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1961. Uterine Artery Injury during Cesarean Delivery Leads to Cardiac Arrests and Emergency Hysterectomy | PSNet
      psnet.ahrq.gov/web-mm/uterine-artery-injury-during-cesarean-delivery-leads-cardiac-arrests-and-emergency
      September 30, 2020 - SPOTLIGHT CASE Uterine Artery Injury during Cesarean Delivery Leads to Cardiac Arrests and Emergency Hysterectomy Citation Text: Lopez C, Tache V. Uterine Artery Injury during Cesarean Delivery Leads to Cardiac Arrests and Emergency Hysterectomy. PSNet [internet]. Rockville (MD): Agency for Healt…

1962. Where Does Risk-Adjusted Mortality Fit Into a Safety Measurement Program? | PSNet
      psnet.ahrq.gov/perspective/where-does-risk-adjusted-mortality-fit-safety-measurement-program
      March 01, 2015 - Where Does Risk-Adjusted Mortality Fit Into a Safety Measurement Program? Ian Scott, MBBS, MHA, MEd | March 1, 2015  Also Read a Conversation View more articles from the same authors. Citation Text: Scott IA. Where Does Risk-Adjusted Mortality Fit Into a Safety …

1963. A Tale of Two Falls | PSNet
      psnet.ahrq.gov/web-mm/tale-two-falls
      March 27, 2024 - A Tale of Two Falls Citation Text: Jackson V, Satake A. A Tale of Two Falls. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2024. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML EndNote 7 XML Endnote tagged P…

1964. The Role of the National Quality Forum (NQF) in the Quest for Transparency in U.S. Hospitals' Patient Safety Performance | PSNet
      psnet.ahrq.gov/perspective/role-national-quality-forum-nqf-quest-transparency-us-hospitals-patient-safety
      April 01, 2010 - July 23, 2010 Impact of health information technology on detection of potential adverse … drug events at the ordering stage.

1965. Open wider: Failure to use an interpreter results in fractured teeth and hypoxia during a simple elective operation. | PSNet
      psnet.ahrq.gov/web-mm/open-wider-failure-use-interpreter-results-fractured-teeth-and-hypoxia-during-simple
      January 29, 2021 - Open wider: Failure to use an interpreter results in fractured teeth and hypoxia during a simple elective operation. Citation Text: Bohringer C, Godoy L. Open wider: Failure to use an interpreter results in fractured teeth and hypoxia during a simple elective operation.. PSNet [internet]. Rockville (MD): Ag…

1966. The Case for Patient Flow Management | PSNet
      psnet.ahrq.gov/web-mm/case-patient-flow-management
      February 23, 2019 - The Case for Patient Flow Management Citation Text: Litvak E, Bernheim SA. The Case for Patient Flow Management. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2011. Copy Citation Format: Google Scholar BibTeX EndNote X…

1967. The Wrongful Resuscitation | PSNet
      psnet.ahrq.gov/web-mm/wrongful-resuscitation
      October 12, 2012 - The Wrongful Resuscitation Citation Text: Teno JM. The Wrongful Resuscitation. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2008. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML EndNote 7 XML Endnote tagged…

1968. Walking Out of a Hospital After Attempted Suicide | PSNet
      psnet.ahrq.gov/web-mm/walking-out-hospital-after-attempted-suicide
      March 29, 2023 - Walking Out of a Hospital After Attempted Suicide Citation Text: Bourgeois JA, Xiong G. Walking Out of a Hospital After Attempted Suicide. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2023. Copy Citation Format: Googl…

1969. Implementation of a medication reconciliation risk stratification tool integrated within an electronic health record: a case series of three academic medical centers. | PSNet
      psnet.ahrq.gov/innovation/implementation-medication-reconciliation-risk-stratification-tool-integrated-within
      April 12, 2023 - EMERGING INNOVATIONS Implementation of a medication reconciliation risk stratification tool integrated within an electronic health record: a case series of three academic medical centers. Citation Text: Chu ES, El-Kareh R, Biondo A, et al. Implementation of a medication reconciliation risk stratif…

1970. Inflicting Confusion | PSNet
      psnet.ahrq.gov/web-mm/inflicting-confusion
      August 04, 2021 - Inflicting Confusion Citation Text: Scott FI, Lichtenstein GR. Inflicting Confusion. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2015. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML EndNote 7 XML Endnote …

