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  1. psnet.ahrq.gov/innovation/rescue-improvement-conference-innovation-summary
    September 23, 2024 - Getting Started with This Innovation When getting started with this innovation, it is essential to … Data is also helpful when getting started with this innovation.
  2. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/852270/psn-pdf
    August 09, 2023 - vulnerability-medical-product-supply-chain-wake-call-covid-19 https://psnet.ahrq.gov/primer/high-reliability https://psnet.ahrq.gov/issue/getting-started-communication-and-resolution-program-crp-policy-or-commitment-statement-cr
  3. psnet.ahrq.gov/issue/interprofessional-education-collaborative-core-competencies-interprofessional-collaborative
    July 31, 2024 - Citation Related Resources Simulation to Improve Patient Safety: Getting Started
  4. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/50614/psn-pdf
    October 30, 2019 - VC: All of the above, but I started to begin with understanding epidemiology and variation with the use … outcomes https://psnet.ahrq.gov/perspective/conversation-vineet-chopra-md-msc issues; that's where we started … When I started to perform systematic reviews to understand the literature, I began to see evidence in … As I started looking at these populations, these diseases, these providers, I understood that they had … So when we started thinking about alternatives to PICCs, we started thinking about this bigger concept
  5. psnet.ahrq.gov/issue/automated-operating-room-team-approach-patient-safety-and-communication
    November 16, 2022 - surgical team, improved operative checklist compliance and nearly doubled the number of cases that started
  6. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/33804/psn-pdf
    March 03, 2016 - Sticht Center on Aging at Wake Forest University, really showed me about health care transformation and started … In the late 1990s, I started to become aware that better quality and coordinated care is actually less … Many of us were familiar with the literature, and we started pulling out the studies individually to … We weren't exactly sure when we started this journey how it would work. … I don't think that's ever been done before, and we made a stated goal when we started this project to
  7. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/33806/psn-pdf
    April 01, 2016 - However, toward the end of the study, we started to notice that there was a trailing off of how much … They also started to complain that the mnemonic used to standardize the verbal handoff process was really … mentioned that after the pilot intervention was done—and I assume this was before the multicenter study started—you … For example, people have started using it frequently in unit-to-unit transfers such as the OR- to-ICU … When we started this study 5 years ago or so, the concepts of standardized high reliability communication
  8. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/33626/psn-pdf
    January 01, 2006 - At that time, we started training crews together, teaching them how to communicate most effectively … conversation-withjack-barker-phd RW: What were your impressions of what would make the best team "player" when you started … JB: When I first started working in health care, yes, I figured that everything from our checklists and … JB: What I've seen has paralleled what happened in aviation when people first started requiring team
  9. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/33642/psn-pdf
    November 01, 2006 - Donald Norman: I started off in engineering, but switched to psychology for my PhD. … And so I started studying everyday human errors—"slips"—I called them. … From there, I started looking at aviation safety, working for NASA and the military. … There's another critical factor that I've recently started to explore.
  10. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/60329/psn-pdf
    May 14, 2020 - We established a partnership with Unity Healthcare, which is an FQHC in DC, and started providing cardiology … NS: We started thinking about how to ramp up our telehealth capabilities to improve safety early. … That’s when we started looking at how we can use telehealth to protect our providers within the hospital … Then we started to think about how we could implement video conferencing to help us communicate provider … If I was a provider that had 1500-2000+ patients and I had started some on new medications and I’m waiting
  11. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/61083/psn-pdf
    October 28, 2020 - LP: When we first started, information technology was simply not being used. … does not seem like it should be hard, it seems like that should be pretty simple, but when we first started … When we started giving them their turnover numbers, particularly their nurse turnover numbers, it was … The advance practice nurses started looking intensely at those transfers and really figuring out where … When all the facilities started to be tested, we were identifying that about 25% of staff and 25% of
  12. psnet.ahrq.gov/issue/saying-sorry
    October 20, 2021 - July 5, 2023 Getting Started with a Communication and Resolution Program (CRP) Policy
  13. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/45893/psn-pdf
    August 28, 2017 - Once electronic prescribing was in place, prescribers started using workarounds and relied too much
  14. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/45796/psn-pdf
    June 29, 2017 - Patients started on higher doses (cumulative dose ? 
  15. psnet.ahrq.gov/submit-innovations-landing
    February 26, 2025 - Get Started!
  16. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/50392/psn-pdf
    September 01, 2019 - Recently, we have started looking at social risk adjustment as an area that measurement needs to take … We started from days when perhaps it was a bit more binary. … Very recently, we started talking about health equity and looking at how outcomes vary across different … RW: When NQF started, probably 5% of hospitals had electronic health records, and now 5% do not.
  17. psnet.ahrq.gov/issue/indication-alerts-improve-problem-list-documentation
    July 28, 2021 - Between 9.6% and 11.1% were abandoned (order started but not signed), which needs further study.
  18. psnet.ahrq.gov/issue/examining-effects-obstetrics-interprofessional-programme-reductions-reportable-events-and
    August 04, 2021 - This decrease was most pronounced 3 to 6 years after the program started.
  19. psnet.ahrq.gov/issue/what-happens-medication-regimens-older-adults-during-and-after-acute-hospitalization
    May 19, 2021 - the medical service at a teaching hospital found that, on average, patients had two new medications started
  20. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/33615/psn-pdf
    June 01, 2005 - PP: When we started this work, the safety and delivery of care were often not viewed as science. … Eliot said, "And the end of all our exploring will be to arrive where we started and know the place … We think the CUSP tool really helps—once people get started, they really run with it.

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