Results

Total Results: over 10,000 records

Showing results for "occurred".

101. Statistical Brief #83: Potentially Preventable Hospitalization Rates Declined for Older Adults, 2003-2007 (pdf file)
     hcup-us.ahrq.gov/reports/statbriefs/sb83.pdf
     December 01, 2009 - Overall, potentially preventable diabetes-related hospitalizations occurred 2.6 times more often among … In contrast, short-term diabetes complications occurred twice as often among younger adults than among … Hospital stays for chronic cardiac conditions which may have been prevented occurred over 10 times more … Potentially preventable hospital stays for acute conditions occurred almost 10 times as frequently among … For older adults, the majority of the decrease in the rates of diabetes-related hospitalizations occurred

102. Missed and delayed diagnoses in the ambulatory setting: a study of closed malpractice claims. | PSNet
     psnet.ahrq.gov/issue/missed-and-delayed-diagnoses-ambulatory-setting-study-closed-malpractice-claims
     October 26, 2010 - Diagnostic errors resulting in patient harm occurred in 181 cases, chiefly consisting of missed or delayed … As with prior studies  using chart review, reviewer's agreement on whether an error occurred was only

103. Spotlight Case [MONTH] 2003 (ppt file)
     psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.64_slideshow.ppt
     June 01, 2004 - dopt=Abstract&list_uids=12477944 Disclosure: What Patients Want Jargon-free statement that error occurred … discussing such issues Physician may choose words carefully to avoid explicitly stating that an error occurred … malpractice claims Others argue that the reason few injured patients sue is because they are unaware error occurred … should be disclosed to patients Error disclosure should include an explicit statement that an error occurred

104. Sb113 (pdf file)
     hcup-us.ahrq.gov/reports/statbriefs/sb113.pdf
     January 01, 2020 - for the following types of hospital stays for:  complicated pregnancy during which no delivery occurred … ■ Among non-delivery maternal stays, the following conditions occurred at a rate of 100 or more … ■ Among maternal stays with delivery, the following conditions occurred at a rate of 50 99 for … stays As shown in table 2, among non-delivery maternal stays, the following complicating conditions occurred … Delivery stays Among maternal stays with delivery, the following common complicating conditions occurred

105. PowerPoint Presentation
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/candor/module6/module6-care-for-caregiver.pptx
     May 01, 2011 - , but they feared that an error may have occurred. … /organization recognizing event occurred. … This stage is characterized by either the second-victim realizing that an event has occurred, or the … organization recognizing that an event has occurred. … The event might produce feelings of internal inadequacy, either because the event occurred or because

106. PowerPoint Presentation
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/candor/module5/module5-response-disclosure-notes.pptx
     August 21, 2015 - The patient and/or family have a reasonable expectation to be informed when a harm event has occurred … of this initial conversation is to advise the patient and/or family that an adverse event may have occurred … Investigation and Analysis, the disclosure should include – An explicit statement that an event has occurred … During disclosure, patients and families generally want a clear, explicit statement that an event has occurred … If the event was preventable and occurred due to error, the communicator should: Consider using the word

107. 111-Ss-Cusp-Lfd-Worksheet-A3 (doc file)
     www.ahrq.gov/sites/default/files/wysiwyg/hai/tools/mrsa-2/111-ss-cusp-lfd-worksheet-a3.docx
     April 01, 2025 - Knee Joint Replacement, and Spinal Fusion SurgeriesOwner: ____________________________ Date Defect Occurred

108. 111-Cusp-Learning-From-Defects-Worksheet (doc file)
     www.ahrq.gov/sites/default/files/wysiwyg/hai/tools/mrsa-surgery/111-cusp-learning-from-defects-worksheet.docx
     April 01, 2025 - Knee Joint Replacement, and Spinal Fusion SurgeriesOwner: ____________________________ Date Defect Occurred

109. Misread Label | PSNet
     psnet.ahrq.gov/web-mm/misread-label
     August 28, 2024 - On face value, it is almost impossible to imagine how this could have occurred. … In addition to exploring why the error occurred at the level of individuals at the "sharp end," such … effectively, but involves interviewing staff involved to identify care management problems and why each occurred … Although physicians disclosed the adverse event, they often avoided stating that an error had occurred

110. Final Progress Report: Mining complex clinical data for patient safety research (pdf file)
     www.ahrq.gov/sites/default/files/2024-07/hripcsak-report.pdf
     January 01, 2024 - NLP successfully identified which of 45 NYPORTS events occurred in 57,452 discharge summaries, achieving … We also expected that it would often be unclear whether an error actually occurred. … If voluntary reporting occurred in the medical record, then this approach might reveal errors that would … The predictive value was best if the word occurred in the hospital course section of the discharge summary … detected conflicts in the medical record that might possibly signal that a medical adverse event has occurred

