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psnet.ahrq.gov/innovation/e-autopsye-biopsy-systematic-chart-review-increase-safety-and-diagnostic-accuracy
April 01, 2005 - Summary
Addressing diagnostic errors to improve outcomes and patient safety has long been a problem … Date First Implemented
2010
Problem Addressed
Diagnostic errors are … a difficult problem. 1 The 2015 National Academy of Medicine report found that “most people will experience … of the Innovation
Solving diagnostic errors to improve outcomes and patient safety has long been a problem … Given the magnitude of the problem as outlined in the 2015 National Academy of Medicine report, 1 there
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digital.ahrq.gov/sites/default/files/docs/page/e-prescribing-toolset-pharmacy.pdf
January 01, 2020 - The most common problem is that the prescriber will select “1” as the quantity, to denote “1
unit” of … If your
pharmacy system vendor is not able to identify or remediate the problem, the vendor might be … Troubleshoot the Problem
First, get more information from the customer. … Troubleshoot the Problem
If you receive an e-prescription that appears to have an error, contact … Troubleshooting the Problem
Most pharmacies find that problems can be resolved easily by phone.
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psnet.ahrq.gov/issue/government-and-industry-fail-protect-public-when-they-suggest-carefully-following
February 24, 2016 - April 13, 2016
Reporting and second-order problem solving can turn short-term fixes into … The sinks can make the problem worse.
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digital.ahrq.gov/sites/default/files/docs/cds-slides-10192021.pdf
October 19, 2021 - Describe the role of cognitive engineering for complex decision making and problem
solving in acute … 6
Funding Disclosures
• AHRQ (R01 HS22542 Cognitive Engineering for Complex
Decision Making & Problem … made to be customized is different than ‘EMR
optimization’
− The code doesn’t change., so not a problem … 1 link
Note 2 link
Note 3 link
Note 4 link
Note 5 link
…
Design Patterns
Flowsheet Navigation
Problem … Cognitive Support in the Emergency Department
Cognitive Engineering for Complex Decision Making & Problem
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www.uspreventiveservicestaskforce.org/uspstf/about-uspstf/methods-and-processes/procedure-manual/procedure-manual-appendix-xiv-decision-framework-assess-and-guide-need-searches-existing-decision-models
July 01, 2017 - The USPSTF topic leads scope the decision problem to be addressed by modeling, briefly articulating the … The optimal timing for this activity may vary by topic, as these components of the decision problem become
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digital.ahrq.gov/principal-investigator/gurses-ayse-pinar
January 01, 2023 - Health Information Technology Design
Characterizing the utilization of the problem … Characterizing the utilization of the problem list for pediatric trauma care.
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digital.ahrq.gov/technology/computerized-provider-order-entry-system
January 01, 2023 - and Clinical Decision Support for Order Entry
Indication alerts to improve problem … Indication alerts to improve problem list documentation.
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psnet.ahrq.gov/perspective/accountability-patient-safety
January 01, 2018 - three large-scale failures at the National Health Service, offers a prominent illustration of this problem … little doubt that disruptive behaviors harm patients, work environments, and staff morale, and that the problem … A prior PSNet perspective summarizes a stepwise approach for managing problem behaviors. … 1, 2018
Perspective
Overuse as a Patient Safety Problem
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digital.ahrq.gov/sites/default/files/docs/HOW%20HEALTH%20IT%20CAN%20REDUCE%20UNNECESSARY%20REHOSPITALIZATION.pdf
June 16, 2021 - What I am going to try to - is to give you a picture of the problem of
rehospitalization and why - up … We have, quite literally, hundreds, I would guess over a thousand hospitals now
working on this problem … Now, finally in this introduction it is important to recognize that this is not just a Medicare problem … This is not just a technical problem. … And the fact that facing up to
this problem is going to be very hard for institutions.
