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psnet.ahrq.gov/primer/deprescribing-patient-safety-strategy
December 15, 2024 - Deprescribing as a Patient Safety Strategy
Citation Text:
Takhar S, Nelson N. Deprescribing as a Patient Safety Strategy. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2021.
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psnet.ahrq.gov/node/33736/psn-pdf
September 01, 2012 - In Conversation With… Jack Needleman, PhD
September 1, 2012
In Conversation With… Jack Needleman, PhD. PSNet [internet]. 2012.
https://psnet.ahrq.gov/perspective/conversation-jack-needleman-phd
Editor's note: Jack Needleman, PhD, is a Professor in the Department of Health Policy and Management
at UCLA School of P…
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psnet.ahrq.gov/node/33806/psn-pdf
April 01, 2016 - In Conversation With… Amy J. Starmer, MD, MPH
April 1, 2016
In Conversation With… Amy J. Starmer, MD, MPH. PSNet [internet]. 2016.
https://psnet.ahrq.gov/perspective/conversation-amy-j-starmer-md-mph
Editor's note: Dr. Starmer is Director of Primary Care Quality Improvement and Assistant Professor of
Pediatrics a…
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psnet.ahrq.gov/web-mm/july-syndrome
July 01, 2011 - July Syndrome
Citation Text:
Young JQ. July Syndrome. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2016.
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Format:
Google Scholar BibTeX EndNote X3 XML EndNote 7 XML Endnote tagged PubMedId RIS
D…
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psnet.ahrq.gov/sites/default/files/2024-05/spotlight_case_stable_airway_slides_final.pptx
January 01, 2024 - Spotlight
Spotlight
A Stable Airway? Fatal Airway Occlusion After Inadequate Post-Tracheostomy Care
1
Source and Credits
This presentation is based on the May 2024 AHRQ WebM&M Spotlight Case
See the full article at https://psnet.ahrq.gov/webmm
CME credit is available
Commentary by: Elizabeth Gould, NP-C, COR…
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psnet.ahrq.gov/web-mm/hyperbilirubinemia-refractory-phototherapy
March 01, 2006 - Hyperbilirubinemia Refractory to Phototherapy
Citation Text:
Bhutani VK, Wong RJ. Hyperbilirubinemia Refractory to Phototherapy. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2017.
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Format:
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psnet.ahrq.gov/web-mm/another-fall
June 01, 2010 - SPOTLIGHT CASE
Another Fall
Citation Text:
Bogardus SG. Another Fall. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2003.
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Format:
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psnet.ahrq.gov/node/49392/psn-pdf
April 01, 2003 - Another Fall
April 1, 2003
Bogardus SG. Another Fall. PSNet [internet]. 2003.
https://psnet.ahrq.gov/web-mm/another-fall
Case Objectives
List risk factors for falls in hospitalized patients
Understand appropriate use of restraints
Identify system issues contributing to falls in hospitalized patients
Case & Comm…
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psnet.ahrq.gov/web-mm/delayed-diagnosis-setting-virtual-care-remembering-physical-examination
April 29, 2020 - Delayed Diagnosis in the Setting of Virtual Care: Remembering the Physical Examination
Citation Text:
Valdes W, Utter GH. Delayed Diagnosis in the Setting of Virtual Care: Remembering the Physical Examination. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Hea…
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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…
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psnet.ahrq.gov/node/865309/psn-pdf
May 29, 2024 - A Stable Airway? Fatal Airway Occlusion After Inadequate
Post-Tracheostomy Care
May 29, 2024
Gould E, Craddock K, Le Tellier T, et al. A Stable Airway? Fatal Airway Occlusion After Inadequate Post-
Tracheostomy Care. PSNet [internet]. 2024.
https://psnet.ahrq.gov/web-mm/stable-airway-fatal-airway-occlusion-after-i…
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psnet.ahrq.gov/node/49750/psn-pdf
January 01, 2016 - A Room Without Orders
January 1, 2016
Vogelsmeier A, Despins L. A Room Without Orders. PSNet [internet]. 2016.
https://psnet.ahrq.gov/web-mm/room-without-orders
Case Objectives
Review a common process for planned direct hospital admissions.
Describe challenges of prioritizing day-to-day patient care activities wi…
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psnet.ahrq.gov/node/34645/psn-pdf
December 23, 2008 - How do patients want physicians to handle mistakes? A
survey of internal medicine patients in an academic
setting.
December 23, 2008
Witman AB, Park DM, Hardin SB. How do patients want physicians to handle mistakes? A survey of
internal medicine patients in an academic setting. Arch Intern Med. 1996;156(22):2565-9…
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psnet.ahrq.gov/node/41868/psn-pdf
January 07, 2015 - Changes in end-user satisfaction with computerized
provider order entry over time among nurses and
providers in intensive care units.
January 7, 2015
Hoonakker P, Carayon P, Brown RL, et al. Changes in end-user satisfaction with Computerized Provider
Order Entry over time among nurses and providers in intensive ca…
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psnet.ahrq.gov/node/45727/psn-pdf
August 03, 2017 - Evidence-based guidelines for fatigue risk management in
EMS: formulating research questions and selecting
outcomes.
August 3, 2017
Patterson D, Higgins S, Lang ES, et al. Evidence-Based Guidelines for Fatigue Risk Management in EMS:
Formulating Research Questions and Selecting Outcomes. Prehosp Emerg Care. 2017;2…
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psnet.ahrq.gov/node/73867/psn-pdf
September 22, 2021 - A dynamic risk management approach for reducing harm
from invasive bedside procedures performed during
residency.
September 22, 2021
Warm E, Ahmad Y, Kinnear B, et al. A dynamic risk management approach for reducing harm from
invasive bedside procedures performed during residency. Acad Med. 2021;96(9):1268-1275.
…
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psnet.ahrq.gov/node/840487/psn-pdf
November 30, 2022 - Interprofessional team collaboration and work
environment health in 68 US intensive care units.
November 30, 2022
Pun BT, Jun J, Tan A, et al. Interprofessional team collaboration and work environment health in 68 US
intensive care units. Am J Crit Care. 2022;31(6):443-451. doi:10.4037/ajcc2022546.
https://psnet.a…
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psnet.ahrq.gov/node/50908/psn-pdf
February 19, 2020 - Psychological safety and infection prevention practices:
results from a national survey.
February 19, 2020
Greene MT, Gilmartin HM, Saint S. Psychological safety and infection prevention practices: results from a
national survey. Am J Infect Control. 2020;48(1):2-6. doi:10.1016/j.ajic.2019.09.027.
https://psnet.ah…
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psnet.ahrq.gov/node/61101/psn-pdf
November 04, 2020 - Investigation into Management of Venous
Thromboembolism Risk in Patients Following
Thrombolysis for an Acute Stroke.
November 4, 2020
Farnborough, UK; Healthcare Safety Investigation Branch. October 2020
https://psnet.ahrq.gov/issue/investigation-management-venous-thromboembolism-risk-patients-following-
thrombol…
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psnet.ahrq.gov/node/848089/psn-pdf
April 26, 2023 - Patient Safety Advisory: fentanyl counterfeit prescription
medications that contain fentanyl and patient safety.
April 26, 2023
Jewell ML, Jewell HL, Singer R, et al. Patient Safety Advisory: fentanyl counterfeit prescription medications
that contain fentanyl and patient safety. Aesthetic Plast Surg. 2023;47(3):123…