111. Medication Overdose | PSNet
     psnet.ahrq.gov/web-mm/medication-overdose
     September 01, 2011 - ADE), and an additional 5% experience a potential ADE (ie, the error reached the patient, but no harm occurred … reported similar rates of ADEs, though rates of potential ADEs were even higher.( 5 ) Most potential ADEs occurred … illegible, can have life-threatening consequences.( Figure 1 , Figure 2 ) The error in this case occurred … confusion between ‘dose’ and ‘day,’ due to ambiguous use of the abbreviation “d” in “mg/kg/d,” could have occurred … and ensures that orders are complete and in a standard format, eliminating ambiguous dosing orders as occurred

112. Facilitator Guide: Build Your SSI Prevention Bundle (doc file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/mvp/modules/technical/measuredesc-dailyearlymobility-facguide.docx
     January 01, 2017 - physical or occupational therapist, and finally, whether any adverse events associated with mobilization occurred … and, if so, what types of events occurred. … Slide 28 Events SAY: The next columns are designed to help track any adverse events that might have occurred … This field allows you to document up to three events if multiple events occurred. … Slide 29 Event Codes SAY: If no adverse events occurred, use “0” (the code for “none”) to indicate

113. Measure Descriptions for Daily Early Mobility: Facilitator Guide | Agency for Healthcare Research and Quality
     www.ahrq.gov/hai/tools/mvp/modules/technical/daily-early-mobility-fac-guide.html
     February 01, 2017 - physical or occupational therapist, and finally, whether any adverse events associated with mobilization occurred … and, if so, what types of events occurred. … 29: Events Say: The next columns are designed to help track any adverse events that might have occurred … This field allows you to document up to three events if multiple events occurred. … Slide 30: Event Codes Say: If no adverse events occurred, use "0" (the code for "none") to indicate

114. Final Progress Report: Creating Learning Cultures Around Mistakes for Residents (pdf file)
     www.ahrq.gov/sites/default/files/2024-02/hoff-report.pdf
     January 01, 2024 - In addition, we looked for instances when errors or near misses occurred and how the interactions between … Regardless of setting, most errors occurred when the resident was alone. … Half (50%) of the 20 surgical resident mistakes and near misses occurred in isolation (i.e., no other … Surprisingly, in surgery’s case, 15 (75%) of the 20 mistakes and near misses occurred on the hospital … In the MICU case, although a higher percentage of mistakes occurred in isolation, 19 of the 21 mistakes

115. AHRQ Impact Case Studies Criteria | Agency for Healthcare Research and Quality
     www.ahrq.gov/news/newsroom/case-studies/criteria.html
     December 01, 2019 - Impact or results must have already occurred.

116. AHRQ's Safety Program for Nursing Homes: On-Time Falls Prevention Training (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/long-term-care/resources/ontime/fallsprev/ontimefallpxreports-ig.pdf
     June 02, 2025 - The new contributing risk factor elements represent changes that occurred in a resident’s clinical … It displays the number of falls that occurred and the risk factors associated with the falls. … For each of the months (1 or 3) included in the report, any fall that occurred before the report date … For each of the months (1 or 3) included in the report, any fall that occurred before the report date … ,  Shift during which the fall occurred,  Time at which the fall occurred,  The location of

117. Final Progress Report: Factors Associated with Effective Implementation of a Surgical Safety Checklist (pdf file)
     www.ahrq.gov/sites/default/files/2024-04/singer-report.pdf
     January 01, 2024 - (1), occurred about 25% of the time (2), occurred about half of the time (3), occurred 75% of the time … (4), or always occurred during the case (5). … They also indicated that desired team-oriented behaviors occurred at least 75% of time (5 on 5-point … 82% of cases, respectively, they occurred at least 75% of the time. … Respectful behaviors occurred least frequently: in 67% of cases, they occurred at least 75% of the time

118. USER GUIDE: Hand Hygiene Observational Audit Data Tracking Tool for Use in Skilled Nursing Facilities (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/nursing-home/materials/hand-hygiene-audit-tool-userguide.pdf
     April 01, 2021 - location within your facility where the observational audit of the employee’s hand hygiene activity occurred … Next enter the date the audit occurred using the month/day/four-digit year format in Column E. … Select the time block that aligns with the time the audit occurred for the employee observed.

119. 68. For the Patient Willing To Quit (Continued) | Agency for Healthcare Research and Quality
     www.ahrq.gov/prevention/guidelines/tobacco/clinicians/presentations/2008update-full/slide68.html
     October 01, 2014 - If tobacco use has occurred, review circumstances and elicit recommitment to total abstinence.

120. Section5 3 (pdf file)
     hcup-us.ahrq.gov/reports/factsandfigures/2007/pdfs/section5_3.pdf
     January 01, 2007 - For stays with Medicare as the primary payer, in-hospital deaths occurred in 4 percent of stays. … Three percent of uninsured discharges occurred against medical advice, compared to less than 1 percent