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Showing results for "review of reported cases".

1. The New York Model: Root Cause Analysis Driving Patient Safety Initiative to Ensure Correct Surgical and Invasive Procedures (pdf file)
   www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety-2/vol1/Advances-Faltz_56.pdf
   March 27, 2008 - .15 In January 2006, after a serious wrong-side surgery event at a New York hospital in 2005 and a review … The expert committee assembled to review the data derived from the RCAs, identified commonalities in … After review by the Department of Health and approval by the Commissioner of Health, the protocol was … One study estimated that 1,200 to 2,700 events occur annually in the United States.20 Based on a review … A follow-up review of wrong site surgery; Oakbrook Terrace, IL: The Joint Commission; 2001 Dec 5.

2. Infections Avoided, Excess Costs Averted, and Changes in Mortality Rate | Agency for Healthcare Research and Quality
   www.ahrq.gov/hai/cusp/clabsi-final-companion/clabsicomp4c.html
   January 01, 2013 - Systematic Review Flowchart Appendix C. … Although prior systematic reviews have been conducted, this review differed in that it focused solely … Literature Review—Methods PubMed, EconLit, Biological Abstract and Science Direct were searched. … Literature Review—Results A total of 841 unique abstracts were identified. … A flowchart of the article review process can be found in Appendix B , and all excluded articles and

3. A System to Describe and Reduce Medical Errors in Primary Care (pdf file)
   www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety-2/vol1/Advances-Kaprielian_9.pdf
   January 01, 2007 - Reviewers filled out a peer review sheet to indicate their opinion as to whether standard of care had … After each incident had been analyzed and peer review completed, the QI director assigned a primary … Each unit or division made local modifications to the reporting format and initial review process to … When a case was closed, it was cross-referenced in the peer review database of involved providers. … Additional physician and staff time are needed for coordination and department-level review.

4. Chapter 2. Determine Surgical Site Infection Rates (continued) | Agency for Healthcare Research and Quality
   www.ahrq.gov/research/findings/final-reports/ssi/ssi2a.html
   April 01, 2018 - Of all of the charts that the algorithm deemed positive and queued for review, we randomly selected up … Sixty procedures were associated with SSI after manual chart review using NHSN methodology. … The modified algorithm flagged 804 procedures (or 37 percent of total charts) for review. … Assuming 20 minutes per chart for manual review, 57 work days (8 hours/day) of chart review would have … Algorithms could also facilitate review by annotating important aspects of the case.

5. Physician-Reported Adverse Events and Medical Errors in Obstetrics and Gynecology (pdf file)
   www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety-2/vol1/Advances-November_45.pdf
   January 01, 2007 - were coded by a physician panel and compared with retrospective chart analysis and hospital incident review … Retrospective chart review corroborated 76 percent of the events with only two noted in hospital incident … prospective, observational project in two 6-week blocks between February 2003 and July 2003 as a peer review … errors.6, 9, 12Although 76 percent of physician-reported events were verified by retrospective chart review … Physician reporting compared with medical record review to identify adverse medical

6. Results | Agency for Healthcare Research and Quality
   www.ahrq.gov/hai/pfp/haccost2017-results.html
   November 01, 2017 - possible inclusion in meta-analysis—the majority of which were screened out based on a title and abstract review … Full text review eliminated 740 of the remaining 941 articles (78.6 percent). … Our systematic literature review found that there is a gap in current literature to examine the impact … For example, the study with the lowest cost estimate ($11,778) involved chart review at a single medical … Eleven studies were included in our review for VTE.

7. Results | Agency for Healthcare Research and Quality
   www.ahrq.gov/es/hai/pfp/haccost2017-results.html
   November 01, 2017 - possible inclusion in meta-analysis—the majority of which were screened out based on a title and abstract review … Full text review eliminated 740 of the remaining 941 articles (78.6 percent). … Our systematic literature review found that there is a gap in current literature to examine the impact … For example, the study with the lowest cost estimate ($11,778) involved chart review at a single medical … Eleven studies were included in our review for VTE.

8. Updating Systematic Reviews | Agency for Healthcare Research and Quality
   www.ahrq.gov/research/findings/evidence-based-reports/sysreviews.html
   April 01, 2018 - order to assess the extent to which they impact survival time (e.g., whether or not delays in the peer review … the occurrence of either a qualitative or quantitative signal for updating the original systematic review … No feature of the original review significantly predicted a signal for updating occurring within 2 years … or trials to see if any exist and determine if the results are consistent with the previous review. … Download Technical Review Updating Systematic Reviews Technical Review (Publication No. 07-0087)

9. A Study of Adverse Occurrences and Major Functional Impairment Following Surgery (pdf file)
   www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol1/Rojas.pdf
   March 15, 2004 - Nurses performed blinded chart review on Initial Cases and Initial Controls. … Patients with an adverse occurrence based upon nurse review are Final Cases. … Patients without an adverse occurrence based upon nurse review were Final Controls. STEP 1. … Adverse events in British hospitals: preliminary retrospective record review. … Reliability of medical record review for estimating adverse event rates.

10. Findings | Agency for Healthcare Research and Quality
    www.ahrq.gov/patient-safety/reports/candor-demo-program/plan-grants/findings.html
    August 01, 2022 - of a “systemwide, evidence-based, ethical, and legally sound standardized recommended process.” 2 A review … Following the claims analysis and a literature review, two predischarge surveys were developed to identify … This project successfully developed a statewide pregnancy-associated mortality review (PAMR) system in … Experts in health care quality assurance and peer review developed criteria for such events that warrant … percent of respondents reporting being “very satisfied” or “satisfied” with the risk management/peer review

11. C1 Prioritization Worksheet (pdf file)
    www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/qitoolkit/combined/c1_combo_prioritizationworksheet.pdf
    June 29, 2016 - Do we have a method to review PI progress on a regular basis? … Do we have a method to review PI progress on a regular basis? … Do we have a method to review PI progress on a regular basis? … Do we have a method to review PI progress on a regular basis? … Do we have a method to review PI progress on a regular basis?

