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psnet.ahrq.gov/issue/advancing-science-measurement-diagnostic-errors-healthcare-safer-dx-framework
December 06, 2023 - Commentary
Advancing the science of measurement of diagnostic errors in healthcare: the Safer Dx framework.
Citation Text:
Singh H, Sittig DF. Advancing the science of measurement of diagnostic errors in healthcare: the Safer Dx framework. BMJ Qual Saf. 2015;24(2):103-110. doi:10.1136/bm…
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psnet.ahrq.gov/issue/cognitive-errors-diagnosis-instantiation-classification-and-consequences
June 21, 2016 - Study
Classic
Cognitive errors in diagnosis: instantiation, classification, and consequences.
Citation Text:
Kassirer JP, Kopelman RI. Cognitive errors in diagnosis: instantiation, classification, and consequences. Am J Med. 1989;86(4):433-41.
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www.uspreventiveservicestaskforce.org/home/getfilebytoken/jaK5cMrYT_E3QkSzf93qbo
January 01, 2015 - that will progress to cause
illness or death from those that will not, overdiagnosis almost always leads
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www.uspreventiveservicestaskforce.org/home/getfilebytoken/dL4dSze-jDjCPgDAzQ_Byj
January 01, 2015 - that will progress to cause
illness or death from those that will not, overdiagnosis almost always leads
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www.ahrq.gov/sites/default/files/wysiwyg/takeheart/training/getting-started-implementation-guide.pdf
March 01, 2023 - Getting Started: Laying the Groundwork for Implementing Automatic Referral and Effective Care Coordination
Implementation Guide for Getting Started
Getting Started:
Laying the Groundwork for Implementing
Automatic Referral and Effective Care
Coordination
Acronym List
Term Abbreviation
AACVPR American Assoc…
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psnet.ahrq.gov/web-mm/which-line-ordering-provider-or-proceduralist
September 16, 2015 - SPOTLIGHT CASE
Which Line: Ordering Provider or Proceduralist?
Citation Text:
Blackmore CC. Which Line: Ordering Provider or Proceduralist?. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2019.
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Format: …
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www.ahrq.gov/sites/default/files/wysiwyg/patient-safety/resources/diagnostic-toolkit/09-diagnostic-safety-practice-orientation.pptx
November 24, 2020 - Co-producing a Diagnosis
Engaging Patients To Improve Diagnostic Safety
Practice Orientation
AHRQ Publication No. 21-0047-8-EF
August 2021
1
Diagnostic Errors Are a
Big Challenge
Nearly every person will experience a diagnostic error in their lifetime.
Diagnostic error is the leading patient safety challenge…
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www.ahrq.gov/sites/default/files/wysiwyg/action-alliance/high-reliability-journey-slides.pptx
September 26, 2023 - VHA's Journey to High Reliability: Advancing Toward Zero Harm and Becoming a Learning Health System
September 26, 2023
Pre-Decisional Deliberative Document
Internal VA Use Only
Advancing Toward Zero Harm and
Becoming a Learning Health System
Gerard R. Cox, MD, MHA
Assistant Under Secretary for Health for Quality & …
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digital.ahrq.gov/sites/default/files/docs/survey/use-web-based-health-information-patient-practice-portal-non-users.pdf
June 16, 2021 - Use of Web-based Health Information – for Patient Practice Portal Non-Users
Use of web-based health information – for patient
practice portal non-users
Virginia Commonwealth University; Richmond, VA
This is a questionnaire designed to be completed by adult patients in their home. The to…
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www.ahrq.gov/research/findings/final-reports/haidesign/haidesign-summary.html
April 01, 2018 - Understanding the Role of Health Care Facility Design in the Acquisition and Prevention of HAIs
This report summarizes the role of the built environment in the transmission of pathogens and discusses the impact that design features could have in mitigating transmission in health care facilities.
