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Showing results for "system".

341. Quantitative and Qualitative Analysis of Medication Errors: The New York Experience (pdf file)
     ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol1/Duthie.pdf
     January 01, 2004 - (NYPORTS) mandatory adverse event reporting system to include the reporting of medication errors. … fixes instead of punitive fixes or inappropriate/incomplete system fixes. … and not the system. … To err is human: building a safer health system. … Albany (NY): New York Patient Occurrence Reporting and Tracking System. c2000–2002.

342. Facilitator Notes | Agency for Healthcare Research and Quality
     ce.effectivehealthcare.ahrq.gov/hai/cusp/modules/apply/ac-cusp.html
     December 01, 2012 - Engineering System Design to Support Behavior Choices Slide 11. … Human error is a product of both system design and behavioral choices. … System design. Behavioral choices. Learning systems. Accountability and justice. … Transparency is also vital in addressing system factors that may contribute to harm. … Explain how system design affects system results.

343. Sustainability: Learning From Defects: Facilitator Notes | Agency for Healthcare Research and Quality
     ce.effectivehealthcare.ahrq.gov/hai/tools/surgery/modules/sustainability/learn-from-defects-fac-notes.html
     December 01, 2017 - It doesn’t protect future patients or strengthen the system. … Slide 7: Individual Mistake or System Failure? … Say: Is a defect an individual mistake or a system failing? … Say: Many small defects often contribute to big system flaws. … Patient safety is a property of the system, not just individuals.

344. National Academy of Medicine (NAM) Reports | Agency for Healthcare Research and Quality
     ce.effectivehealthcare.ahrq.gov/patient-safety/reports/national-academy-medicine.html
     February 01, 2018 - (2000) and Crossing the Quality Chasm: A New Health System for the 21st Century (2001). … Key Capabilities of an Electronic Health Record System this 2003 report sets out 8 core care delivery … Crossing the Quality Chasm: A New Health System for the 21st Century , a 2001 report, makes an urgent … call for fundamental change to the American health care system and provides overarching principles for … To Err is Human: Building A Safer Health System , this 1999/2000 report lays out a comprehensive strategy

345. 3 Key Takeaways from the July 2018 Webcast: New SOPS HIT Patient Safety Supplemental Items for Hospitals (pdf file)
     ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/sops/quality-patient-safety/patientsafetyculture/hospital/healthitwebinar/sops-hit-webcast-keytakeaways.pdf
     August 01, 2018 - hospital providers and staff to address the following topic areas: Electronic Health Record (EHR) System … Training EHR System Support & Communication EHR Patient Safety & Quality Issues EHR & Workflow/Work … Process Overall EHR System Rating 2 What did we learn from the pilot test? … In the past 3 months... 66% discovered incomplete information in their EHR system 61% discovered

346. Optimizing Health and Function as We Age: Roundtable Report (pdf file)
     ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/ncepcr/tools/healthy-aging-roundtable.pdf
     September 08, 2022 - .........................................................4 Developing a Truly Person-Centered Care System … Bierman highlighted the vital need for disruption and innovation in a system not designed to foster … In a system where an estimated 25 percent of all spending is wasted, 2 opportunities exist to capture … Waste in the US Health Care System Estimated Costs and Potential for Savings. … would look like; hearing person and community voices; hearing clinician, practice, and health system

347. The CAHPS Database (pdf file)
     ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/cahps/cahps-database/about/CAHPS-Database-Brief_01_2014.pdf
     January 01, 2014 - The CAHPS Database includes an Online Reporting System displaying aggregated data to facilitate comparisons … The CAHPS Online Reporting System is a Web-based platform for viewing Health Plan and Clinician … The reporting system consists of two major components:  a public site available to anyone with … Database are provided access to a secure, password-protected area of the CAHPS Online Reporting System … CAHPS Health Plan Survey Component CAHPS Clinician & Group Survey Component CAHPS Online Reporting System

