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Showing results for "occurring".

  1. University of California, Davis | Digital Healthcare Research

    digital.ahrq.gov/organization/university-california-davis
    January 01, 2023 - University of California, Davis School-Based Tele-Physiatry Assistance for Rehabilitative and Therapeutic Services for Children with Special Health Care Needs Living in Rural and Underserved Communities Description This study examined parent and provider experiences and care c…

  2. Swiss Cheese Model | PSNet

    psnet.ahrq.gov/glossary/swiss-cheese-model
    September 13, 2021 - Swiss Cheese Model September 13, 2021 Anonymous (not verified) Reason developed the "Swiss cheese model" to illustrate how analyses of major accidents and catastrophic systems failures tend to reveal multiple, smaller failures leading up to the actual hazard. In the model, each slice of cheese represents a safe…

  3. 2024 Network of Patient Safety Databases Chartbook: Medication and Other Substance Events. | PSNet

    psnet.ahrq.gov/issue/2024-network-patient-safety-databases-chartbook-medication-and-other-substance-events
    September 11, 2024 - Book/Report 2024 Network of Patient Safety Databases Chartbook: Medication and Other Substance Events. Citation Text: 2024 Network Of Patient Safety Databases Chartbook: Medication And Other Substance Events. Rockville, MD: Agency for Healthcare Research and Quality; 2024. AHRQ Pub. No. …

  4. Aas IH 2002 "Telemedicine and changes in the distribution of tasks between levels of care." | Digital Healthcare Research

    digital.ahrq.gov/health-it-tools-and-resources/workflow-assessment-health-it-toolkit/research/aas-ih-2002
    January 01, 2002 - Aas IH 2002 "Telemedicine and changes in the distribution of tasks between levels of care." Reference Aas IH. Telemedicine and changes in the distribution of tasks between levels of care. J Telemed Telecare 2002;8 Suppl 2:1-2. Abstract "The present investigation, which was part of a larger stu…

  5. When medical students make errors. | PSNet

    psnet.ahrq.gov/issue/when-medical-students-make-errors
    March 08, 2017 - Newspaper/Magazine Article When medical students make errors. Save Save to your library Print Download PDF Share Facebook Twitter Linkedin Copy URL May 28, 2014 View more articles from the same authors. This newspa…

  6. Effective Health Care (pdf file)

    effectivehealthcare.ahrq.gov/sites/default/files/pdf/TND_0215_01-06-2010.pdf
    January 01, 2010 - Effective Health Care Topic Number(s): 0239 Document Completion Date: 8-13-10 1 Results of Topic Selection Process & Next Steps  Treatment of restless legs syndrome will go forward for refinement as a systematic review. The scope of this topic, including populations, interventions, comparato…

  7. Primary Care Visual Error Reporting Tool- Part 2 (pdf file)

    digital.ahrq.gov/sites/default/files/docs/resource/b4_singh_017020_archives_17_part2.pdf
    January 01, 2009 - Primary Care Visual Error Reporting Tool- Part 2 1/2 In an effort to bring some standardization and efficiency to the chart-review process, a two-step method is used. As the first step, a set of screening criteria identifying the presence of ce…

  8. Data Display and Organization | Digital Healthcare Research

    digital.ahrq.gov/health-it-tools-and-resources/evaluation-resources/workflow-assessment-health-it-toolkit/all-workflow-tools/data-display
    January 01, 2023 - Data Display and Organization Social Network Analysis Description A social network analysis (SNA) shows relationships between people, technology, and groups and allows one to evaluate these relationships. The method is used to find the type, importance, and quantity of relatio…

  9. Process Mapping | Digital Healthcare Research

    digital.ahrq.gov/health-it-tools-and-resources/evaluation-resources/workflow-assessment-health-it-toolkit/all-workflow-tools/process-0
    January 01, 2023 - Process Mapping Use Case Description A use case is a set of instructions that an individual in a process completes to go through one single step in that process. It describes what the user does to interact with a system. Value Stream Mapping Descr…

