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psnet.ahrq.gov/web-mm/liver-biopsy-proceed-caution
March 07, 2012 - Severe bleeding is uncommon, occurring in 1 to 2500 to 10,000 patients ( 6 ) undergoing biopsy to obtain
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psnet.ahrq.gov/web-mm/diagnosing-missed-diagnosis
October 26, 2022 - focal segmental glomerulosclerosis.( 1 ) The most common renal toxicity from lithium is acquired NDI, occurring
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www.ahrq.gov/hai/cusp/modules/apply/ac-cusp.html
December 01, 2012 - and Sensemaking tools to identify defects and discuss ways to prevent these and other defects from occurring
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psnet.ahrq.gov/node/49549/psn-pdf
December 06, 2007 - 17353756
https://psnet.ahrq.gov//#references
https://psnet.ahrq.gov//#references
Wandering—defined as occurring
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www.uspreventiveservicestaskforce.org/uspstf/recommendation/preeclampsia-screening-1996
January 01, 1996 - Hypertension is a common medical complication of pregnancy, occurring
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety-2/vol4/Advances-Walsh_74.pdf
May 28, 2008 - medications
for their child(ren) with chronic disease and to describe possible prior medication errors
occurring
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/surgery/modules/implementation/imp_opt_briefings.pptx
December 01, 2017 - Debriefings are often brief meetings immediately following a case, either regularly occurring or under
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www.uspreventiveservicestaskforce.org/uspstf/recommendation/colorectal-cancer-screening-june-2016
June 15, 2016 - apparent without screening (ie, overdiagnosis and overtreatment). 1 Extracolonic findings are common, occurring … Extracolonic findings detected on CT colonography are common, occurring in about 40% to 70% of screening
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety-2/vol2/Advances-Elder_18.pdf
February 19, 2008 - care and delineated the steps in which physicians and
their staff members perceive the most errors occurring
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety-2/vol1/Advances-Browne_5.pdf
January 20, 2008 - • Occurrence (O) evaluates the risk of the event occurring again.
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digital.ahrq.gov/health-it-tools-and-resources/evaluation-resources/workflow-assessment-health-it-toolkit/all-workflow-tools/histogram
January 01, 2023 - Histogram
Also Known As
Frequency Distribution
Description
A histogram graphically demonstrates the frequency with which various values of a particular variable occur in a set of data. The height of the bar indicates the frequency of occurrence.
Uses
To quickly and easily demonst…
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digital.ahrq.gov/health-it-tools-and-resources/evaluation-resources/workflow-assessment-health-it-toolkit/all-workflow-tools/comms-usage-diagram
January 01, 2023 - Comms Usage Diagram
Acronym
CUD
Description
A comms usage diagram (CUD) displays how teams in different geographical areas collaborate across their respective locations. The diagram also includes information about how and why the communication occurs, the specific technology being used, and th…
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digital.ahrq.gov/health-it-tools-and-resources/evaluation-resources/workflow-assessment-health-it-toolkit/all-workflow-tools/workflow-diagram
January 01, 2023 - Workflow Diagram
Also Known As
Physical Layout Flowchart
Spaghetti Diagram
Transportation Diagram
Description
A workflow diagram demonstrates movement through a process. The diagram is comprised of a map (such as a floor plan) of the area where the process occurs and uses lines to show…
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hcup-us.ahrq.gov/reports/factsandfigures/2008/pdfs/section5_4.pdf
January 01, 2008 - HCUP Facts and Figures: Statistics on Hospital-Based Care in the United States, 2008 64
EXHIBIT 5.4 MH and SA Inpatient Hospital Discharges Against Medical Advice
All Other
Diagnoses
292,300
79%
MH
25,000
7%
SA
52,700
14%
* Based on principal CCS diagnosis.
Source: AHRQ, Center for Delivery, Organiza…
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psnet.ahrq.gov/node/46902/psn-pdf
August 20, 2018 - Making soft intelligence hard: a multi-site qualitative
study of challenges relating to voice about safety
concerns.
August 20, 2018
Martin G, Aveling E-L, Campbell A, et al. Making soft intelligence hard: a multi-site qualitative study of
challenges relating to voice about safety concerns. BMJ Qual Saf. 2018;27(9…
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www.ahrq.gov/practiceimprovement/delivery-initiative/ihs/chap6tab26.html
December 01, 2017 - Table 26. Utilization of education and case management service by type of visit among adults with diabetes who had at least one visit. Fiscal year 2010
ARRA Grant Initiative
Findings from a set of 16 grants on improving delivery systems and on spreading evidence-based practices through delivery systems; recom…
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psnet.ahrq.gov/node/39082/psn-pdf
January 04, 2010 - Communication practices on 4 Harvard surgical
services: a surgical safety collaborative.
January 4, 2010
Elbardissi AW, Regenbogen SE, Greenberg CC, et al. Communication practices on 4 Harvard surgical
services: a surgical safety collaborative. Ann Surg. 2009;250(6):861-5.
doi:10.1097/SLA.0b013e3181afe0db.
https:…
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psnet.ahrq.gov/node/45491/psn-pdf
May 09, 2017 - A systematic review of the types and causes of
prescribing errors generated from using computerized
provider order entry systems in primary and secondary
care.
May 9, 2017
Brown CL, Mulcaster HL, Triffitt KL, et al. A systematic review of the types and causes of prescribing errors
generated from using computerize…
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psnet.ahrq.gov/node/45714/psn-pdf
December 20, 2017 - US emergency department visits for outpatient adverse
drug events, 2013–2014.
December 20, 2017
Shehab N, Lovegrove MC, Geller AI, et al. US Emergency Department Visits for Outpatient Adverse Drug
Events, 2013-2014. JAMA. 2016;316(20):2115-2125. doi:10.1001/jama.2016.16201.
https://psnet.ahrq.gov/issue/us-emergenc…
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psnet.ahrq.gov/node/38900/psn-pdf
January 03, 2017 - Dropping the baton during the handoff from emergency
department to primary care: pediatric asthma continuity
errors.
January 3, 2017
Hsiao AL, Shiffman RN. Dropping the baton during the handoff from emergency department to primary
care: pediatric asthma continuity errors. Jt Comm J Qual Patient Saf. 2009;35(9):467…