348. Military Hospitals Employ AHRQ Hospital Survey on Patient Safety Culture | Agency for Healthcare Research and Quality
     ce.effectivehealthcare.ahrq.gov/news/newsroom/case-studies/cquips0703.html
     October 01, 2014 - attitudes and beliefs about patient safety, medical errors, and event reporting in Military Health System … discussion regarding the identification of safety issues specific to each unique environment in our system … (Team Strategies and Tools to Enhance Performance and Patient Safety) is an evidence-based teamwork system … Secondly, the Patient Safety Reporting System will provide standardized event and near-miss capturing … The mission of the DoD Patient Safety Program is to lead the Military Health System to a culture of safety

349. Using the CAHPS Database to Compare, Report, and Improve Organizational Performance (Webcast) | Agency for Healthcare Research and Quality
     ce.effectivehealthcare.ahrq.gov/cahps/news-and-events/events/20140115_DB/webcast_01_15_14_cg.html
     July 01, 2018 - The Webcast featured: A demonstration of the Online Reporting System , a Web-based platform for viewing … Current examples of how organizations use the CAHPS Database and the Online Reporting System to compare … Director, Research and Evaluation University Health System Consortium Presentation slides ( … Karls, MBA Director, Consumer Performance Metrics and Improvement University of Michigan Health System … site Read CAHPS Database Overview Brief ( PDF [126.68 KB] )   CAHPS Database Online Reporting System

350. Understand the Science of Safety for Perinatal Safety: Facilitator Guide | Agency for Healthcare Research and Quality
     ce.effectivehealthcare.ahrq.gov/patient-safety/settings/labor-delivery/perinatal-care/modules/teamwork/understand-sci-fac-guide.html
     July 01, 2023 - Explain how system design affects system results. … Being cognizant of the system design and how it contributes to the results that it delivers will help … Slide 6: System-Level Factors Affect Safety Say: As the illustration shows, at any given time, … there are several system factors that simultaneously influence unit culture and patient safety. … Slide 7: System-Level Factors Can Predict Performance Say: When nurse-to-patient ratios exceed

351. AHRQ Safety Program for Perinatal Care: Monitoring for Perinatal Safety: Under the Science of Safety
     ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/perinatal-care/modules/teamwork/understand/understand-science-safety.pptx
     May 01, 2017 - AHRQ Safety Program for Perinatal Care Science of Safety Health Care Defects In the U.S. health care system … patient 4 AHRQ Safety Program for Perinatal Care Science of Safety 4 The Science of Safety Every system … Factors Affect Safety6 6 AHRQ Safety Program for Perinatal Care Science of Safety 6 System-Level … Factors Can Predict Performance Examples of Impact of System-Level Factors System Factor Effect Nurse-to-patient … To err is human: building a safer health system. Washington, DC: National Academy Press; 1999.

352. Health Literacy and Patient and Family Engagement: Strategic Tools to Prevent CAUTI | Agency for Healthcare Research and Quality
     ce.effectivehealthcare.ahrq.gov/hai/cauti-tools/archived-webinars/health-literacy-slides.html
     December 01, 2017 - Barriers to Health Literacy: Increasingly Complex Health System    35 Years Ago Today Treatment … Barriers to Health Literacy Increasingly Complex Healthcare System Hospitalists, not your family … Slide 22 System Approaches: Assess All Patients for Literacy Key Strategies: Initial Patient … Social history/support system Watch for subtle clues that they don’t read well Slide 23 System … Partnering with Patients and Families to Design a Patient- and Family-Centered Health Care System: A  

353. Table 7B.1 (pdf file)
     ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/acute/chipra-143-section-7b.pdf
     February 02, 2018 - GAPPS study analytic sample (n= 3,442) Chronic Condition Indicators n (%) AE rate P-Value 0 body system … 1,935 (56.2%) 0.07 Reference 1 body system 1,067 (31.0%) 0.12 <0.001 2 body systems 315 (9.2%) 0.25 … analytic sample (n= 3,442) Chronic Condition Indicators (CCI) RRa (95% CIb) P-Value 0 body system

