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541. Section 2: Explanation of Mutual Support Key Concepts and Tools | Agency for Healthcare Research and Quality
     www.ahrq.gov/teamstepps-program/curriculum/mutual/tools/index.html
     June 01, 2023 - Section 2: Explanation of Mutual Support Key Concepts and Tools This section contains explanations and illustrations to help you better understand and appreciate the importance of TeamSTEPPS mutual support concepts and tools. If you teach this content or want additional insights into how the material can be mor…

542. CHIPRA 241: Section 5, Table 2 (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/chronic/chipra-241-bmi-communication-section-5-table-2.pdf
     May 01, 2010 - CHIPRA 241: Section 5, Table 2 Table 2: Evidence for Communication of Weight Classification of Children Who Are Overweight or Obese Type of Evidence Key Findings Level of Evidence (USPSTF Ranking*) Citations Expert recommendation In 2007, the AAP, AMA, and CDC collaborated to form an expert c…

543. Table 5.1. Intervention Steps and Implementation Tools | Agency for Healthcare Research and Quality
     www.ahrq.gov/research/findings/final-reports/crcscreeningrpt/crcscreentab5-1.html
     April 01, 2018 - Health Care Systems for Tracking Colorectal Cancer Screening Tests Table 5.1. Intervention Steps and Implementation Tools Previous Page Next Page Table of Contents Health Care Systems for Tracking Colorectal Cancer Screening Tests Executive Summary 1. Introduction 2. Description of the Interve…

544. Diagnostic Safety Across Transitions of Care Throughout the Healthcare System: Current State and a Call to Action (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/patient-safety/reports/issue-briefs/diagnostic-safety-transitions-care.pdf
     June 01, 2023 - diagnostic momentum, anchoring bias, and early closure can result from poor handoff communication, lack … of shared mental models, and lack of shared understanding between handoff senders and receivers. … High patient complexity AI/ML prediction tools Diagnostic uncertainty Patient and family involvement Lack … of structured handoffs Standardized communication tools Lack of family engagement Explicitly mentioning … of shared mental model Standardized communication tools Lack of structured handoffs Patient and family

545. Transforming Primary Care Practice: Lessons From the New Orleans Safety Net | Agency for Healthcare Research and Quality
     www.ahrq.gov/ncepcr/research-transform-primary-care/transform/profile/rittenhouse.html
     October 01, 2015 - challenge of balancing comprehensive care management with maintaining access to services for new patients, lack

546. Shadowing Another Professional Tool | Agency for Healthcare Research and Quality
     www.ahrq.gov/hai/cusp/toolkit/shadowing.html
     December 01, 2012 - Were there obstacles that prevented effective handling of the situation (e.g., lack of staff, equipment

547. Slide 1
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/cauti-tools/archived-webinars/engaging-nurse-physician-patient.pptx
     May 28, 2015 - Physician Worklife : Limited Time Attend at Several Hospitals Not Hospital Employees Not Aware of Projects Lack … Resources and Data/outcomes Connect with Early Adopters Craft a Communication plan Physician Champion Lack … champions Leverage CDC CAUTI Expert videos Provide scripts as needed Individual Physicians : Non-Surgeons Lack

548. CAHPS Elicitation Protocol Webcast (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/cahps/news-and-events/events/webinars/cahps-webinar-jan-2017-rabson.pdf
     January 01, 2017 -  Broad collection of patient comments requires electronic survey modes, but there are barriers:  Lack

549. Chapter 5a. Presentation Content | Agency for Healthcare Research and Quality
     www.ahrq.gov/patient-safety/settings/long-term-care/resource/injuries/fallspx/slides.html
     December 01, 2017 - Insecure toilet seat or handrail Hard-to-reach personal items Unstable wheels Low toilet seat Lack

550. Use of Data and Measurement in Improving Diagnostic Safety (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/news/events/ahrq-research-summit/newman-toker-summit2016.pdf
     September 28, 2016 - Barriers include lack of chief complaint reporting, problem-oriented records, routine follow-up 3.

