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digital.ahrq.gov/location/usa-ca-oakland
January 01, 2023 - USA, CA, Oakland
Improving Safety and Quality of Emergency Care Using Machine Learning-Based Clinical Decision Support at Triage
Description
This research will design, implement, and evaluate an emergency department triage machine learning algorithm, with an emphasis on predic…
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psnet.ahrq.gov/issue/nhs-resolution
June 12, 2019 - Government Resource
NHS Resolution.
Citation Text:
NHS Resolution. NHS Resolution.
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March 7, 2018
NHS Res…
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psnet.ahrq.gov/issue/healthcare-simulation-week
June 08, 2023 - Multi-use Website
Healthcare Simulation Week.
Citation Text:
Healthcare Simulation Week. Society for Simulation in Healthcare.
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psnet.ahrq.gov/issue/who-collaborating-centres-patient-safety
April 06, 2016 - Multi-use Website
Global Patient Safety Collaborative.
Citation Text:
Global Patient Safety Collaborative. World Alliance for Patient Safety; World Health Organization
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psnet.ahrq.gov/issue/council-surgical-and-perioperative-safety
February 08, 2023 - Multi-use Website
Council on Surgical and Perioperative Safety.
Citation Text:
Council on Surgical and Perioperative Safety. 633 N. St. Clair St. Chicago, IL, 60611.
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psnet.ahrq.gov/node/43506/psn-pdf
September 10, 2014 - Review of Alleged Patient Deaths, Patient Wait Times, and
Scheduling Practices at the Phoenix VA Health Care
System.
September 10, 2014
Washington, DC: VA Office of the Inspector General; August 26, 2014. Report No.14-02603-267.
https://psnet.ahrq.gov/issue/review-alleged-patient-deaths-patient-wait-times-and-sche…
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digital.ahrq.gov/sites/default/files/docs/page/ahrq-dhr-2022-year-in-review.pdf
January 01, 2022 - For example, we can evaluate the lessons learned in the early years of health IT implementation, when … “One of the interesting things we learned was how high some
of these potentially inappropriate medication … groups used Plan-Do-Study-Act cycles to test and improve workflows
and shared feedback and lessons learned … Jinoos Yazdany
Network shares what they learned to scale use of PROs
Among the key findings of the … Mueller and her team
hope that the lessons learned will inform successful and sustained
adoption by
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www.ahrq.gov/sites/default/files/wysiwyg/antibiotic-use/long-term-care/changing-system-facilitator-guide.docx
June 01, 2021 - We learned about latent failures, which are problems in the system.
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psnet.ahrq.gov/node/73302/psn-pdf
May 26, 2021 - I learned
root-cause analysis when I was the Director of Clinical Services at MedStar (Mobile Healthcare
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www.ahrq.gov/patient-safety/settings/long-term-care/resource/hcbs/medicaidmgmt/mm4.html
October 01, 2014 - States have learned to "sell" the profiles to physicians as a mechanism for physicians to acquire additional … Lessons Learned: Provider Interventions
Involve providers early.
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psnet.ahrq.gov/perspective/health-care-data-science-quality-improvement-and-patient-safety
October 01, 2016 - Acute Hospital Care Units
April 26, 2023
Changing smart pump vendors: lessons learned … Perspective
Assessing the Safety of Electronic Health Records: What Have We Learned
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psnet.ahrq.gov/perspective/conversation-withdonald-norman-phd
November 01, 2006 - We have learned a lot about how automation has been introduced to other industries, to know that it always … By being the last in line to automate, we may be able to take advantage of what we've learned from errors
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www.ahrq.gov/sites/default/files/wysiwyg/mcc/pccp4p/pccp4p-summitsummary.pdf
September 01, 2025 - Share lessons learned from TEP, PR, and LC sessions as a foundation for identifying opportunities
for … The Summit shared lessons learned from the prior year’s work conducted by three expert panel groups … Objectives
1) Share lessons learned from Roundtable and Learning Collaborative sessions as a
foundation
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www.ahrq.gov/sites/default/files/wysiwyg/hai/tools/perinatal-care-2/hemorrhage_3_communication.pptx
July 01, 2023 - Confirm, clarify, or suggest changes to response plans
Ensure all staff understand the new information learned … Confirm, clarify, or suggest changes to response plans
Ensure all staff understand the new information learned … established care plan Use SBAR to:
Frame event reports
Structure case scenarios for sharing lessons learned … useful at the Reporting stage to frame event reports, structure case scenarios for sharing lessons learned … 51
Hospital AIM Team
Leads
SPPC-II
SCRIPT
Now that you’ve learned about the communication tools and
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www.ahrq.gov/sites/default/files/wysiwyg/hai/tools/perinatal-care-2/hemorrhage_3-communication-speaker-notes.pdf
July 01, 2023 - clarify, or
suggest changes to
response plans
• Ensure all staff
understand the new
information learned … Confirm, clarify, or suggest changes to response plans
• Ensure all staff understand the new information learned … care plan
Use SBAR to:
• Frame event reports
• Structure case
scenarios for sharing
lessons learned … useful at the
Reporting stage to frame event reports, structure case scenarios for sharing lessons
learned … 51
SCRIPT
Now that you’ve learned about the communication tools and strategies we have for
improving
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digital.ahrq.gov/sites/default/files/docs/citation/uc1hs015236-jose-final-report-2008.pdf
January 01, 2008 - safety during the transition period; qualitative evaluation of the change
process to identify lessons learned … implementation, barriers to
implementation, strategies to combat implementation problems, and lessons learned … participants
rated the success of their hospital’s implementation as “very good” or “good” and the lessons
learned … were examined and
redesigned, IT usability was evaluated and improved, and implementation lessons learned … the implementation process and end user acceptance of the technology
provide some valuable lessons learned
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digital.ahrq.gov/sites/default/files/docs/publication/r18hs017188-mold-final-report-2010.pdf
January 01, 2010 - Conclusions and Lessons Learned
Results of the Wellness Portal study suggest that a comprehensive … We used lessons learned from the pilot study and other, previous projects to
redesign patient enrollment … tested
practice facilitation method that included weekly cross-pollination of good ideas and lessons
learned … From lessons learned in Portal intervention practices, a set of “best
practice” implementation principles … Portal Study
Pilot Study
Cluster Randomized Trial
Results of the c-RCT
Conclusions and Lessons Learned
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www.ahrq.gov/patient-safety/settings/labor-delivery/perinatal-care/modules/strategies/medication/safe-medication-slides.html
July 01, 2023 - Safe Medication Administration: Slide Presentation
AHRQ Safety Program for Perinatal Care
Slide 1: AHRQ Safety Program for Perinatal Care
Safe Medication Administration
Slide 2: Learning Objectives
Image: Four ascending steps show the learning objectives:
Define high-alert medications.
Identif…
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digital.ahrq.gov/program-overview/research-reports/2023-year-review/research-themes-and-findings
January 01, 2023 - Research Themes and Findings
The DHR program funds research that demonstrates how digital healthcare solutions can be designed and implemented to improve healthcare system performance and patient health outcomes. Our funded research focuses on advancing patient safety, care, and shared decis…
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psnet.ahrq.gov/periodic-issue/periodic-issue-470
December 31, 2024 - January 15, 2025 Weekly Issue
PSNet highlights the latest patient safety literature, news, and expert commentary, including Weekly
Updates, WebM&M, and Perspectives on Safety. The current issue highlights what's new this week in patient
safety literature, news, conferences, report…