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8041. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49719/psn-pdf
      September 01, 2014 - No BP During NIBP September 1, 2014 Görges M, Ansermino MJ. No BP During NIBP. PSNet [internet]. 2014. https://psnet.ahrq.gov/web-mm/no-bp-during-nibp The Case An otherwise healthy 49-year-old man with atrial fibrillation was scheduled for ablation in the catheterization laboratory under general endotracheal anes…

8042. An Untimely End Despite End-of-Life Care Planning | PSNet
      psnet.ahrq.gov/web-mm/untimely-end-despite-end-life-care-planning
      February 01, 2012 - An Untimely End Despite End-of-Life Care Planning Citation Text: Elia G, Barbour S, Anderson WG. An Untimely End Despite End-of-Life Care Planning. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2018. Copy Citation Format: …

8043. Anesthesia: A Weighty Issue | PSNet
      psnet.ahrq.gov/web-mm/anesthesia-weighty-issue
      September 01, 2006 - June 21, 2016 Can surveillance systems identify and avert adverse drug events? 

8044. Safety in Radiology | PSNet
      psnet.ahrq.gov/perspective/safety-radiology
      October 01, 2013 - February 14, 2024 Evaluation of accuracy of IHI Trigger Tool in identifying adverse drug … events: a prospective observational study.

8045. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49804/psn-pdf
      September 01, 2017 - Transfusion Thresholds in Gastrointestinal Bleeding September 1, 2017 Strate L, Swanson S. Transfusion Thresholds in Gastrointestinal Bleeding. PSNet [internet]. 2017. https://psnet.ahrq.gov/web-mm/transfusion-thresholds-gastrointestinal-bleeding Case Objectives Describe risk factors for poor outcome in patients w…

8046. Health Care Worker Presenteeism: A Challenge for Patient Safety | PSNet
      psnet.ahrq.gov/perspective/health-care-worker-presenteeism-challenge-patient-safety
      November 03, 2015 - Health Care Worker Presenteeism: A Challenge for Patient Safety Julia E. Szymczak, PhD | October 1, 2017  View more articles from the same authors. Citation Text: Szymczak JE. Health Care Worker Presenteeism: A Challenge for Patient Safety. PSNet [internet]. Rockvi…

8047. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/33689/psn-pdf
      October 01, 2009 - The Media: An Essential, If Sometimes Arbitrary, Promoter of Patient Safety October 1, 2009 Wachter R. The Media: An Essential, If Sometimes Arbitrary, Promoter of Patient Safety. PSNet [internet]. 2009. https://psnet.ahrq.gov/perspective/media-essential-if-sometimes-arbitrary-promoter-patient-safety Perspective …

8048. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/33659/psn-pdf
      October 01, 2007 - Making Just Culture a Reality: One Organization's Approach October 1, 2007 Page AH. Making Just Culture a Reality: One Organization's Approach. PSNet [internet]. 2007. https://psnet.ahrq.gov/perspective/making-just-culture-reality-one-organizations-approach Perspective We've all been there...something goes wrong,…

8049. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49536/psn-pdf
      May 01, 2007 - On the Other Hand May 1, 2007 Henneman EA. On the Other Hand. PSNet [internet]. 2007. https://psnet.ahrq.gov/web-mm/other-hand The Case A young woman with Takayasu's arteritis presented to the hospital with severe abdominal pain. The patient had been diagnosed with Takayasu's a decade earlier. The disease results…

8050. Care Transitions | PSNet
      psnet.ahrq.gov/perspective/care-transitions
      December 01, 2007 - Care Transitions Sunil Kripalani, MD, MSc | December 1, 2007  Also Read a Conversation View more articles from the same authors. Citation Text: Kripalani S. Care Transitions. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Depart…

8051. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/33594/psn-pdf
      November 18, 2021 - Debriefing for Clinical Learning November 18, 2021 Edwards JJ, Wexner S, Nichols A. Debriefing for Clinical Learning. PSNet [internet]. 2021. https://psnet.ahrq.gov/primer/debriefing-clinical-learning Updated in September 2021. Originally published in December 2011 by researchers at the University of California, S…

8052. In Conversation With… Gordon Schiff, MD | PSNet
      psnet.ahrq.gov/perspective/conversation-gordon-schiff-md
      February 26, 2025 - In Conversation With… Gordon Schiff, MD July 1, 2018  Citation Text: In Conversation With… Gordon Schiff, MD. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2018. Copy Citation Format: …

8053. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/33861/psn-pdf
      July 01, 2018 - In Conversation With… Gordon Schiff, MD July 1, 2018 In Conversation With… Gordon Schiff, MD. PSNet [internet]. 2018. https://psnet.ahrq.gov/perspective/conversation-gordon-schiff-md Editor's note: Dr. Schiff is Associate Director of Brigham and Women's Center for Patient Safety Research and Practice, Associate Pr…

8054. Strategies to Improve Organizational Health Literacy. | PSNet
      psnet.ahrq.gov/primer/strategies-improve-organizational-health-literacy
      August 30, 2023 - Strategies to Improve Organizational Health Literacy. Citation Text: Seidel E, Cortes T, Chong C. Strategies to Improve Organizational Health Literacy.. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2023. Copy Citation Format:…

8055. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49508/psn-pdf
      January 01, 2007 - Language Barrier April 1, 2006 Flores G. Language Barrier. PSNet [internet]. 2006. https://psnet.ahrq.gov/web-mm/language-barrier The Case A previously healthy 10-month-old girl was taken to a pediatrician's office by her monolingual Spanish- speaking parents when they noted that their daughter had generalized we…

8056. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49693/psn-pdf
      October 01, 2013 - It's Sarah, Not Stephen! October 1, 2013 Sarkar U. It's Sarah, Not Stephen!. PSNet [internet]. 2013. https://psnet.ahrq.gov/web-mm/its-sarah-not-stephen Case Objectives Define and distinguish the terms gender identity, gender expression, and gender variance. Delineate patient safety issues associated with transge…

8057. Spotlight Nstemi (pdf file)
      psnet.ahrq.gov/sites/default/files/2020-07/spotlight_nstemi.pdf
      January 01, 2020 - Spotlight The NSTEMI Curbside Consultation Source and Credits • This presentation is based on the July 2020 AHRQ WebM&M Spotlight Case o See the full article at https://psnet.ahrq.gov/webmm o CME credit is available o Commentary by: Amparo C. Villablanca, MD and Gordon Wong, MD MBA o AHRQ WebM&M Editors …

8058. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/849661/psn-pdf
      June 28, 2023 - Hurried Team Huddle and Poor Communication: Unsafe Practice During Anesthesia for Emergency Cesarean Delivery June 28, 2023 Curtin A, Schloemerkemper N. Hurried Team Huddle and Poor Communication: Unsafe Practice During Anesthesia for Emergency Cesarean Delivery. PSNet [internet]. 2023. https://psnet.ahrq.gov/web…

8059. Health Care Data Science for Quality Improvement and Patient Safety | PSNet
      psnet.ahrq.gov/perspective/health-care-data-science-quality-improvement-and-patient-safety
      October 01, 2016 - Health Care Data Science for Quality Improvement and Patient Safety Alvin Rajkomar, MD | October 1, 2016  Also Read a Conversation View more articles from the same authors. Citation Text: Rajkomar A. Health Care Data Science for Quality Improvement and Patient S…

8060. Weighing In on Surgical Safety | PSNet
      psnet.ahrq.gov/web-mm/weighing-surgical-safety
      August 04, 2021 - August 4, 2021 Risk reduction for adverse drug events through sequential implementation