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hcup-us.ahrq.gov/db/nation/nis/corrections_2011.jsp
January 01, 2011 - The original 2011 NIS version dated June 4, 2013 was replaced on July 10, 2013 to fix a problem with … The updated NIS version dated July 10, 2013 fixed the problem by increasing the length of KEY from 14
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psnet.ahrq.gov/issue/initial-clinical-evaluation-handheld-device-detecting-retained-surgical-gauze-sponges-using
August 18, 2010 - November 6, 2013
Application of an engineering problem-solving methodology to address … September 25, 2013
Retained surgical items: a problem yet to be solved.
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psnet.ahrq.gov/node/33776/psn-pdf
January 01, 2015 - But all of the things you mention
there—PDSA cycles, root cause analysis, problem solving, continuous … to look mainly at the system
because there's this very human desire to put a neat little bow around problem … I can
tell you, having worked at General Motors in the mid-1990s, the problem was not that people wouldn't … The problem was that managers didn't listen. … That's a pretty common problem.
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www.uspreventiveservicestaskforce.org/uspstf/document/screening-and-interventions-for-childhood-obesity-where-is-t/obesity-in-children-and-adolescents-screening-2005
July 11, 2005 - Extreme obesity in childhood is an obvious problem, and is associated with immediate adverse health and … identify children at increased risk for adverse health outcomes related to excess weight, we face the problem … A final and pervasive problem is that we have little information about the potential harms of screening … recommendation is of concern to pediatricians who are interested in obesity screening and care about the problem
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psnet.ahrq.gov/perspective/conversation-michael-cohen-rph-ms-scd-hon-0
October 24, 2021 - MC : Well, handwriting and lookalike drug names were a big problem. … But the medication safety problem hasn't gone away, obviously. … Things like that are a problem today. … They can contact us about a problem. … You could work for half an hour on a problem and you're not going to get reimbursed one cent.
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www.uspreventiveservicestaskforce.org/home/getfilebytoken/z8AVsCHJEZUBSJtdSx424H
May 23, 2019 - Screening for problem drinking. In:
DiGuiseppi C, Atkins D, Woolf SH, Kamerow DB, eds. … Effectiveness of physician-based interventions
with problem drinkers: a review. … Brief physi-
cian advice for problem alcohol drinkers. … Screening for problem drinking and counseling by the primary care physi-
cian-nurse team. … A study of minimal interventions for problem drinkers in
acute care settings.
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digital.ahrq.gov/ahrq-funded-projects/ambulatory-electronic-medical-record-and-shared-access
January 01, 2023 - 2009, provides a means to share a longitudinal medical record that contains, at a minimum, a patient problem … These records will contain, at a minimum, a patient problem list, medication list, allergies, radiology … As part of the new EMR system, each patient has a "problem list," to let emergency staff know if they
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digital.ahrq.gov/ahrq-funded-projects/understanding-primary-care-teamwork-context-implications-health-information
January 01, 2023 - includes resources designed to assist in processes such as information searching, situation assessment, problem … identification, and problem solving, all related to making a clinical diagnosis.
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psnet.ahrq.gov/perspective/diagnostic-errors
December 01, 2013 - Causes of the Problem
As noted at the outset, something about diagnostic errors strikes many clinicians … reflecting individual performance, with less obvious roles for a systems approach to addressing the problem … Addressing the Problem
As intellectually appealing as cognitive debiasing may be, addressing systems … If you have passion to solve a specific quality or safety problem, that's what you should do. … It really tried to bring this problem to the limelight.
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digital.ahrq.gov/ahrq-funded-projects/cognitive-engineering-complex-decisionmaking-problem-solving-acute-care/citation/cognitive
January 01, 2023 - Project Name
Cognitive Engineering for Complex Decisionmaking & Problem Solving in Acute Care
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cds.ahrq.gov/sites/default/files/workgroups/241/jun-2017-cholesterol-wg-notes.docx
January 01, 2017 - .
· Concerning the accuracy of using conditions deemed as Active on the problem list: this provides transparency … Problem lists can be neglected at times and some items may need to be resolved and moved to the Past … Utilizing the problem list to determine the presence of a condition is a manageable constraint when creating