551. Experiences From the Frontline: Case Studies (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/perinatal-care/frontline-cases-studies.pdf
     May 01, 2015 - Common errors when administering it are typically dose related and sometimes involve a lack of timely … Hospital management noticed that this lack of consistency led to a lack of communication, which in turn … and near-misses (events that did not produce patient injury) revealed that 60 percent were due to lack … poor communication is no longer a root cause; in fact, near-misses and adverse events attributed to lack

552. AHRQ Safety Program for Surgery: Final Report (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/surgery/safe_surgery_finalreport.pdf
     December 01, 2017 - Competing priorities and distractions, as well as a lack of leadership support from physicians were … Through this direct contact, we were able to identify barriers to data collection, such as a lack of … of understanding how to upload the data to the online Web portal, and lack of access to raw survey … Interview respondents recited examples that reinforced the lack of anonymity in a small work group. … One pattern from a few sites was indicative of a lack of engagement.

553. Introduction to the Case Studies | Agency for Healthcare Research and Quality
     www.ahrq.gov/practiceimprovement/systemdesign/leancasestudies/lean-intro.html
     November 01, 2014 - We found that the majority of studies about Lean lack data on key areas and domains important for understanding … This lack of research warrants additional investigation of the implementation of and outcomes related … Currently, most health care organizations lack this expertise in-house, so typically they are in the … in organizations), and b) understand the relationship among these levels. 5 , 10–12 For example, a lack

554. Standardizing Ambulatory Care Procedures in a Public Hospital System to Improve Patient Safety (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol4/Kleinpeter.pdf
     January 01, 2004 - The initial findings revealed a lack of standardization of patient flow and process for ambulatory … Following the investigation of the initial event, the regulatory compliance department cited a lack … This lack of communication often resulted in postponing or canceling procedures, based upon the lack

555. System Redesign Responses to Challenges in Safety-Net Systems (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/system/systemredesignsafetynet/systemredesign.pdf
     June 01, 2015 -  Lack of capital funding. …  Lack of urgency among staff. … Systems that currently lack such resources must expend significant human capital or create elaborate … Some, but not all sites, are also challenged by lack of experience with financial controls and lack … Examples of limitations range from lack of capital funding for electronic data systems to lack of resources

556. Guide to Improving Patient Safety in Primary Care Settings by Engaging Patients and Families | Agency for Healthcare Research and Quality
     www.ahrq.gov/patient-safety/reports/engage/faq.html
     April 01, 2018 - Time in primary care, or the lack of it, is a major barrier to improvement activities. … Lack of time seems to be a perpetual issue in primary care. Consider starting small.

557. Established Child Health Care Quality Measures--Child and Adolescent Health Measurement Initiative (CAHMI): Promoting Healthy Development Survey (PHDS) | Agency for Healthcare Research and Quality
     www.ahrq.gov/patient-safety/quality-resources/tools/chtoolbx/measures/measure-6.html
     November 01, 2017 - represented in these surveys and tools, nearly all of the PHDS items were newly developed due to a lack … Lack of more reliable, valid, or efficient way to measure the topic.

558. Development and Implementation of The University of Texas Close Call Reporting System (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol2/Martin.pdf
     March 01, 2004 - Paper forms had the advantage of being easy to store in health care institutions that lack a large number … content An examination of the literature on elements common to existing reporting systems revealed a lack … Given the lack of consensus in the literature concerning response format, the advisory board recommended … The lack of consensus about contributing factors played a part in the richest experience of the present

559. Developing a Taxonomy of Anesthetists’ Nontechnical Skills (ANTS) (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol4/Patey.pdf
     January 01, 2004 - are primarily related to deficiencies in nontechnical (cognitive and social) skills, rather than a lack … changes in the clinical situation (n = 5), having to assist directly with patient care (n = 3), and lack … Those who found difficulty or were unable to use the ANTS System reported lack of opportunity as the … Another reason was lack of time to use the system.

560. Medical Product Safety Network (MedSun) Collaborates with Medical Product Users to Create Specialty Subnetworks (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety-2/vol1/Advances-Engleman_86.pdf
     June 04, 2008 - One example is the lack of clinical data on how the pediatric population responds to treatment with … adults, but once a device is cleared for marketing, it might also be used on children because of the lack … Common barriers to reporting include: • A lack of awareness by clinicians of the need to identify … • A lack of feedback from the FDA.