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  1. Develop and Validate Health IT Safety Measures to Capture Violations of the 5 Rights of Medication Safety – Final Report (pdf file)

    digital.ahrq.gov/sites/default/files/docs/citation/r01hs024538-adelman-final-report-2022.pdf
    January 01, 2022 - interview to confirm whether the RAR event was an error and to elicit details about the circumstances leading … developed by Schiff and colleagues to identify reasons for order errors.7,26 This approach uses non-leading

  2. AHRQ-Funded Patient Safety Project Highlights (pdf file)

    www.ahrq.gov/sites/default/files/wysiwyg/patient-safety/highlights/ps-project-highlights-hit-hie-rev-0724update.pdf
    July 01, 2024 - possible failure points before and after using a commercially available integrated CPOE system at a leading … The project addressed key issues in a large academic setting, Brigham and Women’s Hospital, leading

  3. Inpatient Stays and Emergency Department Visits Involving Traumatic Brain Injury, 2017 (pdf file)

    hcup-us.ahrq.gov/reports/statbriefs/sb255-Traumatic-Brain-Injury-Hospitalizations-ED-Visits-2017.pdf
    January 01, 2017 - ■ Unintentional MVT and other transport incidents was the leading cause of TBI-related inpatient … stays for patients aged 5–34 years and the leading cause of treat-and-release ED visits for patients

  4. Telehealth Education for Asthma Connecting Hospital and Home (TEACHH) - Final Report (pdf file)

    digital.ahrq.gov/sites/default/files/docs/citation/r03hs028033-frey-final-report-2024.pdf
    January 01, 2024 - disease of childhood, affecting more than 8% of children across the US.1 Poorly controlled asthma is a leading … Uncontrolled asthma is a leading cause of pediatric ED visits in the US, with considerable disparities

  5. Respectful Maternity Care: Dissemination and Implementation of Perinatal Safety Culture to Improve Equitable Maternal Healthcare Delivery and Outcomes (pdf file)

    effectivehealthcare.ahrq.gov/sites/default/files/product/pdf/respectful-maternity-care-protocol.pdf
    September 16, 2022 - 2 has been identified as part of systems’ failures leading … A table or evidence map may facilitate the synthesis of various categories corresponding to leading

  6. Disposition of Comments for Technical Brief 21, Management Strategies To Reduce Psychiatric Readmissions (pdf file)

    effectivehealthcare.ahrq.gov/sites/default/files/related_files/psychiatric-readmissions_disposition-comments.pdf
    May 21, 2015 - consequences of hospitalization (e.g., housing loss, job loss, school disruption, financial costs leading … latter category often corresponds to patients for whom treatment is complex and challenging, therefore leading

  7. Venous Thromboembolism Prophylaxis in Major Orthopedic Surgery: Systematic Review Update (pdf file)

    effectivehealthcare.ahrq.gov/sites/default/files/related_files/thromboembolism-update-executive-170622.pdf
    June 01, 2017 - Adverse events due to intervention(s) – Major bleeding, including: � Fatal bleeding � Bleeding leading … to transfusion � Major bleeding leading to reoperation � Major bleeding leading to readmission … � Surgical site / joint bleeding � Bleeding leading to infection � As defined by authors – Surgical

  8. Venous Thromboembolism Prophylaxis in Major Orthopedic Surgery: Systematic Review Update (pdf file)

    effectivehealthcare.ahrq.gov/sites/default/files/thromboembolism-update-executive-170622.pdf
    June 01, 2017 - Adverse events due to intervention(s) – Major bleeding, including: � Fatal bleeding � Bleeding leading … to transfusion � Major bleeding leading to reoperation � Major bleeding leading to readmission … � Surgical site / joint bleeding � Bleeding leading to infection � As defined by authors – Surgical

  9. Archived: Chronic Obstructive Pulmonary Disease: Screening | United States Preventive Services Taskforce

    www.uspreventiveservicestaskforce.org/uspstf/recommendation/chronic-obstructive-pulmonary-disease-screening-2016
    April 05, 2016 - Importance About 14% of US adults aged 40 to 79 years have COPD, and it is the third leading

  10. Using Health IT to Improve Care Coordination and Outcomes in Patients with Complex Health Care Needs (pdf file)

    digital.ahrq.gov/sites/default/files/docs/coordination-patients-complex-needs-slides-022014.pdf
    February 20, 2014 - standardization and improved provider communication improves follow-up for medically complex patients, leading

  11. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49759/psn-pdf
    May 01, 2016 - the literature at that time were approximately 2.3 to 7 falls per 1000 patient days, with about 30% leading

  12. Dying in the Hospital With Advanced Dementia | PSNet

    psnet.ahrq.gov/web-mm/dying-hospital-advanced-dementia
    November 01, 2016 - It is now the fifth leading cause of death for Americans age 65 and older, and 1 in 3 seniors die with

  13. ___APS-DRGs-Weights_Public.book (pdf file)

    hcup-us.ahrq.gov/db/nation/nis/APS_DRGsWeightsV26Public.pdf
    April 01, 2010 - The APS-DRGs® Normalized Charge, LOS, and Mortality Weights User’s Guide is published by Ingenix, a leading

  14. Unseen Perils of Urinary Catheters | PSNet

    psnet.ahrq.gov/web-mm/unseen-perils-urinary-catheters
    January 31, 2024 - to a one-point restraint ( 5 ), because like restraints, catheters can cause functional impairment leading

  15. Enhancing Hawaii Hospital Information Content: Linking Lab Data to Inpatient Discharge Data.

    hcup-us.ahrq.gov/datainnovations/clinicalcontentenhancementtoolkit/hi27.jsp
    September 01, 2014 - Medical Record inconsistencies due to formatting variances such as medical record numbers that contained leading

  16. Disposition of Comments Report for Whole-Body Vibration Therapy for Osteoporosis (pdf file)

    effectivehealthcare.ahrq.gov/sites/default/files/related_files/osteoporosis-vibration-therapy_disposition-comments.pdf
    November 15, 2011 - We understand the role of animal models in leading to whole- body vibration applications in humans.

  17. EHC Protocol: Addressing Social Isolation To Improve Health of Older Adults: A Rapid Evidence Review (pdf file)

    effectivehealthcare.ahrq.gov/sites/default/files/related_files/mhs4-computerized-cds-protocol.pdf
    May 08, 2023 - “an injury resulting from medical intervention related to a drug”.1, 2 Adverse drug events are a leading

  18. Evidence-based Practice Center Systematic Review Protocol (pdf file)

    effectivehealthcare.ahrq.gov/sites/default/files/pdf/hepatitis-c-screening_research-protocol.pdf
    October 20, 2011 - ) estimates that there were 17,000 new cases of HCV infection in 2007. 4 Infection with HCV is a leading

  19. Final Progress Report: Reducing Adverse Drug Events From Anticoagulants, Diabetes Agents and Opioids in Primary Care (pdf file)

    www.ahrq.gov/sites/default/files/2024-01/wessell2-report.pdf
    January 01, 2024 - Medication Use Leading to Emergency Department Visits for Adverse Drug Events in Older Adults.

  20. Beeline to Spine | PSNet

    psnet.ahrq.gov/web-mm/beeline-spine
    March 01, 2014 - WebM&M Cases Failure to Adhere to Dietary Restrictions Leading
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