-
www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/esrd/clinical-care/clinicalcare_slides.pptx
September 03, 2014 - connection and after disconnection
Contamination of needles, other sterile supplies, or equipment
Lack … or water
Inconvenient placement of hand-washing stations
Forgetfulness or lack of time management
Other … and a lack of understanding of the importance of hand hygiene. … of knowledge regarding implications of choice
Lack of support of fistula first by team members8
25 … Patient and team member preferences and lack of support by team members for using fistulas first also
-
psnet.ahrq.gov/node/33697/psn-pdf
June 01, 2010 - disrupts sleep, causes fatigue, and creates
problems with thinking, memory, and decision making.8 Lack … health care system.12 The ED often acts
as the health care entry point for uninsured patients who lack … services, telephone translation, and interconnected electronic medical records provide some
support, the lack … creates a huge burden on ED nurses because of the
resources needed for newly admitted patients and lack … disease
Inadequate
staffing
Inadequate
teamwork
Inadequate
consultation
Noise,
interruptions
Lack
-
hcup-us.ahrq.gov/reports/factsandfigures/figures/2005/2005_4_2.jsp
January 01, 2005 - 90,400
3,400
26.2
31.2
2,816.716
220
Intrauterine hypoxia and birth asphyxia (lack … )
7,602
125
1.7
4.004
487.176871
220
Intrauterine hypoxia and birth asphyxia (lack
-
www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/perinatal-care/modules/teamwork/assemble/assemble-team-facilitator-guide.docx
May 01, 2017 - Slide 17
SAY:
Barriers to team performance include—
Inconsistent team membership,
Lack of time 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. … of clinical background,
Lack of recognition for the value of CUSP for L&D, and
Unavailability to meet
-
digital.ahrq.gov/sites/default/files/docs/citation/r01hs015188-huck-final-report-2008.pdf
January 01, 2008 - • Perceived and stated lack of physician support or “buy-in.” … s medical history and situation
• Guidelines take time and resources to document
• There is a lack … technologically
savvy than other hospital staff
• Perceived barriers to using IT include:
• Lack … of buy-in from providers and staff and lack of
time/resources.
13 … • There is a lack of quality improvement expertise in most critical access hospitals taking
part
-
www.ahrq.gov/hai/tools/mvp/modules/technical/4es-early-mobility-slides.html
February 01, 2017 - 2
Lack of leadership:
Designate an overall leader who is involved and committed to quality improvement … Lack of staffing and equipment:
Identify equipment rental process. … Lack of knowledge and training:
Educate multidisciplinary team on evidence for early mobility interventions … Lack of referrals and standardized documentation:
Establish screening criteria.
-
psnet.ahrq.gov/node/49767/psn-pdf
August 21, 2016 - The lack of
interoperability between the office-based medical record platform and the inpatient system … systems or products
without special effort on the part of the user.(1) In the case described, the lack … Why might the health system described still lack interoperability between its inpatient and outpatient … While this reasoning may explain why a lack of interoperability resulted in this particular adverse drug … We lack interoperability across EHRs today because of myriad technical, policy, and cultural barriers
-
psnet.ahrq.gov/node/33569/psn-pdf
June 15, 2024 - dictated discharge summary) generally fail to reach
outpatient providers in a timely fashion and often lack … Lack of medication reconciliation results
in the potential for inadvertent medication discrepancies … that
only a minority of 30-day readmissions in medical patients are truly preventable, and clinicians lack
-
www.ahrq.gov/sites/default/files/publications/files/bozicstudysnapshot.pdf
February 01, 2015 - f Lack of trust, driven by competing interests: Participating health plans,
hospitals, and physicians … Lack of trust and transparency might have been
the result of a history of aggressive contract negotiations … Even when such software became
available, the lack of patient volume and the cost to buy and implement
-
www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/system/delivery-system-initiative/bozicstudysnapshot/bozicstudysnapshot.pdf
February 01, 2015 - f Lack of trust, driven by competing interests: Participating health plans,
hospitals, and physicians … Lack of trust and transparency might have been
the result of a history of aggressive contract negotiations … Even when such software became
available, the lack of patient volume and the cost to buy and implement
-
psnet.ahrq.gov/node/33703/psn-pdf
November 01, 2010 - been limited by many factors, including differences in
definitions and concepts of adverse events, lack … patient safety, infrequent events, inconsistencies in data elements across health care systems, and lack … The transfer of patients
between systems, lack of staff training or experience in documenting patients … We lack an integrated approach to
measuring patient safety; at present, we have several complementary … "systems failures" compared with condition-specific processes or
outcomes of care, as well as the lack
-
digital.ahrq.gov/ahrq-funded-projects/using-health-information-technology-improve-health-care-quality-primary-care-ok/annual-summary/2011
January 01, 2011 - A major barrier to RHIO use, however, is the lack of a convincing value proposition for providers. … Many medical practices lack managers with the necessary implementation skills and experience.
