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www.ahrq.gov/teamstepps-program/curriculum/implement/pre/ready.html
January 01, 2024 - Determining whether your organization or unit is ready for a TeamSTEPPS implementation is vital because lack
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www.ahrq.gov/sites/default/files/2025-02/woods2-report.pdf
January 01, 2025 - children and adults
are unlikely to have pediatric-trained emergency physicians, on staff, and many lack … Less effective communication/
Poor hand off
1 1
Communication- Message Miscommunicated 1 1 2
Lack … of communication Less effective communication/
Poor hand off
1 1
Lack of data Delay waiting for … A specific concern in pediatrics is the lack of information
on errors in the pediatric population and … For example, the lack of
pediatric knowledge in the assessment of acuity of a pediatric patient is a
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety-2/vol3/Advances-Meliones_40.pdf
January 01, 2006 - Discussion
Because of the wide variety of options available and the hospital staff’s lack of experience … Engaging physicians is challenging, as they typically lack a
background in PI and perceive that they … This can be very unsettling to the team and result in confusion and a lack of
clear direction. … This is a function of multiple issues including, but
not limited to, lack of contemporary IT (e.g., … bar coding), lack of IT investment, and conflicting
priorities.
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www.ahrq.gov/sites/default/files/wysiwyg/teamstepps-program/dx-improvement/module2-team-structure.pptx
January 12, 2022 - Obstacles can include conflict among team members, lack of coordination, distraction, fatigue, lack of … Dangers to good team communication include:
Lack of role clarity: Some members of the team may not … may affect diagnosis (e.g., other team members may be able to provide valuable input when there is lack
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www.ahrq.gov/sites/default/files/wysiwyg/teamstepps-program/dx-improvement/module2-presenters-notes.pdf
January 12, 2022 - Obstacles can include conflict among team members, lack of coordination,
distraction, fatigue, lack … Dangers to good team communication include:
Lack of role clarity: Some members of the team may not … may affect diagnosis (e.g., other team
members may be able to provide valuable input when there is lack
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www.ahrq.gov/patient-safety/settings/labor-delivery/perinatal-care/modules/situ/simulation-postpart-hemorrhage.html
July 01, 2023 - Nurse uses critical language to express concern about lack of blood T&C match. … If not already done after first trigger, nurse uses critical language to express concern about lack of … Nurse uses critical language to express concern about lack of blood T&C match.
… Nurse uses critical language to express concern about lack of blood T&C match.
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www.ahrq.gov/sites/default/files/wysiwyg/antibiotic-use/best-practices/cellulitis-slides.pptx
November 01, 2019 - makes complete drainage difficult or that can be associated with septic phlebitis of a major vessel
Lack … Acute Care
Cellulitis and SSTI
20
Moment 3: Narrowing and Converting to Oral Therapy
An increase or lack … cellulitis and skin and soft tissue infections can be challenging
Some reasons may include frequent lack … based on the expected microbiology of these different syndromes
Patients should be improving by day 3
Lack
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www.ahrq.gov/research/findings/nhqrdr/2014chartbooks/hispanichealth/part3-nqs7.html
October 01, 2015 - -Mexico Border (continued)
NQS Priority: Care Affordability
Lack of Usual Source of
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www.ahrq.gov/sites/default/files/wysiwyg/hai/tools/clabsi-cauti-icu/engaging-senior-leaders.pdf
April 01, 2022 - Barriers
Lack of clinical background: A senior leader may not possess clinical knowledge and will need … Lack of meaningful recognition: A senior leader may not directly recognize the value of patient safety … Lack of communication: A senior leader receives a lot of information everyday via email, face to face
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www.ahrq.gov/ncepcr/care/coordination/atlas/chapter1.html
June 01, 2014 - Much of the ambiguity in definitions of care coordination and lack of consensus around a single conceptual … However, given the lack of a broader consensus and the continued rapid expansion of the care coordination … coordination domains, and application of the framework while mapping measures, we have recognized the lack … particular organization would likely be a daunting task, and one of questionable utility given the lack
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www.ahrq.gov/sites/default/files/2024-05/schoenfeld-report.pdf
January 01, 2024 - SDM: time constraints, clinical uncertainty,
fear of a bad outcome, certain patient characteristics, lack … Though logistic concerns such
as time, space, and lack of follow-up are clearly important barriers, … However, a lack of recognition of the need for formal training does not mean it is not warranted – in … contrast, this lack of recognition is a barrier in itself, as these physicians are unlikely to seek … Many barriers to using SDM are logistic issues: Time constraints and lack of follow-up often prevent
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/perinatal-care/modules/teamwork/assemble/assemble-team-facilitator-guide.pdf
May 01, 2017 - Slide 17
SAY:
Barriers to team performance include—
• Inconsistent team membership,
• Lack of time … and follow up,
• Misinterpretation of cues,
• Lack of role clarity,
• Ineffective leadership, and
• … Teams that lack
sufficient structure with a wide variety of input
or that lack fully involved members … Additional barriers to successful teamwork are
conflict, lack of coordination, misinterpretation
of … cues, and lack of role clarity.