…
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psnet.ahrq.gov/sites/default/files/2020-09/final_slides_sept_spotlight_case_when_the_lytes_go_out_slides_08.25.2020-revised.pdf
January 01, 2020 - Microsoft PowerPoint - FINAL SLIDES Sept_Spotlight Case_When the Lytes Go Out_SLIDES_08.25.2020-revised.pptx
Spotlight
When the Lytes Go Out: A Case
of Inpatient Cardiac Arrest
Source and Credits
• This presentation is based on the September 2020 AHRQ WebM&M
Spotlight Case
o See the full article at https://psne…
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www.ahrq.gov/sites/default/files/wysiwyg/hai/tools/mrsa/162-example-completed-learning-defects-tool.docx
October 01, 2024 - AHRQ Safety Program for MRSA Prevention
Learning From Defects Tool - Example
ICU & Non-ICU
Problem statement: Healthcare organizations can increase the extent to which they learn from defects. We define this learning as reducing the probability that future patients will be harmed.
What is a defect? A defect is any cli…
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www.ahrq.gov/patient-safety/settings/hospital/candor/modules/guide6.html
August 01, 2022 - Care for the Caregiver Program Implementation Guide
AHRQ Communication and Optimal Resolution Toolkit
Purpose: To guide an organization in developing and implementing a Care for the Caregiver program.
Who should use this tool? The Care for the Caregiver Program Lead
How to use this tool: Use this guide…
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www.ahrq.gov/hai/quality/tools/cauti-ltc/modules/implementation/long-term-modules/module6/mod6-slides.html
March 01, 2017 - Module 6: Sustainability
AHRQ Safety Program for Long-Term Care: HAIs/CAUTI
Slide 1: Module 6: Sustainability
Slide 2: Objectives
Define sustainability and understand the importance of maintaining positive change.
Describe the link between sustainability and spread.
Develop a plan for sustainabi…
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psnet.ahrq.gov/node/49845/psn-pdf
October 01, 2018 - Coming Up Short: Maintaining Safety in the Face of Drug
Shortages
October 1, 2018
Plogsted S. Coming Up Short: Maintaining Safety in the Face of Drug Shortages. PSNet [internet]. 2018.
https://psnet.ahrq.gov/web-mm/coming-short-maintaining-safety-face-drug-shortages
The Case
A 1-month-old preterm infant in the ne…
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www.ahrq.gov/sites/default/files/publications/files/haidesign-summary.pdf
September 01, 2013 - Understanding the Role of Health Care Facility Design in the Acquisition and Prevention of HAIs: Summary
1
Contract Final Report
Understanding the Role of Health Care Facility Design
in the Acquisition and Prevention of HAIs
Executive Summary
Prepared for:
Agency for Healthcare Research…
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effectivehealthcare.ahrq.gov/sites/default/files/10_obesity_potential_high_impact_2012-12-11.pdf
January 01, 2012 - AHRQ did not directly
participate in horizon scanning, assessing the leads for topics, or providing … Since that implementation, review of more than 15,000 leads about potential topics has resulted in … From a broader perspective, multiple experts
noted that if EndoBarrier leads to patients undergoing
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www.ahrq.gov/sites/default/files/2024-04/anderson-report.pdf
January 01, 2024 - We have demonstrated that the wire navigation simulator leads
to faster and more precise placement of … Simulator training leads to improved wire navigation in
first year orthopaedic residents. 41st Annual … Simulator training leads to improved wire navigation in
first year residents. 64th Annual Meeting of
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www.uspreventiveservicestaskforce.org/home/getfilebytoken/wyAJqjxBX_dHMF3WdA7WNt
September 05, 2017 - found adequate evidence that treatment of amblyo
pia or its risk factors in children aged 3 to 5 years leads … inadequate evi
dence that treatment of amblyopia or its risk factors in children
younger than 3 years leads …
equate evidence that treatment of amblyopia or its risk factors in
children younger than 3 years leads
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www.ahrq.gov/sites/default/files/wysiwyg/patient-safety/settings/ambulatory/6bb-toolkit-fasttrack-complete.pdf
October 01, 2021 - The Fast Track Approach Guide leads you through an assessment of your organization’s support
systems … This guide leads you through an assessment of your organization’s chronic pain and opioid management … include clinicians,
medical assistants, nurses, care coordinators, information technology (IT)/data leads