1971. Supervision and Entrustment in Clinical Training: Protecting Patients, Protecting Trainees | PSNet
      psnet.ahrq.gov/web-mm/supervision-and-entrustment-clinical-training-protecting-patients-protecting-trainees
      February 22, 2017 - SPOTLIGHT CASE Supervision and Entrustment in Clinical Training: Protecting Patients, Protecting Trainees Citation Text: Cate O ten-. Supervision and Entrustment in Clinical Training: Protecting Patients, Protecting Trainees. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Qu…

1972. The Forgotten Drip | PSNet
      psnet.ahrq.gov/web-mm/forgotten-drip
      April 01, 2014 - The Forgotten Drip Citation Text: Josephson AS. The Forgotten Drip. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2008. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML EndNote 7 XML Endnote tagged PubMedId R…

1973. Implementation of Patient Safety Projects | PSNet
      psnet.ahrq.gov/curated-library/implementation-patient-safety-projects
      April 17, 2025 - Breadcrumb Home The PSNet Collection Curated Libraries Subscribed Implementation of Patient Safety Projects  Download  Share Facebook Twitter Linkedin Copy URL Subscribe Created By: Lorri Zipperer, Cybraria…

1974. EMS Patient Safety in the Field | PSNet
      psnet.ahrq.gov/perspective/ems-patient-safety-field
      July 28, 2021 - EMS Patient Safety in the Field July 28, 2021  Also Read the Conversation View more articles from the same authors. Citation Text: Augustine JJ, Fitall E, Hall KK, et al. EMS Patient Safety in the Field. PSNet [internet]. Rockville (MD): Agency for Healthcare Re…

1975. Management of CSF Leaks After Elective Spine Surgery: Routine Laminectomy Leads to Fatal Discitis and Sepsis | PSNet
      psnet.ahrq.gov/web-mm/management-csf-leaks-after-elective-spine-surgery-routine-laminectomy-leads-fatal-discitis
      March 09, 2022 - SPOTLIGHT CASE Management of CSF Leaks After Elective Spine Surgery: Routine Laminectomy Leads to Fatal Discitis and Sepsis Citation Text: Castillo JA, Price R, Kim KD. Management of CSF Leaks After Elective Spine Surgery: Routine Laminectomy Leads to Fatal Discitis and Sepsis. PSNet [internet]. …

1976. Beyond the Pandemic: Creating Total Systems Safety | PSNet
      psnet.ahrq.gov/perspective/beyond-pandemic-creating-total-systems-safety
      August 30, 2023 - measures associated with healthcare-acquired conditions, such as central-line bloodstream infections and adverse … drug events.

1977. In Conversation with... Patricia McGaffigan about Beyond the Pandemic: Creating Total Systems Safety | PSNet
      psnet.ahrq.gov/perspective/conversation-patricia-mcgaffigan-about-beyond-pandemic-creating-total-systems-safety
      August 30, 2023 - measures associated with healthcare-acquired conditions, such as central-line bloodstream infections and adverse … drug events.

1978. Periodic Issue | PSNet
      psnet.ahrq.gov/periodic-issue/periodic-issue-469
      December 31, 2024 - January 8, 2025 Weekly Issue PSNet highlights the latest patient safety literature, news, and expert commentary, including Weekly Updates, WebM&M, and Perspectives on Safety. The current issue highlights what's new this week in patient safety literature, news, conferences, reports…

1979. In Conversation with Elizabeth Salisbury-Afshar about Harm Reduction Strategies to Improve Safety for People Who Use Substances | PSNet
      psnet.ahrq.gov/perspective/conversation-elizabeth-salisbury-afshar-about-harm-reduction-strategies-improve-safety
      October 30, 2024 - In Conversation with Elizabeth Salisbury-Afshar about Harm Reduction Strategies to Improve Safety for People Who Use Substances Elizabeth Salisbury-Afshar, MD, MPH, Bryan Gale, MA, Sarah Mossburg, Phd | October 30, 2024  Also Read the Essay View more articles from the same auth…

1980. Harm Reduction Strategies to Improve Safety for People Who Use Substances | PSNet
      psnet.ahrq.gov/perspective/harm-reduction-strategies-improve-safety-people-who-use-substances
      October 30, 2024 - Harm Reduction Strategies to Improve Safety for People Who Use Substances Elizabeth Salisbury-Afshar, MD, MPH, Bryan Gale, MA, Sarah Mossburg, Phd | October 30, 2024  Also Read the Conversation View more articles from the same authors. Citation Text: Salisbury-…