12. Final Progress Report: The Role of Collective Mindfulness in Delivering Reliable and Safe Perioperative Care to Neonates (pdf file)
    www.ahrq.gov/sites/default/files/2024-01/france-report.pdf
    January 01, 2024 - assessed our experts’ intra-rater reliability (IRR > 0.7) using existing methods.77,108,109,120 A review … processes, used the instrument to rate audible and observed high-reliability behaviors during the review … Patient safety in the NICU: a comprehensive review. Journal of Perinatal & Neonatal Nursing. … A systematic review of behavioural marker systems in healthcare: what do we know about their attributes … Method agreement analysis: a review of correct methodology. Theriogenology.

13. Findings | Agency for Healthcare Research and Quality
    www.ahrq.gov/patient-safety/capacity/candor/demo-program/plan-grants/findings.html
    May 01, 2016 - of a “systemwide, evidence-based, ethical, and legally sound standardized recommended process.” 2 A review … Following the claims analysis and a literature review, two predischarge surveys were developed to identify … This project successfully developed a statewide pregnancy-associated mortality review (PAMR) system in … Experts in health care quality assurance and peer review developed criteria for such events that warrant … percent of respondents reporting being “very satisfied” or “satisfied” with the risk management/peer review

14. Reducing Waste and Inefficiency in Health Care Through Lean Process Redesign: Literature Review | Agency for Healthcare Research and Quality
    www.ahrq.gov/research/findings/final-reports/leanprocess/leanprocess.html
    May 01, 2018 - Reducing Waste and Inefficiency in Health Care Through Lean Process Redesign: Literature Review … This literature review explores possible adaptation of Lean/TPS to health care settings. … This literature review was designed to begin to answer these questions. … The full literature review, which was conducted for AHRQ by the American Institutes of Research, will

15. Final Progress Report: The Role of Collective Mindfulness in Delivering Reliable and Safe Perioperative Care to Neonates (pdf file)
    www.ahrq.gov/sites/default/files/wysiwyg/research/findings/final-reports/26069-France-draft-1.pdf
    March 29, 2022 - assessed our experts’ intra-rater reliability (IRR > 0.7) using existing methods.77,108,109,120 A review … processes, used the instrument to rate audible and observed high-reliability behaviors during the review … Patient safety in the NICU: a comprehensive review. Journal of Perinatal & Neonatal Nursing. … A systematic review of behavioural marker systems in healthcare: what do we know about their attributes … Method agreement analysis: a review of correct methodology. Theriogenology.

16. Final Progress Report: The Role of Collective Mindfulness in Delivering Reliable and Safe Perioperative Care to Neonates (pdf file)
    www.ahrq.gov/sites/default/files/wysiwyg/research/findings/final-reports/26069-France-report.pdf
    March 29, 2022 - assessed our experts’ intra-rater reliability (IRR > 0.7) using existing methods.77,108,109,120 A review … processes, used the instrument to rate audible and observed high-reliability behaviors during the review … Patient safety in the NICU: a comprehensive review. Journal of Perinatal & Neonatal Nursing. … A systematic review of behavioural marker systems in healthcare: what do we know about their attributes … Method agreement analysis: a review of correct methodology. Theriogenology.

17. Selected Best Practices and Suggestions for Improvement (pdf file)
    www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/qitoolkit/combined/d4n_combo_iqi-mortalityreview-bestpractices.pdf
    May 20, 2016 - Conduct preliminary case review Quality-trained clinicians perform initial case review to eliminate … IQIs for Review: This guideline will focus on an overview of a mortality review process that can be … case review to screen for cases not needing further review and prepare selected cases for committee … Recommended Practice: Conduct Systematic Review of Case • Hold an open discussion with mortality review … mortality review sessions

18. New Patient Safety Network Cases Offer Commentaries on Avoiding Severe Medical Errors | Agency for Healthcare Research and Quality
    www.ahrq.gov/news/avoiding-severe-medical-errors.html
    January 01, 2022 - outcomes at hospitals serving economically disadvantaged patients: a case for investment in nursing Review

19. Estimating the Additional Hospital Inpatient Cost and Mortality Associated With Selected Hospital-Acquired Conditions | Agency for Healthcare Research and Quality
    www.ahrq.gov/hai/pfp/haccost2017.html
    November 01, 2017 - Contents Summary Introduction      Need for New Measurements Data and Methods      Systematic Review … For this review, we used 69 studies in 20 individual meta-analyses to estimate the additional cost and … → 2) Screening: Review title and abstract to identify articles most likely to contain relevant … Systematic Review Process The first stage of our work involved conducting a systematic review of published … However, the preponderance of full-text review focused on assessing the methodology and applicability

20. Draft Final Report Estimating the Additional Hospital Inpatient Cost and Mortality Associated with Selected Hospital Acquired Conditions (pdf file)
    www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/pfp/hac-cost-report2017.pdf
    November 01, 2017 - Clostridium difficile Infections In this report, we present the findings of our literature review … Full text review eliminated 740 of the remaining 941 articles (78.6 percent). … Eleven studies were included in our review for VTE. … AHRQ Quality and Safety Review System. … AHRQ Quality and Safety Review System (QSRS).