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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/candor/module3/mod03-gap-analysis-guide.pdf
April 01, 2016 - Purpose: To evaluate the extent to which current processes align with the Communication and Optimal Resolution
(CANDOR) process and includes;
■ Identifying the existing process
■ Identifying the existing outcome(s)
■ Identifying the desired outcome(s)
■ Identifying and documenting the gap(s)
Who should use t…
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www.ahrq.gov/sites/default/files/2024-11/kupka-report.pdf
January 01, 2024 - Final Progress Report: Risks of Inaccurate or Incomplete Preoperative Assessments in Freestanding ASCs
Title Page
Title of Project:
Risks Of Inaccurate Or Incomplete Preoperative Assessments In Freestanding ASCs
Principal Investigator:
Nancy Kupka DNSc, MPH, RN - The Joint Commission
Team Members:
Diana Bickham, …
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www.ahrq.gov/sites/default/files/wysiwyg/hai/tools/mrsa-2/023-ss-cusp-learning-from-defects-fg.docx
April 01, 2025 - AHRQ Safety Program for MRSA Prevention: Targeting SSI
Learning From Defects
Surgical Services
For: Cardiac, Hip and Knee Joint Replacement, and Spinal Fusion Surgeries
Slide Title and Commentary
Slide Number and Slide
Learning From Defects
SAY:
Welcome to this presentation on Learning From Defects as part of an o…
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www.ahrq.gov/practiceimprovement/systemdesign/leancasestudies/lean-case6.html
November 01, 2014 - Improving Care Delivery Through Lean: Implementation Case Studies
Case 6. Horizon Hospital—Lakeview Healthcare
Previous Page Next Page
Table of Contents
Improving Care Delivery Through Lean: Implementation Case Studies
Introduction to the Case Studies
Case 1. Lakeview Healthcare
Case 2. Centra…
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol1/Potter.pdf
January 01, 2003 - This requires a concomitant processing and cognitive storage of
information.11 Information in the RN
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www.ahrq.gov/patient-safety/settings/hospital/resource/pressureulcer/tool/pu7.html
October 01, 2014 - Preventing Pressure Ulcers in Hospitals
7. Tools and Resources
Previous Page Next Page
Table of Contents
Preventing Pressure Ulcers in Hospitals
Overview
Key Subject Area Index
1. Are we ready for this change?
2. How will we manage change?
3. What are the best practices in pressure ulcer p…
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www.ahrq.gov/es/patient-safety/settings/hospital/resource/pressureulcer/tool/pu7.html
October 01, 2014 - Preventing Pressure Ulcers in Hospitals
7. Tools and Resources
Previous Page Next Page
Table of Contents
Preventing Pressure Ulcers in Hospitals
Overview
Key Subject Area Index
1. Are we ready for this change?
2. How will we manage change?
3. What are the best practices in pressure ulcer p…
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www.ahrq.gov/patient-safety/reports/hotline/eval4.html
May 01, 2016 - Processing of the Patient and Caregiver Reports
In 34 of the 37 reports, the respondent agreed to … enabled several different options for reporting (e.g., anonymous, de-identified), the back-end review and processing
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www.ahrq.gov/sites/default/files/2024-01/anumba-report_0.pdf
January 01, 2024 - Recent
examples show that processing the healthcare facility information together with the medical
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/candor/module7/module7-resolution-facilitator.pptx
August 24, 2015 - PowerPoint Presentation
Communication and Optimal Resolution
(CANDOR)
Toolkit
Module 7: Resolution
Module 7 of the CANDOR Toolkit describes the resolution phase of the CANDOR process.
1
Objectives
Define the CANDOR Resolution component and its importance in the CANDOR process.
