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psnet.ahrq.gov/sites/default/files/2025-01/spotlight_case_misdiagnosis_of_small_bowel_obstruction_-_slides_-_final.pptx
January 01, 2025 - differential, and assist clinicians to refine their selection of laboratory tests and imaging:
Pain location, quality … symptoms such as fever, nausea, vomiting, and diarrhea
Physical exam findings such as the location and quality … imaging has increased significantly over the last 20 years, driven largely by improved availability and quality
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psnet.ahrq.gov/issue/charting-course-launching-patient-centric-healthcare
December 19, 2018 - Same Author(s)
Why Hospitals Should Fly: The Ultimate Flight Plan to Patient Safety and Quality … March 5, 2013
Health IT-Enabled Quality Measurement: Perspectives, Pathways, and Practical … Unintended consequences of health care reform: impact of changes in payor mix on patient safety indicators … April 1, 2024
National Healthcare Quality and Disparities Reports. … November 26, 2013
HealthGrades Quality Study: Fourth Annual Patient Safety in American
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psnet.ahrq.gov/primer/rapid-response-systems
July 18, 2024 - Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services … Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services … project was funded under contract number 75Q80119C00004 from the Agency for Healthcare Research and Quality … Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services
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psnet.ahrq.gov/primer/disruptive-and-unprofessional-behavior
September 15, 2024 - Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services … Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services … project was funded under contract number 75Q80119C00004 from the Agency for Healthcare Research and Quality … Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services
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psnet.ahrq.gov/node/33561/psn-pdf
September 15, 2024 - Background
The term "Never Event" was first introduced in 2001 by Ken Kizer, MD, former CEO of the National Quality … multiple
times, and now consists of 29 "serious reportable events" grouped into 7 categories:
National Quality … than as intended
https://psnet.ahrq.gov/primer/never-events
https://psnet.ahrq.gov/issue/national-quality-forum … Events are also being publicly reported, with the goal of increasing accountability and improving the
quality … National Quality Forum. List of Serious Reportable Events.
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psnet.ahrq.gov/issue/improvement-cymru
October 20, 2014 - The quality of 'Learning from Deaths' reporting in quality accounts within the NHS in England 2017-2020 … View More
Related Resources
Validity of 16 AHRQ Patient Safety Indicators … May 9, 2012
WebM&M Cases
The Safety and Quality of Long
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psnet.ahrq.gov/node/60363/psn-pdf
March 01, 2021 - Knowledge of “red flags”: The patient is knowledgeable of indicators that his or her
condition is worsening … Journal for
Healthcare Quality. 2015:37(1):2-11. … Journal for Healthcare Quality. 2015:37(1):12-21. … Association between quality improvement for care transition in communities and
rehospitalizations among … assets.ctfassets.net/ld0m6d2hhals/0mFeNi4VsJ4uRZ4ayDVVw/f784d626646a32dc8df2cd4d1a00d04d/Association-
Between-Quality-Improvement-for-Care-Transitions-in-Communities-and-Rehosptializations-among
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psnet.ahrq.gov/perspective/role-fda-ensuring-device-safety
May 28, 2020 - Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services … Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services … As a result, the FDA has incomplete information regarding the quality of device servicing, raising concern … KH: When thinking about surveillance and indicators that potentially unsafe conditions exist, is there … Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services
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psnet.ahrq.gov/node/72618/psn-pdf
December 23, 2020 - Supports Physician, Patient Behavioral
Changes Towards Medical Decisions that Improve Care
Value and Quality … effectively guide an individual to choose a behavior or action is an
ongoing question for patient safety and quality … This approach can be applied to a wide variety of quality improvement projects, including
those with
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psnet.ahrq.gov/node/74252/psn-pdf
January 12, 2022 - Safety Organizations (PSOs) are organizations dedicated to improving patient
safety and healthcare quality … developed when a healthcare provider works with a federally
listed PSO under the Patient Safety and Quality … I'm a master's-level registered nurse and certified
professional in healthcare quality [CPHQ]. … I have been working in the field of quality and patient safety
since 2007 and serve as the Director … Copies of the de-identified cases
are sent to our Atrium Health PSO for quality improvement and learning
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psnet.ahrq.gov/web-mm/anticoagulation-held-too-long
April 01, 2008 - Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services … Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services … One clear source of the clinical dilemma is the lack of high-quality data to help guide clinicians. … Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services … October 7, 2015
Hospital quality and patient safety competencies: development, description
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psnet.ahrq.gov/web-mm/speaking-patient-safety-what-they-dont-tell-you-training-about-feedback-and-burnout
January 22, 2020 - Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services … Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services … Adair, PhD Assistant Director of Research Duke Center for Healthcare Safety and Quality Duke University … The Improvement Readiness scale of the SCORE survey: a metric to assess capacity for quality improvement … Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services
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psnet.ahrq.gov/node/43745/psn-pdf
December 17, 2014 - longer length of stay, and higher cost) beyond the
standard Centers for Medicare and Medicaid Services indicators … complications (i.e., increased sensitivity), not all of
them can be attributed with certainty to the quality
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psnet.ahrq.gov/node/45744/psn-pdf
December 19, 2017 - hospital-characteristics-associated-penalties-centers-medicare-medicaid-services-hospital
https://psnet.ahrq.gov/issue/validity-agency-healthcare-research-and-quality-patient-safety-indicators-and-centers
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psnet.ahrq.gov/issue/do-junior-doctors-make-more-prescribing-errors-experienced-doctors-when-prescribing
February 22, 2023 - 2024
Annual Perspective
Improving Diagnostic Safety and Quality
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psnet.ahrq.gov/node/33562/psn-pdf
September 15, 2024 - https://psnet.ahrq.gov/issue/100000-lives-campaign-setting-goal-and-deadline-improving-health-care-quality
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psnet.ahrq.gov/node/49864/psn-pdf
June 01, 2019 - Adair, PhD Assistant Director of Research Duke Center for Healthcare Safety and Quality
Duke University … Bryan Sexton, PhD Director Duke Center for Healthcare Safety and Quality Associate Professor,
Psychiatry … The Improvement Readiness scale of the SCORE survey: a metric
to assess capacity for quality improvement … project was funded under contract number 75Q80119C00004 from the Agency for Healthcare
Research and Quality
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psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.464_slideshow.ppt
January 01, 2019 - are common in inpatient psychiatry
Overdiagnosis and underdiagnosis are common in routine practice
Quality … occur in the emergency department (ED), on the psychiatric unit, or during a transition in providers
Quality … the psychiatric facility
*
*
Improving Safety in Psychiatry
Psychiatric units can initiate quality … psychiatry
Error reporting systems lag behind
Psychiatry training programs should improve education in quality
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psnet.ahrq.gov/web-mm/picking-cause-stroke
August 07, 2024 - Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services … Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services … project was funded under contract number 75Q80119C00004 from the Agency for Healthcare Research and Quality … Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services
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psnet.ahrq.gov/web-mm/standard-deviations
January 01, 2006 - Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services … Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services … project was funded under contract number 75Q80119C00004 from the Agency for Healthcare Research and Quality … Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services