03/lacson-report.pdf January 01, 2025 - Final Progress Report: Factors That Enhance Diagnostic Imaging Safety in the Ambulatory Setting
Project Title: Factors that Enhance Diagnostic Imaging Safety in the Ambulatory Setting
Principal Investigator: Ronilda Lacson, MD, PHD
Team Members:
Ramin Khorasani, MD, MPH 
Ivan Ip, MD, MPH 
Sonali Desai, MD 
Allen Ka…  
- 
                                        
www.ahrq.gov/sites/default/files/2024-01/lo-report.pdf January 01, 2024 - specificity (0.92) and negative predictive value (0.99) but low 
sensitivity (0.68) and PPV (0.02) for incident … indicating that decreasing platelet count and increasing total bilirubin 
were strong predictors of incident … of Hy’s 
Law biochemical criteria, determined at recognition of drug-induced hepatitis, to predict incident … practice, clinicians would be unlikely to embrace a prognostic score that leads to a high 
rate of missed incident … Incident liver aminotransferases >200 U/L occurred in 2% of the 10,083 HIV-infected patients in 
the 
- 
                                        
www.ahrq.gov/sites/default/files/2025-05/fraser-dunagan-report.pdf January 01, 2025 - patient safety 
events, including root cause analytical techniques, human factors analysis, critical 
incident … The system is collecting data from other incident reporting 
systems as well as supporting direct data … patient safety events, including root cause analytical techniques, human factor 
analysis, critical incident … Reporting of adverse drug events:  Examination of a hospital incident reporting system. … Reliable safety event severity 
scoring by incident reporters. 
- 
                                        
www.ahrq.gov/sites/default/files/wysiwyg/sops/surveys/nursing-home/nursing-home-items-composite-measures-english-2.0.pdf June 05, 2025 - Staff are supported when they are involved in a resident safety incident. 
- 
                                        
www.ahrq.gov/sites/default/files/wysiwyg/hai/tools/mrsa-2/144-cusp-tip-sheet-engaging-surgeons.docx April 01, 2025 - Smith to discuss this incident and see how we can address Dr. 
- 
                                        
www.ahrq.gov/sites/default/files/wysiwyg/ncepcr/about/profiles/profile_kharbanda.pdf January 01, 2023 - Evaluation of an electronic clinical decision support tool for incident elevated bp in adolescents. 
- 
                                        
www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol1/Mohr.pdf February 01, 2004 - The Critical Incident Analysis Technique15—a method first employed in 
aviation to examine aircraft training … The Constant Comparative Method19 provided the analytic structure for the 
Critical Incident Analysis … The Critical Incident Technique. Psychol 
Bull 1954;51(4):327–58. 
16. … Adverse sedation 
events in pediatrics: a Critical Incident Analysis of 
contributing factors. … Patient safety 
problems in children’s medical care: a Critical 
Incident Analysis. 
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www.ahrq.gov/sites/default/files/wysiwyg/sops/surveys/nursing-home/2025-nursing-home-20-pilot-test-results.pdf January 01, 2025 - Mistakes 
(e.g., feel safe reporting mistakes, are treated fairly, and are supported when involved in an 
incident … Mistakes (e.g., feel safe 
reporting mistakes, are treated fairly, and are supported when involved in an incident … are treated fairly when they 
make mistakes, and are supported when involved in a resident 
safety incident … (Item 
A11)
Staff are supported when they are involved in a resident 
safety incident. 
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www.ahrq.gov/es/patient-safety/settings/hospital/resource/pressureulcer/tool/put5.html October 01, 2014 - Preventing Pressure Ulcers in Hospitals 
 5. How do we measure our pressure ulcer rates and practices? 
 
 
 
 
 Previous Page Next Page 
 
 Table of Contents 
 
 Preventing Pressure Ulcers in Hospitals 
 Overview 
 Key Subject Area Index 
 1. Are we ready for this change? 
 2. How will we manage change? 
 3. What are …  
- 
                                        
www.ahrq.gov/patient-safety/settings/hospital/resource/pressureulcer/tool/put5.html October 01, 2014 - Preventing Pressure Ulcers in Hospitals 
 5. How do we measure our pressure ulcer rates and practices? 
 
 
 
 
 Previous Page Next Page 
 
 Table of Contents 
 
 Preventing Pressure Ulcers in Hospitals 
 Overview 
 Key Subject Area Index 
 1. Are we ready for this change? 
 2. How will we manage change? 
 3. What are …