List the steps of the resolution pr…
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www.ahrq.gov/practiceimprovement/systemdesign/leancasestudies/index.html
November 01, 2014 - Improving Care Delivery Through Lean: Implementation Case Studies
Next Page
Table of Contents
Improving Care Delivery Through Lean: Implementation Case Studies
Introduction to the Case Studies
Case 1. Lakeview Healthcare
Case 2. Central Hospital
Case 3. Grand Hospital Center
Case 4. Suntown …
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/candor/module1/grand-rounds-presentation-slides.pptx
January 01, 2014 - PowerPoint Presentation
Communication and Optimal Resolution (CANDOR): Grand Rounds Presentation
Presenter: Timothy B. McDonald, MD, JD
This presentation will introduce you to Communication and Optimal Resolution, or the CANDOR process. Some organizations struggle to improve the way they and their care teams respond…
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www.ahrq.gov/sites/default/files/wysiwyg/npsd/Blood_Dashboard_Data_2024.xlsx
January 01, 2024 - Blood Dashboard Data
Introduction
Introduction-Blood or Blood Product
The tables in this workbook present data on Blood or Blood Product reports submitted by AHRQ-listed Patient Safety Organizations (PSOs) to the Network of Patient Safety Databases (NPSD) through December 31, 2023. They include the relative frequen…
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www.ahrq.gov/practiceimprovement/systemdesign/leancasestudies/lean-case1.html
November 01, 2014 - Improving Care Delivery Through Lean: Implementation Case Studies
Case 1. Lakeview Healthcare
Previous Page Next Page
Table of Contents
Improving Care Delivery Through Lean: Implementation Case Studies
Introduction to the Case Studies
Case 1. Lakeview Healthcare
Case 2. Central Hospital
Case…
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www.ahrq.gov/sites/default/files/2025-03/mahajan-manojlovich-report.pdf
January 01, 2025 - Final Progress Report: Developing a Framework to Study and Improve Communication to Enhance Diagnostic Quality in the ED
A. Title Page
Project Title: Developing a Framework to Study and Improve Communication to Enhance
Diagnostic Quality in the ED
Principal Investigator Information:
PRASHANT MAHAJAN, MBA, MD, MPH …
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www.ahrq.gov/sites/default/files/wysiwyg/hai/tools/mrsa/004-cusp-learning-from-defects.docx
October 01, 2024 - AHRQ Safety Program for MRSA Prevention
Learning From Defects
ICU & Non-ICU
Slide Title and Commentary
Slide Number and Slide
Learning From Defects
SAY:
Welcome to this presentation on Learning From Defects (LFD) as part of an overall approach to preventing MRSA in ICU and non-ICU settings.
Slide 1
Educational…
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/qitoolkit/combined/e1_combo_monitorprogress.pdf
June 02, 2025 - Monitoring Progress for Sustainable Improvement
Toolkit for Using the AHRQ Quality Indicators
How To Improve Hospital Quality and Safety
Monitoring Progress for Sustainable Impro…
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/qitoolkit/pdi/e1_pdi_monitorprogress.pdf
June 02, 2025 - Monitoring Progress for Sustainable Improvement
Pediatric Toolkit for Using the AHRQ Quality Indicators
How To Improve Hospital Quality and Safety
i Tool E.1
Monitoring Progress for Sustainable Improvement
What is the purpose of this tool? This tool provides guidance on how to monitor and report
your progres…
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www.ahrq.gov/patient-safety/settings/hospital/match/chapter-2.html
July 01, 2022 - Medications at Transitions and Clinical Handoffs (MATCH) Toolkit for Medication Reconciliation
Chapter 2. Building the Project Foundation: Project Teams and Scope
Previous Page Next Page
Table of Contents
Medications at Transitions and Clinical Handoffs (MATCH) Toolkit for Medication Reconciliation …
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www.ahrq.gov/es/patient-safety/settings/hospital/match/chapter-2.html
July 01, 2022 - Medications at Transitions and Clinical Handoffs (MATCH) Toolkit for Medication Reconciliation
Chapter 2. Building the Project Foundation: Project Teams and Scope
Previous Page Next Page
Table of Contents
Medications at Transitions and Clinical Handoffs (MATCH) Toolkit for Medication Reconciliation …