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psnet.ahrq.gov/node/45892/psn-pdf
October 31, 2017 - Relationship between state malpractice environment and
quality of health care in the United States.
October 31, 2017
Bilimoria KY, Chung JW, Minami CA, et al. Relationship Between State Malpractice Environment and
Quality of Health Care in the United States. Jt Comm J Qual Patient Saf. 2017;43(5):241-250.
doi:10.1…
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psnet.ahrq.gov/node/45527/psn-pdf
January 23, 2017 - Do work condition interventions affect quality and errors
in primary care? Results from the Healthy Work Place
Study.
January 23, 2017
Linzer M, Poplau S, Brown RL, et al. Do Work Condition Interventions Affect Quality and Errors in Primary
Care? Results from the Healthy Work Place Study. J Gen Intern Med. 2017;32…
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psnet.ahrq.gov/node/837748/psn-pdf
August 05, 2022 - not only be able to obtain an accurate
medication history but could also have updated the PAML by assessing
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psnet.ahrq.gov/node/853902/psn-pdf
September 27, 2023 - A Missed Bowel Perforation - the Importance of
Diagnostic Reasoning
September 27, 2023
Timbag L, Sinigayan VR, Molla M. A Missed Bowel Perforation - the Importance of Diagnostic Reasoning.
PSNet [internet]. 2023.
https://psnet.ahrq.gov/web-mm/missed-bowel-perforation-importance-diagnostic-reasoning
Disclosure of …
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psnet.ahrq.gov/web-mm/fatal-patient-controlled-analgesia-pca-opioid-induced-respiratory-depression
May 26, 2021 - SPOTLIGHT CASE
Fatal Patient-Controlled Analgesia (PCA) Opioid-Induced Respiratory Depression
Citation Text:
Fazio S, Firestone R. Fatal Patient-Controlled Analgesia (PCA) Opioid-Induced Respiratory Depression. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Depar…
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psnet.ahrq.gov/web-mm/missed-bowel-perforation-importance-diagnostic-reasoning
January 29, 2021 - SPOTLIGHT CASE
A Missed Bowel Perforation - the Importance of Diagnostic Reasoning
Citation Text:
Timbag L, Sinigayan VR, Molla M. A Missed Bowel Perforation - the Importance of Diagnostic Reasoning. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of He…
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psnet.ahrq.gov/web-mm/under-pressure-delayed-diagnosis-compartment-syndrome-after-lower-leg-fracture
November 25, 2020 - Under Pressure: Delayed Diagnosis of Compartment Syndrome after Lower Leg Fracture.
Citation Text:
Barnes DK, Randhawa SDS, Fitzpatrick EP. Under Pressure: Delayed Diagnosis of Compartment Syndrome after Lower Leg Fracture.. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US De…
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psnet.ahrq.gov/node/49735/psn-pdf
June 01, 2015 - Anchoring Bias With Critical Implications
June 1, 2015
Etchells E. Anchoring Bias With Critical Implications. PSNet [internet]. 2015.
https://psnet.ahrq.gov/web-mm/anchoring-bias-critical-implications
Case Objectives
Appreciate that diagnostic errors are common in primary and ambulatory care.
Define premature clo…
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psnet.ahrq.gov/print/pdf/node/866419
March 27, 2024 - PSNet
Curated Library
AHRQ: Agency for Healthcare Research and Quality
Artificial Intelligence: System-Level
Considerations
Curated Library
Foundations
Generative artificial intelligence, patient safety and healthcare quality: a review.
Howell MD. BMJ Qual Saf. 2024;33:748-754.
Artificial intelligence (AI) is…
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psnet.ahrq.gov/web-mm/safety-and-quality-long-term-care
January 01, 2016 - SPOTLIGHT CASE
The Safety and Quality of Long Term Care
Citation Text:
Vogelsmeier AA. The Safety and Quality of Long Term Care. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2011.
Copy Citation
Format:
Goog…
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psnet.ahrq.gov/issue/effect-increased-inpatient-attending-physician-supervision-medical-errors-patient-safety-and
December 07, 2011 - Study
Emerging Classic
Effect of increased inpatient attending physician supervision on medical errors, patient safety, and resident education: a randomized clinical trial.
Citation Text:
Finn KM, Metlay JP, Chang Y, et al. Effect of Increased Inpatient Attendin…
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psnet.ahrq.gov/issue/assessment-safety-discharging-select-patients-directly-home-intensive-care-unit-multicenter
May 20, 2020 - Study
Assessment of the safety of discharging select patients directly home from the intensive care unit: a multicenter population-based cohort study.
Citation Text:
Stelfox HT, Soo A, Niven DJ, et al. Assessment of the Safety of Discharging Select Patients Directly Home From the Intensi…
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psnet.ahrq.gov/issue/primary-care-physicians-willingness-disclose-oncology-errors-involving-multiple-providers
July 28, 2014 - Study
Primary care physicians' willingness to disclose oncology errors involving multiple providers to patients.
Citation Text:
Mazor KM, Roblin DW, Greene SM, et al. Primary care physicians' willingness to disclose oncology errors involving multiple providers to patients. BMJ Qual Saf. …
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psnet.ahrq.gov/issue/patients-and-families-teachers-mixed-methods-assessment-collaborative-learning-model-medical
July 12, 2017 - Study
Patients and families as teachers: a mixed methods assessment of a collaborative learning model for medical error disclosure and prevention.
Citation Text:
Langer T, Martinez W, Browning DM, et al. Patients and families as teachers: a mixed methods assessment of a collaborative lea…
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psnet.ahrq.gov/issue/quality-hospital-work-environments-and-missed-nursing-care-linked-heart-failure-readmissions
September 09, 2020 - Study
The quality of hospital work environments and missed nursing care is linked to heart failure readmissions: a cross-sectional study of US hospitals.
Citation Text:
Carthon MB, Lasater KB, Sloane DM, et al. The quality of hospital work environments and missed nursing care is linked t…
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psnet.ahrq.gov/issue/speaking-about-traditional-and-professionalism-related-patient-safety-threats-national-survey
November 20, 2015 - Study
Classic
Speaking up about traditional and professionalism-related patient safety threats: a national survey of interns and residents.
Citation Text:
Martinez W, Lehmann LS, Thomas EJ, et al. Speaking up about traditional and professionalism-related patient…
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psnet.ahrq.gov/innovation/clinician-collaboration-improve-clinical-decision-support-clickbusters-initiative
October 21, 2020 - EMERGING INNOVATIONS
Clinician collaboration to improve clinical decision support: the Clickbusters initiative.
Citation Text:
Clinician collaboration to improve clinical decision support: the Clickbusters initiative. Mc Coy AB, Russo EM, Johnson KB, et al. Clinician collaboration to improve clini…
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psnet.ahrq.gov/node/38064/psn-pdf
February 23, 2009 - same-system-different-outcomes-comparing-transitions-two-paper-based-systems-same
https://psnet.ahrq.gov/primer/computerized-provider-order-entry
https://psnet.ahrq.gov/issue/assessing-anticipated-consequences-computer-based-provider-order-entry-three-community
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psnet.ahrq.gov/node/39074/psn-pdf
November 04, 2009 - and
validity testing, early feedback suggested its usability as a comprehensive and quick method for assessing
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psnet.ahrq.gov/node/47314/psn-pdf
November 24, 2018 - measuring-communication-surgical-icu-better-communication-equals-better-care
https://psnet.ahrq.gov/perspective/assessing-safety-electronic-health-records-what-have-we-learned