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Picu Lfe Reporting Form

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PICU LfE Reporting Form

Reporting form for Learning from Excellence in the PICU

Page 1

Please fill out the following information

Email*

Patient Name*

Date of Event*

Date of Report*

Select date

PICU Team Member Reporting*

Description:This PICU LfE Reporting Form is designed to help healthcare professionals report and learn from excellence in the Pediatric Intensive Care Unit (PICU). By using this form, you can share positive experiences and identify areas for improvement, ultimately improving patient care and outcomes.

Learning from Excellence (LfE) is a positive approach to quality improvement that focuses on identifying and learning from instances of excellence in healthcare. This PICU LfE Reporting Form is a tool that can be used to facilitate this process in the PICU. By reporting positive experiences and identifying the factors that contributed to them, healthcare professionals can learn from these instances and apply these lessons to other areas of care. This form can also help to identify areas for improvement and guide quality improvement efforts. Overall, the PICU LfE Reporting Form is a valuable tool for promoting a culture of excellence and continuous improvement in the PICU.

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Evaluation Date*

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Patient Information*

Telehealth Services*

Consent to Telehealth Services*

I have read and understand the information provided above.

I have had the opportunity to ask questions and have had my questions answered to my satisfaction.

I voluntarily consent to participate in telehealth services.

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