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www.ahrq.gov/patient-safety/resources/learning-lab/imaging-quality-long-desc.html
April 01, 2021 - identified numerous process failures and opportunities for improvement in its three focus areas, such as (1) lack … pulmonary emboli (PE) before ordering CT pulmonary angiography (CTPA) in the emergency department (ED); (2) lack
-
www.ahrq.gov/sites/default/files/wysiwyg/ncepcr/about/impact-stories/increasing-access.pdf
January 01, 2023 - low-
barrier way for patients to access treatment for an OUD,
many primary care clinicians report a lack … capacity and appointment
flexibility, as well as clinicians’ discomfort with providing
MOUD due to lack
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/education/curriculum-tools/cusptoolkit/modules/engage/engageexec.pptx
January 01, 2006 - Accountable for Reducing Patient Harm
15
The Challenges of Partnering With a Senior Executive
Lack … of clinical background
Lack of recognition for the value of CUSP
Unavailability to meet with the CUSP
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/cauti-tools/archived-webinars/breaking-down-barriers-051215.pptx
February 01, 2015 - of 10cc. syringe of sterile water only after urine is observed in tubing
18
Execution: Lack … level strategies:
Post CAUTI rates for all units, so that comparisons can be seen.
20
Execution: Lack … non-punitive culture
Visible and supportive leadership
Identify system-wide barriers to aseptic insertion:
Lack … of adequate supplies
Lack of space for sterile field set-ups
Lack of manpower
Allocate resources to
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www.ahrq.gov/prevention/guidelines/tobacco/clinicians/presentations/2008update-full/slide73.html
October 01, 2014 - Lack of support.
Depression.
Enjoyment of tobacco.
Being around other tobacco users.
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www.ahrq.gov/hai/cusp/modules/assemble/team-notes.html
December 01, 2012 - Lack of time and information sharing.
Hierarchy.
Varying communication styles.
Conflict. … Lack of coordination and followup.
Misinterpretation of cues.
Lack of role clarity. … Teams that lack sufficient structure with a wide variety of input or that lack fully involved members … Additional barriers to successful teamwork are conflict, lack of coordination, misinterpretation of cues … , and lack of role clarity.
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www.ahrq.gov/prevention/resources/vision/resources/vision3.html
October 01, 2002 - One limitation of this study is the lack of followup with study participants; it is unclear if these … One reported drawback to the program is the lack of followup with veterans. … Most studies addressing this debate have serious limitations (e.g., small sample sizes, lack of adequate … of awareness of low vision services. 93 Moreover, the lack of adequate diagnostic tools may preclude … The lack of research limits opportunities to establish specific standards of care.
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www.ahrq.gov/diagnostic-safety/resources/issue-briefs/dxsafety-current-state3.html
January 01, 2024 - diagnostic error experiences. 87 In a recent study, three common barriers for reporting errors were lack … of time, complexity of the reporting system, and lack of feedback to the reporting clinician on analysis … physician-patient miscommunication, information overload, absence of record retrieval systems, and lack … to diagnostic safety improvement in healthcare organizations include low awareness of the problem, lack … of infrastructure and resources to address diagnostic safety, lack of leadership commitment, and low