354. Science of Safety and Identifying Defects in Care of Mechanically Ventilated Patients: Slide Presentation | Agency for Healthcare Research and Quality
     ce.effectivehealthcare.ahrq.gov/hai/tools/mvp/modules/cusp/science-of-safety-slides.html
     February 01, 2017 - Identify how system factors and design affect patient outcomes. … Slide 6: System Factors Impact Safety 2 Image: A series of small circles around a larger circle captioned … Slide 7: Apply System Lenses Engage staff by asking them to apply systems lenses with the following … system is perfectly designed to achieve its end results. … Slide 11: Safety Is a Property of the System Safety Is a Property of the System http://www.ahrq.gov

355. Facilitator Guide: Learning From Defects Through Sensemaking (doc file)
     ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/surgery/modules/implementation/imp_learn_from_defects_facnotes.docx
     December 01, 2017 - Slide 6 Individual Mistake or System Failing? … While no system is perfect, we build redundancies into the care delivery system to compensate for minor … Slide 16 System Factors Impact Safety SAY: Each level of the health care delivery system matters. … Because emergencies strain any system. … The focus is on the system, not on the individuals.

356. Building, Implementing, and Troubleshooting an Automatic Referral for Cardiac Rehabilitation
     ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/takeheart/training/implementing-automatic-referral-slides.pptx
     December 31, 2022 - help you understand the steps required for designing, testing, implementing, and troubleshooting an AR system … in your hospital/health system. … Guide (RG) Original Training Modules #5: Building and Implementing a Successful Automatic Referral System … #7: Troubleshooting Your Automatic Referral System Other Related Webinars Cerner Q&A Epic Q&A (Please … Is your new AR design aligned with how providers are using the system?

357. Introducing electronic screening tools for developmental delay and autism into pediatric primary care: Special Innovation Feature (pdf file)
     ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/policymakers/chipra/demoeval/what-we-learned/pa-specialinnovation.pdf
     August 01, 2015 - Sites gradually transitioned to the new system between 2011 and 2013, so the two different methods … Providers reported that the fully- automated electronic system minimized the amount of time that they … The electronic system also supports billing during the screening encounter and the ability to review … Families reported that the electronic system was easy to use and it allowed them to feel more involved … with 12 practices before going system- wide.

358. Patient Safety Learning Pilot: Narratives from the Frontlines (pdf file)
     ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety-2/vol1/Advances-Kellie_30.pdf
     April 21, 2008 - The prototype included an event reporting system (the Medical Events Reporting System - Total HealthSystem … MERS-TH is a unique reporting system, since it is also a comprehensive error management system. … • Computerized charting system. … Trending and investigation reports are produced through the Midas system. … System changes are made as issues are identified.”

359. 2022 National Healthcare Quality and Disparities Report Data Sources (pdf file)
     ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/research/findings/nhqrdr/2022qdr-datasources.pdf
     December 01, 2022 - National HIV Surveillance System (NHSS) Sponsor U.S. … National Tuberculosis Surveillance System (NTSS) Sponsor U.S. … Resource and Patient Management System (RPMS) and National Patient Information Reporting System (NPIRS … System. … surveillance system designed to replace the Medicare Patient Safety Monitoring System (MPSMS) for measurement

360. Understand the Science of Safety for Perinatal Safety | Agency for Healthcare Research and Quality
     ce.effectivehealthcare.ahrq.gov/patient-safety/settings/labor-delivery/perinatal-care/modules/teamwork/understand-sci-slides.html
     July 01, 2023 - Explain how system design affects system results. … Slide 5: The Science of Safety Every system is perfectly designed to achieve its end results. … Slide 6: System-Level Factors Affect Safety 6 Image: Concentric circles show the layered impact of … Slide 7: System-Level Factors Can Predict Performance Examples of Impact of System-Level Factors … To err is human: building a safer health system. Washington, DC: National Academy Press; 1999.