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psnet.ahrq.gov/issue/biases-detection-apparent-weekend-effect-outcome-administrative-coding-data-population-based
September 23, 2020 - Study
Classic
Biases in detection of apparent "weekend effect" on outcome with administrative coding data: population based study of stroke.
Citation Text:
Li L, Rothwell PM, Study OV. Biases in detection of apparent "weekend effect" on outcome with administrati…
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psnet.ahrq.gov/issue/ethical-considerations-and-patient-safety-concerns-cancelling-non-urgent-surgeries-during
June 23, 2021 - Commentary
Ethical considerations and patient safety concerns for cancelling non-urgent surgeries during the COVID-19 pandemic: a review.
Citation Text:
Brown NJ, Wilson B, Szabadi S, et al. Ethical considerations and patient safety concerns for cancelling non-urgent surgeries during the…
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psnet.ahrq.gov/issue/perception-patient-safety-alternate-site-care-elective-surgery-during-first-wave-novel
May 12, 2021 - Study
The perception of patient safety in an alternate site of care for elective surgery during the first wave of the novel coronavirus pandemic in the United Kingdom: a survey of 158 patients.
Citation Text:
Lee G, Clough OT, Walker JA, et al. The perception of patient safety in an alte…
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psnet.ahrq.gov/innovation/implicit-bias-and-patient-care-mitigating-bias-preventing-harm
September 22, 2021 - EMERGING INNOVATIONS
Implicit bias and patient care: mitigating bias, preventing harm.
Citation Text:
Barber Doucet H, Wilson T, Vrablik L, et al. Implicit bias and patient care: mitigating bias, preventing harm. MedEdPORTAL. 2023;19:11343. doi:10.15766/mep_2374-8265.11343.
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psnet.ahrq.gov/issue/national-incidence-medication-error-surgical-patients-and-after-accreditation-council
September 23, 2020 - Study
National incidence of medication error in surgical patients before and after Accreditation Council for Graduate Medical Education duty-hour reform.
Citation Text:
Vadera S, Griffith SD, Rosenbaum BP, et al. National Incidence of Medication Error in Surgical Patients Before and Afte…
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psnet.ahrq.gov/issue/changes-medication-safety-indicators-england-throughout-covid-19-pandemic-using-opensafely
October 19, 2022 - Study
Changes in medication safety indicators in England throughout the covid-19 pandemic using OpenSAFELY: population based, retrospective cohort study of 57 million patients using federated analytics.
Citation Text:
Fisher L, Hopcroft LEM, Rodgers S, et al. Changes in medication safety…
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psnet.ahrq.gov/issue/relationship-between-patient-safety-culture-and-intentions-nursing-staff-report-near-miss
September 15, 2021 - Study
The relationship between patient safety culture and the intentions of the nursing staff to report a near-miss event during the COVID-19 crisis.
Citation Text:
Idilbi N, Dokhi M, Malka-Zeevi H, et al. The relationship between patient safety culture and the intentions of the nursing …
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psnet.ahrq.gov/issue/families-partners-hospital-error-and-adverse-event-surveillance
December 19, 2018 - Study
Classic
Families as partners in hospital error and adverse event surveillance.
Citation Text:
Khan A, Coffey M, Litterer KP, et al. Families as Partners in Hospital Error and Adverse Event Surveillance. JAMA Pediatr. 2017;171(4):372-381. doi:10.1001/jamape…
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psnet.ahrq.gov/issue/burnout-and-its-relationship-self-reported-quality-patient-care-and-adverse-events-during
August 25, 2021 - Study
Burnout and its relationship to self-reported quality of patient care and adverse events during COVID-19: a cross-sectional online survey among nurses.
Citation Text:
Kakemam E, Chegini Z, Rouhi A, et al. Burnout and its relationship to self‐reported quality of patient care and adv…
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psnet.ahrq.gov/issue/serious-misdiagnosis-related-harms-malpractice-claims-big-three-vascular-events-infections
July 28, 2023 - Study
Emerging Classic
Serious misdiagnosis-related harms in malpractice claims: the "Big Three": vascular events, infections, and cancers.