  10. Wrong site surgery: a critical incident analysis of a near miss. | PSNet

    psnet.ahrq.gov/issue/wrong-site-surgery-critical-incident-analysis-near-miss
    June 15, 2024 - Commentary Wrong site surgery: a critical incident analysis of a near miss. Citation Text: Tichanow S. Wrong site surgery: A critical incident analysis of a near miss. J Perioper Pract. 2016;26(1-2):11-5. Copy Citation Format: Google Scholar PubMed BibTeX EndNote X3 XML End…

  11. Fault Tree Analysis | Digital Healthcare Research

    digital.ahrq.gov/health-it-tools-and-resources/evaluation-resources/workflow-assessment-health-it-toolkit/all-workflow-tools/fault-tree-analysis
    January 01, 2023 - Fault Tree Analysis Acronym FTA Description Fault tree analyses (FTAs) study specific system, process, or product failures using a tree diagram . The process can be used to study a failure that actually occurred, or it could study a potential failure. The technique starts with the failure an…

  12. Grant Final Report: Toward an Optimal Patient Safety Information System (TOPSIS) (pdf file)

    www.ahrq.gov/sites/default/files/2024-04/koss-report.pdf
    January 01, 2024 - Grant Final Report: Toward an Optimal Patient Safety Information System (TOPSIS) Grant Final Report Grant ID: R01HS015164 Toward an Optimal Patient Safety Information System (TOPSIS) Inclusive Dates: 09/30/04 - 03/31/08 Principal Investigator: Richard Koss, MA Team Members: Stacey…

  13. In Conversation with...Richard Ricciardi about Office-Based Patient Safety | PSNet

    psnet.ahrq.gov/perspective/conversation-withrichard-ricciardi-about-office-based-patient-safety
    January 31, 2024 - They found that such deviations were common, occurring in 70% of reviewed cases.

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

    effectivehealthcare.ahrq.gov/sites/default/files/related_files/recombinant-factor-viia_disposition-comments.pdf
    June 01, 2010 - of results from studies with disparity in trial design, endpoint and sample size − Hemorrhages occurring … Erroneous assumptions are made that hemorrhage occurring in different clinical settings is comparable

  15. Ten Considerations for Easing the Transition to a Web-based Patient Safety Reporting System (pdf file)

    www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol3/Ulep.pdf
    January 01, 2004 - then develop and follow through on an action plan that will attempt to prevent similar errors from occurring

  16. The Role of Undergraduate Nursing Education in Patient Safety | PSNet

    psnet.ahrq.gov/perspective/role-undergraduate-nursing-education-patient-safety
    November 27, 2023 - started a national discussion on what nursing needed to do to address the multitude of errors that were occurring

  17. In Conversation with... Joan Stanley about The Role of Undergraduate Nursing Education in Patient Safety | PSNet

    psnet.ahrq.gov/perspective/conversation-joan-stanley-about-role-undergraduate-nursing-education-patient-safety
    November 27, 2023 - started a national discussion on what nursing needed to do to address the multitude of errors that were occurring

  18. A Nonpunitive, Computerized System for Improved Reporting of Medical Occurrences (pdf file)

    www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol4/Arroyo.pdf
    June 11, 2003 - The submitted information is tracked over time and reviewed to see if any trends are occurring that

  19. Using Data To Drive Change and Improve Patient Safety Facilitator Notes (doc file)

    www.ahrq.gov/sites/default/files/wysiwyg/hai/tools/clabsi-cauti-icu/data-change-notes.docx
    April 01, 2022 - This chart shows the number of CAUTIs occurring in this unit by month, along with annotations describing

  20. Triaging Interhospital Transfers | PSNet

    psnet.ahrq.gov/web-mm/triaging-interhospital-transfers
    April 12, 2023 - Medicare patients admitted to the hospital undergo interhospital transfer ( 1 ), with greater frequency occurring
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