-
psnet.ahrq.gov/node/846170/psn-pdf
March 15, 2023 - multiple unknown factors that
may have contributed to the delay in dispensing, such as understaffing, lack … an improved patient counseling process, both cases reflect errors that occur from fragmented care – lack … of pharmacist-led TOC interventions have
documented the heterogeneity of these interventions, the lack … the medication
in a timely manner reflects human error and can be due to variability in practice, lack … of standardization across documentation systems, and lack of interoperability between the
pharmacy’
-
www.ahrq.gov/hai/cusp/modules/learn/fac-cusp.html
December 01, 2012 - Lack of time and information sharing.
Hierarchy.
Varying communication styles. … Lack of coordination and follow-up.
Misinterpretation of cues.
Lack of role clarity. … Teams that lack sufficient structure, with inconsistent input, or that lack fully engaged members, will … Additional barriers to successful teamwork include conflict, lack of coordination, misinterpretation … of cues, and lack of role clarity.
-
psnet.ahrq.gov/node/33800/psn-pdf
January 01, 2015 - Difficulty interpreting displays;
Vulnerability to wrong-patient errors when multiple records were open;
A lack … of standardized alerts, an abundance of irrelevant alerts, and a lack of reasons documented
for alert … Most importantly, a lack of efficient two-way communication between physician offices and
https://psnet.ahrq.gov … shortcomings of the technologies, as discussed above, as well as local implementation factors such
as lack
-
psnet.ahrq.gov/sites/default/files/2024-03/delayed_diagnosis_and_treatment_of_sle.pdf
January 01, 2024 - – The psychiatric prodromal concept also may lack predictive value, in that many patients
(eventually … Misidentification delusions (Capgras
syndrome)
• Constitutional symptoms (e.g., significant
weight loss)
• Lack … of family history of psychotic disorders
• Lack of personal history of schizoid
personality disorder … primary
physician of record.
25
Approaches to Improving Patient Safety (3)
• In this case, the lack … • In this context, the lack of a primary care physician to coordinate post-discharge
care may have
-
digital.ahrq.gov/ahrq-funded-projects/disseminating-and-implementing-medsmart-families-emergency-departments
September 30, 2024 - crisis is the easy access adolescents have to unused prescription opioids in their homes, coupled with a lack … Research shows that adolescents and their families often lack the knowledge needed to safely manage opioids
-
effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/pdf/epc-march-2023-grand-rounds-slides.pdf
January 01, 2023 - difficult to
reach and engage via telehealth and may result in missed or delayed diagnoses owing to the lack … • There is a lack of evidence about telehealth implementation cost and sustainability of services, … with existing values, workflows & systems
• Challenges that may be unique to rural applications
• Lack … of agreement about important outcomes or goals
• Lack of consideration and measurement of harms and … difficult to attribute impact to telehealth because:
• Most common: weaker study designs are common
- Lack
-
digital.ahrq.gov/program-overview/research-stories/evaluation-scaling-acceptable-cds-scaled-approach-interoperable
January 01, 2023 - decision support (CDS) tools are an indispensable solution to address this issue, but poor design, lack … Christopher Tignanelli
Collective efforts support widespread adoption of interoperable CDS
Due to the lack
-
digital.ahrq.gov/ahrq-funded-projects/health-care-stakeholder-participation-health-information-exchanges
January 01, 2023 - How does key stakeholder participation (or lack of it) affect the initiation development and sustainability … However, the team found that CareSpark and the Tampa Bay RHIO lack similar robust hospital participation