Citation Text:
Newman-Toker DE, Schaffer AC, Yu-Moe CW, et al. Serious misdiagnosis-related harms in malpractice claims: T…
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psnet.ahrq.gov/web-mm/getting-good-report-card-unintended-consequences-public-reporting-hospital-quality
October 01, 2004 - SPOTLIGHT CASE
Getting a Good Report Card: Unintended Consequences of the Public Reporting of Hospital Quality
Citation Text:
Lindenauer PK. Getting a Good Report Card: Unintended Consequences of the Public Reporting of Hospital Quality. PSNet [internet]. Rockville (MD): Agency for Healthcare Res…
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psnet.ahrq.gov/web-mm/pains-chronic-opioid-usage
April 04, 2018 - SPOTLIGHT CASE
The Pains of Chronic Opioid Usage
Citation Text:
Manchikanti L, Hirsch JA. The Pains of Chronic Opioid Usage. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2013.
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psnet.ahrq.gov/node/866618/psn-pdf
December 31, 2024 - A Fatal Twist in Pseudohyperkalemia
December 31, 2024
Devera JL, Barnes DK, Lewis WR. A Fatal Twist in Pseudohyperkalemia. PSNet [internet]. 2024.
https://psnet.ahrq.gov/web-mm/fatal-twist-pseudohyperkalemia
Disclosure of Relevant Financial Relationships: As a provider accredited by the Accreditation Council
for C…
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psnet.ahrq.gov/web-mm/incomplete-anesthesia-history-leads-adverse-outcomes
January 29, 2021 - An Incomplete Anesthesia History Leads to Adverse Outcomes
Citation Text:
Bohringer C. An Incomplete Anesthesia History Leads to Adverse Outcomes. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2022.
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psnet.ahrq.gov/web-mm/management-cardiac-arrest-unconventional-locations
June 14, 2023 - Management of Cardiac Arrest in Unconventional Locations.
Citation Text:
Agrawal G, Molla M. Management of Cardiac Arrest in Unconventional Locations.. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2022.
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psnet.ahrq.gov/web-mm/dropping-new-lows
December 18, 2024 - SPOTLIGHT CASE
Dropping to New Lows
Citation Text:
Juang PC, Kulasa K. Dropping to New Lows. 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/node/851099/psn-pdf
June 28, 2023 - Misconnection Leading to Arterial Thrombosis
June 28, 2023
Bohringer C, Lee G. Misconnection Leading to Arterial Thrombosis. PSNet [internet]. 2023.
https://psnet.ahrq.gov/web-mm/misconnection-leading-arterial-thrombosis
The Case
A 55-year-old man with chronic obstructive pulmonary disease (COPD) was brought by am…
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psnet.ahrq.gov/web-mm/updates-management-high-risk-pulmonary-embolism
December 02, 2020 - Updates in the Management of High-Risk Pulmonary Embolism
Citation Text:
Kabrhel C, Aaronson E. Updates in the Management of High-Risk Pulmonary Embolism. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2019.
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psnet.ahrq.gov/web-mm/delayed-diagnosis-mesenteric-ischemia
March 31, 2021 - SPOTLIGHT CASE
Delayed Diagnosis of Mesenteric Ischemia
Citation Text:
Robles A, Utter GH. Delayed Diagnosis of Mesenteric Ischemia. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2022.
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psnet.ahrq.gov/node/74121/psn-pdf
November 30, 2021 - Hidden Danger! Insidious Postpartum Bleeding After
Emergency Cesarean Delivery.
November 30, 2021
Leiserowitz GS, Hedriana H. Hidden Danger! Insidious Postpartum Bleeding After Emergency Cesarean
Delivery. PSNet [internet]. 2021.
https://psnet.ahrq.gov/web-mm/hidden-danger-insidious-postpartum-bleeding-after-emerg…