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psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.341_slideshow.ppt
March 01, 2015 - PowerPoint Presentation
Spotlight
Two Wrongs Don't Make a Right (Kidney)
This presentation is based on the March 2015
AHRQ WebM&M Spotlight Case
See the full article at http://webmm.ahrq.gov
CME credit is available
Commentary by: John G. DeVine, MD, Professor of Orthopaedic Surgery, Medical College of Georgia
Ed…
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psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.104_slideshow.ppt
September 01, 2005 - Spotlight Case [MONTH] 2003
Spotlight Case September 2005
Double Trouble
Source and Credits
This presentation is based on the Sept. 2005
AHRQ WebM&M Spotlight Case
See the full article at http://webmm.ahrq.gov
CME credit is available through the Web site
Commentary by: Jerry H. Gurwitz, MD, University of…
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psnet.ahrq.gov/primer/rapid-response-systems
July 18, 2024 - Rapid Response Systems
Citation Text:
Rapid Response Systems. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2019.
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Format:
Google Scholar BibTeX EndNote X3 XML EndNote 7 XML Endnote tagged PubMedId RIS
…
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psnet.ahrq.gov/primer/checklists
September 15, 2024 - Checklists
Citation Text:
Checklists. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2019.
Copy Citation
Format:
Google Scholar BibTeX EndNote X3 XML EndNote 7 XML Endnote tagged PubMedId RIS
Download Citation…
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psnet.ahrq.gov/node/33588/psn-pdf
March 15, 2025 - Second Victims: Support for Clinicians Involved in Errors
and Adverse Events
March 15, 2025
Second Victims: Support for Clinicians Involved in Errors and Adverse Events. PSNet [internet]. 2019.
https://psnet.ahrq.gov/primer/second-victims-support-clinicians-involved-errors-and-adverse-events
PSNet primers are regu…
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psnet.ahrq.gov/perspective/telemedicine-and-patient-safety
September 01, 2016 - Telemedicine and Patient Safety
Stephen Agboola, MD, MPH, and Joseph Kvedar, MD | September 1, 2016
Also Read a Conversation
View more articles from the same authors.
Citation Text:
Agboola SO, Kvedar JC. Telemedicine and Patient Safety. PSNet [internet]. Rockv…
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psnet.ahrq.gov/perspective/conversation-reed-v-tuckson-md
September 01, 2016 - In Conversation With… Reed V. Tuckson, MD
September 1, 2016
Also Read an Essay
Citation Text:
In Conversation With… Reed V. Tuckson, MD. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2016…
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psnet.ahrq.gov/perspective/rapid-response-teams-lessons-early-experience
November 01, 2005 - Rapid Response Teams: Lessons from the Early Experience
William S. Krimsky, MD | November 1, 2005
Also Read a Conversation
View more articles from the same authors.
Citation Text:
Krimsky WS. Rapid Response Teams: Lessons from the Early Experience. PSNet [inter…
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psnet.ahrq.gov/node/866261/psn-pdf
July 10, 2024 - Approaches to Improving Patient Safety
Minimize the time and degree of both lithotomy and Trendelenburg
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psnet.ahrq.gov/web-mm/great-pretender-syphilis-still-stumping-healthcare-providers
January 07, 2022 - These steps comprise multiple approaches to improving safety as no single system can ensure that all
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psnet.ahrq.gov/sites/default/files/2025-01/spotlight_case_misdiagnosis_of_small_bowel_obstruction_-_slides_-_final.pptx
January 01, 2025 - appearance of free fluid was likely “the earliest indicator of an acute abdomen needing surgery.”13
APPROACHES
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psnet.ahrq.gov/web-mm/laceration-needed-proper-exam-not-x-ray
November 25, 2020 - Suggest possible approaches to mitigating errors caused by human factors.
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psnet.ahrq.gov/perspective/annual-perspective-topics-medication-safety
April 27, 2022 - indicate that machine learning classifiers can better predict adverse outcomes compared with individual approaches
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psnet.ahrq.gov/node/72516/psn-pdf
November 25, 2020 - will
discuss the specific errors highlighted by this case and identify individual and systems-based approaches
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psnet.ahrq.gov/perspective/conversation-richard-platt-md-msc
October 01, 2016 - RP : There are a couple approaches to consider.
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psnet.ahrq.gov/web-mm/do-you-want-everything-done-clarifying-code-status
March 27, 2024 - Determine systems approaches that facilitate advance care planning between the healthcare team, patient
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psnet.ahrq.gov/node/49546/psn-pdf
October 17, 2007 - Do Not Disturb!
October 1, 2007
Duffy DF, Cassel C. Do Not Disturb!. PSNet [internet]. 2007.
https://psnet.ahrq.gov/web-mm/do-not-disturb
Case Objectives
Define professionalism.
Discuss behaviors associated with lack of professionalism.
Outline steps one should take if a significant breach of professionalism is …
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psnet.ahrq.gov/node/837660/psn-pdf
July 08, 2022 - An Incomplete Anesthesia History Leads to Adverse
Outcomes
July 8, 2022
Bohringer C. An Incomplete Anesthesia History Leads to Adverse Outcomes. PSNet [internet]. 2022.
https://psnet.ahrq.gov/web-mm/incomplete-anesthesia-history-leads-adverse-outcomes
The Cases
Case 1: A 64-year-old man came in for a routine bron…
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psnet.ahrq.gov/node/49478/psn-pdf
April 01, 2005 - Compare and Contrast
April 1, 2005
Cho KC, Chertow GM. Compare and Contrast. PSNet [internet]. 2005.
https://psnet.ahrq.gov/web-mm/compare-and-contrast
Case Objectives
Define contrast nephropathy (CN)
List risk factors for CN
Implement pharmacologic strategies for CN prophylaxis
Follow an algorithm for CN risk …
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psnet.ahrq.gov/node/49675/psn-pdf
February 01, 2013 - Delay in Treatment: Failure to Contact Patient Leads to
Significant Complications
February 1, 2013
Shapiro DS. Delay in Treatment: Failure to Contact Patient Leads to Significant Complications. PSNet
[internet]. 2013.
https://psnet.ahrq.gov/web-mm/delay-treatment-failure-contact-patient-leads-significant-complicat…