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hcup-us.ahrq.gov/reports/statbriefs/sb135.pdf
March 01, 2012 - which
vehicle were m
hospital admis
than those with
involvement (6
Inpatient stays
injury in which
involved … Bicycle-relat
involved a mot
more likely to re
ssion (16.3 perc
hout motor veh
6.7 percent). … In more than 1 in 10 of these visits (12 percent or 50,600 visits), a motor vehicle was also involved … Hospital admissions more
frequently resulted from those injuries in which a motor vehicle was involved … Patients whose bicycle injuries involved a motor vehicle were more likely to die in
the hospital than
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psnet.ahrq.gov/issue/changing-course
March 26, 2014 - A few well-publicized cases of medical errors have led the hospitals involved to transform how they approach … A few well-publicized cases of medical errors have led the hospitals involved to transform how they approach
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hcup-us.ahrq.gov/reports/statbriefs/sb135.jsp
June 01, 2012 - In more than 1 in 10 of these visits (12 percent or 50,600 visits), a motor vehicle was also involved … Hospital admissions more frequently resulted from those injuries in which a motor vehicle was involved … Approximately 1 in 10 ED visits for bicycle-related injuries also involved a motor vehicle. … Inpatient stays for a bicycle-related injury in which a motor vehicle was involved were longer and more … Patients whose bicycle injuries involved a motor vehicle were more likely to die in the hospital than
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hcup-us.ahrq.gov/reports/statbriefs/sb186-Operating-Room-Procedures-United-States-2012.jsp
December 01, 2014 - In 2011, nearly 29 percent of hospital stays involved OR procedures and 48 percent of hospital costs … were for stays that involved OR procedures. 2 Mean hospital costs for stays with OR procedures were … The most common inpatient OR procedures in 2012 involved the musculoskeletal system: knee arthroplasty … Another 4 of the 15 most common OR procedures involved the digestive system: cholecystectomy (removal … The remaining stays involved OR procedures related to the cardiovascular system—including the second
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hcup-us.ahrq.gov/reports/statbriefs/sb233-Operating-Room-Procedures-United-States-2014.jsp
December 01, 2017 - Although just over one-quarter (28.6 percent) of all hospital stays involved OR procedures, these stays … In 2014, 36.7 percent of stays that were privately insured involved OR procedures compared with 23-25 … In 2014, 28.6 percent of all inpatient stays involved at least one OR procedure, but costs for stays … Percentage of inpatient stays that involved operating room (OR) procedures, by patient characteristic … Among inpatients aged 85 years and older, only 15.5 percent of stays involved OR procedures.
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hcup-us.ahrq.gov/reports/statbriefs/sb255-Traumatic-Brain-Injury-Hospitalizations-ED-Visits-2017.pdf
January 01, 2017 - Most TBI-related inpatient stays involved cerebral (epidural, subdural, subarachnoid, or intracerebral … In contrast, 72.7 percent of TBI-related ED visits involved an
uncomplicated concussion and only 10.1 … or any duration of loss with death (vs. 0.3 percent of TBI-related ED visits); 12.4 percent
involved … Overall, 6.6 percent of TBI-related treat-and-release ED visits involved contact or collision sports … and
another 8.5 percent involved other sports-related injuries, compared with 0.3 and 3.9 percent of
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psnet.ahrq.gov/web-mm/total-parenteral-nutrition-multifarious-errors
January 23, 2017 - Health care providers involved with PN should be knowledgeable and skilled in patient PN management and … Caregivers involved with PN should work within an interdisciplinary setting that includes certified nutrition … The error in this case involved a breakdown in oversight and system checks; breakdowns leading to medication … When knowledgeable pharmacists are involved, pediatric PN prescribing errors are identified and resolved … It is the responsibility of the involved prescriber, pharmacist, nurse, and dietitian to recognize and
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psnet.ahrq.gov/web-mm/patient-identification-errors-systems-challenge
February 23, 2011 - The Cases The following four events involving five patients all involved incorrect patient identification … Event #1 involved a 68-year-old woman who presented to the emergency department (ED) from the ambulatory … Event #2 involved two patients whose ED visits overlapped in time. … Event #3 involved a 2-year-old patient who presented to the ED, subsequently underwent surgery, recovered … electronic records performed at New York Presbyterian Hospital revealed that only 3.2% of the errors involved
