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  1. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/861760/psn-pdf
    January 31, 2024 - Syringe Swap During Regional Block: A Case of Medication Error and Recovery January 31, 2024 Beres K, Gutierrez MC. Syringe Swap During Regional Block: A Case of Medication Error and Recovery. PSNet [internet]. 2024. https://psnet.ahrq.gov/web-mm/syringe-swap-during-regional-block-case-medication-error-and-recover…

  2. Do Not Disturb! | PSNet

    psnet.ahrq.gov/web-mm/do-not-disturb
    February 03, 2011 - SPOTLIGHT CASE Do Not Disturb! Citation Text: Duffy DF, Cassel C. Do Not Disturb!. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2007. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML EndNote 7 XML…

  3. The Perils of Cross Coverage | PSNet

    psnet.ahrq.gov/web-mm/perils-cross-coverage
    September 22, 2010 - SPOTLIGHT CASE The Perils of Cross Coverage Citation Text: Farnan JM, Arora V. The Perils of Cross Coverage. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2012. Copy Citation Format: Google Scholar BibTeX En…

  4. Spotlight (pdf file)

    psnet.ahrq.gov/sites/default/files/2021-11/spotlight_integration_and_coordination_of_disesase_treatment_and_palliative_care_final.pdf
    January 01, 2021 - Spotlight Spotlight Culture Clash No More: Integration and Coordination of Disease Treatment and Palliative Care Source and Credits • This presentation is based on the November 2021 AHRQ WebM&M Spotlight Case o See the full article at https://psnet.ahrq.gov/webmm o CME credit is available o Commentary by: Han…

  5. In Conversation With… David M. Gaba, MD | PSNet

    psnet.ahrq.gov/perspective/conversation-david-m-gaba-md
    March 01, 2013 - In Conversation With… David M. Gaba, MD March 1, 2013  Also Read an Essay Citation Text: In Conversation With… David M. Gaba, MD. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2013. Copy…

  6. Spotlight Case [MONTH] 2003 (ppt file)

    psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.176_slideshow.ppt
    May 01, 2008 - Spotlight Case [MONTH] 2003 Spotlight Case May 2008 Diagnosing HIV: It Doesn’t Take a Brain Surgeon Source and Credits This presentation is based on the May 2008 AHRQ WebM&M Spotlight Case See the full article at http://webmm.ahrq.gov CME credit is available Commentary by: Roger Chou, MD, Oregon Health &…

  7. Complications of ECMO During Transport | PSNet

    psnet.ahrq.gov/web-mm/complications-ecmo-during-transport
    January 27, 2021 - An A-B-C algorithm/checklist should be used for conducting structured assessments and the entire team

  8. Clinician collaboration to improve clinical decision support: the Clickbusters initiative. | PSNet

    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…

  9. Electronic health record usability issues and potential contribution to patient harm. | PSNet

    psnet.ahrq.gov/issue/electronic-health-record-usability-issues-and-potential-contribution-patient-harm
    July 07, 2021 - Study Classic Electronic health record usability issues and potential contribution to patient harm. Citation Text: Howe JL, Adams KT, Hettinger Z, et al. Electronic Health Record Usability Issues and Potential Contribution to Patient Harm. JAMA. 2018;319(12):127…

  10. Incidence of nosocomial COVID-19 in patients hospitalized at a large US academic medical center. | PSNet

    psnet.ahrq.gov/issue/incidence-nosocomial-covid-19-patients-hospitalized-large-us-academic-medical-center
    October 14, 2020 - Study Emerging Classic Incidence of nosocomial COVID-19 in patients hospitalized at a large US academic medical center. Citation Text: Rhee C, Baker M, Vaidya V, et al. Incidence of nosocomial COVID-19 in patients hospitalized at a large US academic medical cent…

  11. Problem list completeness in electronic health records: a multi-site study and assessment of success factors. | PSNet

    psnet.ahrq.gov/issue/problem-list-completeness-electronic-health-records-multi-site-study-and-assessment-success
    April 29, 2018 - Study Problem list completeness in electronic health records: a multi-site study and assessment of success factors. Citation Text: Wright A, McCoy AB, Hickman T-TT, et al. Problem list completeness in electronic health records: A multi-site study and assessment of success factors. Int J …

  12. Patients and families as teachers: a mixed methods assessment of a collaborative learning model for medical error disclosure and prevention. | PSNet

    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…

  13. Association of cataract surgical outcomes with late surgeon career stages: a population-based cohort study. | PSNet

    psnet.ahrq.gov/issue/association-cataract-surgical-outcomes-late-surgeon-career-stages-population-based-cohort
    September 23, 2020 - Study Association of cataract surgical outcomes with late surgeon career stages: a population-based cohort study. Citation Text: Campbell RJ, El-Defrawy SR, Gill SS, et al. Association of Cataract Surgical Outcomes With Late Surgeon Career Stages: A Population-Based Cohort Study. JAMA Op…

  14. Hospital-acquired functional decline and clinical outcomes in older cardiac surgical patients: a multicenter prospective cohort study. | PSNet

    psnet.ahrq.gov/issue/hospital-acquired-functional-decline-and-clinical-outcomes-older-cardiac-surgical-patients
    February 06, 2019 - Study Hospital-acquired functional decline and clinical outcomes in older cardiac surgical patients: a multicenter prospective cohort study. Citation Text: Morisawa T, Saitoh M, Otsuka S, et al. Hospital-acquired functional decline and clinical outcomes in older cardiac surgical patients…

  15. Primary care physicians' willingness to disclose oncology errors involving multiple providers to patients. | PSNet

    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. …

  16. Effect of increased inpatient attending physician supervision on medical errors, patient safety, and resident education: a randomized clinical trial. | PSNet

    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…

  17. Assessment of the safety of discharging select patients directly home from the intensive care unit: a multicenter population-based cohort study. | PSNet

    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…

  18. Speaking up about traditional and professionalism-related patient safety threats: a national survey of interns and residents. | PSNet

    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…

  19. The quality of hospital work environments and missed nursing care is linked to heart failure readmissions: a cross-sectional study of US hospitals. | PSNet

    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…

  20. A national survey assessing the number of records allowed open in electronic health records at hospitals and ambulatory sites. | PSNet

    psnet.ahrq.gov/issue/national-survey-assessing-number-records-allowed-open-electronic-health-records-hospitals-and
    May 29, 2019 - Study A national survey assessing the number of records allowed open in electronic health records at hospitals and ambulatory sites. Citation Text: Adelman JS, Berger MA, Rai A, et al. A national survey assessing the number of records allowed open in electronic health records at hospital…
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