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psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.167_slideshow.ppt
January 01, 2008 - Understand coping strategies, including error disclosure
Review potential support structures for providers involved … Support for Providers Involved in Medical Errors
Few formal support programs are available for providers … cmd=retrieve&db=pubmed&dopt=abstract&list_uids=10720336
Support for Providers Involved in Medical … cmd=retrieve&db=pubmed&dopt=abstract&list_uids=12606742
Support for Providers Involved in Medical … cmd=retrieve&db=pubmed&dopt=abstract&list_uids=12764888
Improving Support for Providers Involved
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psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.317_slideshow.ppt
March 01, 2014 - Standardizing performance review and assessment
Committing to providing feedback early and often to the involved … Unsafe Acts Algorithm
In the present case, Reason's algorithm may define the error as blameless if the involved … clinician acted in good faith
However, if the involved professional had a history of unsafe acts, the … regarding how to provide feedback and what recipients should expect
For example, in this case, assume the involved … intervention by an authority figure may be necessary
At this level, an authority figure may direct the involved
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effectivehealthcare.ahrq.gov/get-involved/nominated-topics/medical-management-of-urinary-stone-disease
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psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.218_slideshow.ppt
May 01, 2010 - After the error was discovered, the nurse involved was fired by the hospital and her license was revoked … , expectations, or procedures that could get in the way
Determine clinical knowledge of the person involved … have managed organization’s risk, but likely seen as unjust by all other major stakeholders: the nurse involved
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cdsic.ahrq.gov/cdsic/cdsic-about
January 01, 2016 - and Coordinating CDS
Resources
News
CDSiC Leadership Viewpoints
Get Involved … GET INVOLVED IN CDSiC BY:
Signing up for the CDSiC Insider newsletter
Expressing interest … joining a CDSiC Workgroup
Sharing your feedback and/or questions with the CDSiC team
Get Involved
-
digital.ahrq.gov/ahrq-funded-projects/ehealth-records-improve-dental-care-patients-chronic-illnesses/annual-summary/2011
January 01, 2011 - This project involved a randomized clinical trial to evaluate the effectiveness of simple reminders in … This project involved a randomized clinical trial to evaluate the effectiveness of simple reminders in … The study involved 102 dentists from 15 dental clinics within HealthPartners, a large integrated health
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www.uspreventiveservicestaskforce.org/home/getfilebytoken/5newnV_sfH4xnGCbpoh4Ma
KQ1 Direct Grade
change
Randomized,
controlled
trials§
Adolescents or adults
involved with … change
Health
disparities
General
Randomized,
controlled
trials§
Adolescents or adults
involved … Health
disparities
General
Randomized,
controlled
trials§
Adolescents or adults
involved
-
psnet.ahrq.gov/issue/managing-alarm-systems-quality-and-safety-hospital-setting
August 13, 2014 - September 21, 2016
Increased risk of burnout for physicians and nurses involved in a … April 10, 2019
Supporting involved health care professionals (second victims) following
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digital.ahrq.gov/sites/default/files/docs/publication/Parisetal_HFES2008.pdf
January 01, 2008 - When errors are not
caught, attention is usually focused on people involved, e.g. … medication use process is complex and varies according to
multiple factors, including the medication involved … For
example, pharmacists may be involved in monitoring the use
of certain medications and communicating … The protocol involved the
review of medication orders through the medication use
process by reviewing … The nurse, pharmacist, technician, and
unit clerk all may become involved in remedying the situation
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effectivehealthcare.ahrq.gov/get-involved/nominated-topics/evidence-gaps-for-mhealth-tools-in-diabetes
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effectivehealthcare.ahrq.gov/get-involved/nominated-topics/multimodal-pain-management-for-post-hip-surgery
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effectivehealthcare.ahrq.gov/get-involved/nominated-topics/iron-deficiency-anemia-in-renal-dialysis-patients