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  1. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/38378/psn-pdf
    September 24, 2010 - I-CaRe: a case review tool focused on improving inpatient care. … I-CaRe: a case review tool focused on improving inpatient care. … https://psnet.ahrq.gov/issue/i-care-case-review-tool-focused-improving-inpatient-care This article describes … the development and implementation of a tool for retrospective case review by hospitalists. … https://psnet.ahrq.gov/issue/i-care-case-review-tool-focused-improving-inpatient-care https://psnet.ahrq.gov
  2. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/34962/psn-pdf
    November 11, 2015 - Case study research: the view from complexity science. … Case study research: the view from complexity science. Qual Health Res. 2005;15(5):669-85. … https://psnet.ahrq.gov/issue/case-study-research-view-complexity-science The authors advocate using … the complexity science perspective in case study research. … https://psnet.ahrq.gov/issue/case-study-research-view-complexity-science
  3. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/36291/psn-pdf
    October 25, 2010 - Medicare payment for selected adverse events: building the business case for investing in patient safety … Medicare payment for selected adverse events: building the business case for investing in patient safety … https://psnet.ahrq.gov/issue/medicare-payment-selected-adverse-events-building-business-case-investing … https://psnet.ahrq.gov/issue/medicare-payment-selected-adverse-events-building-business-case-investing-patient-safety … https://psnet.ahrq.gov/issue/medicare-payment-selected-adverse-events-building-business-case-investing-patient-safety
  4. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/42178/psn-pdf
    April 10, 2013 - Outside case review of surgical pathology for referred patients: the impact on patient care. … Outside case review of surgical pathology for referred patients: the impact on patient care. … https://psnet.ahrq.gov/issue/outside-case-review-surgical-pathology-referred-patients-impact-patient-care … These high stakes have led many institutions to routinely require outside case review prior to treatment … https://psnet.ahrq.gov/issue/outside-case-review-surgical-pathology-referred-patients-impact-patient-care
  5. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/35409/psn-pdf
    September 11, 2009 - The Perruche case and the issue of compensation for the consequences of medical error. … The Perruche case and the issue of compensation for the consequences of medical error. … https://psnet.ahrq.gov/issue/perruche-case-and-issue-compensation-consequences-medical-error The author … presents a high-profile French diagnostic error case and draws parallels from its resolution to the … https://psnet.ahrq.gov/issue/perruche-case-and-issue-compensation-consequences-medical-error https://
  6. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/37781/psn-pdf
    May 21, 2008 - Alcohol based surgical prep solution and the risk of fire in the operating room: a case report. … Alcohol based surgical prep solution and the risk of fire in the operating room: a case report. … https://psnet.ahrq.gov/issue/alcohol-based-surgical-prep-solution-and-risk-fire-operating-room-case-report … This case report discusses mechanisms to prevent alcohol-based prep solutions from igniting when using … https://psnet.ahrq.gov/issue/alcohol-based-surgical-prep-solution-and-risk-fire-operating-room-case-report
  7. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/37531/psn-pdf
    February 22, 2011 - Patient safety and telephone medicine: some lessons from closed claim case review. … Patient safety and telephone medicine : some lessons from closed claim case review. … https://psnet.ahrq.gov/issue/patient-safety-and-telephone-medicine-some-lessons-closed-claim-case- review … A diagnostic error due to faulty telephone triage is discussed in this AHRQ WebM&M case, and a prior … https://psnet.ahrq.gov/issue/patient-safety-and-telephone-medicine-some-lessons-closed-claim-case-review
  8. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/40113/psn-pdf
    December 21, 2014 - Working with a fixed operating room team on consecutive similar cases and the effect on case duration … Working with a fixed operating room team on consecutive similar cases and the effect on case duration … https://psnet.ahrq.gov/issue/working-fixed-operating-room-team-consecutive-similar-cases-and-effect-case … https://psnet.ahrq.gov/issue/working-fixed-operating-room-team-consecutive-similar-cases-and-effect-case-duration-and … https://psnet.ahrq.gov/issue/working-fixed-operating-room-team-consecutive-similar-cases-and-effect-case-duration-and
  9. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/42236/psn-pdf
    May 01, 2013 - Nursing student medication errors: a case study using root cause analysis. … Nursing student medication errors: a case study using root cause analysis. … https://psnet.ahrq.gov/issue/nursing-student-medication-errors-case-study-using-root-cause-analysis … This commentary examines a medication error involving insulin using root case analysis to identify factors … https://psnet.ahrq.gov/issue/nursing-student-medication-errors-case-study-using-root-cause-analysis https
  10. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/41261/psn-pdf
    May 04, 2012 - Case-based learning for patient safety: the Lessons Learnt program for UK junior doctors. … Case-based learning for patient safety: the Lessons Learnt program for UK junior doctors. … https://psnet.ahrq.gov/issue/case-based-learning-patient-safety-lessons-learnt-program-uk-junior-doctors … This commentary details how a medical program implemented case-based learning (CBL) seminars and examines … https://psnet.ahrq.gov/issue/case-based-learning-patient-safety-lessons-learnt-program-uk-junior-doctors
  11. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/37121/psn-pdf
    March 09, 2009 - An innovative mobile approach for patient safety services: the case of a Taiwan health care provider … An innovative mobile approach for patient safety services: The case of a Taiwan health care provider … https://psnet.ahrq.gov/issue/innovative-mobile-approach-patient-safety-services-case-taiwan-health-care … https://psnet.ahrq.gov/issue/innovative-mobile-approach-patient-safety-services-case-taiwan-health-care-provider … https://psnet.ahrq.gov/issue/innovative-mobile-approach-patient-safety-services-case-taiwan-health-care-provider
  12. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/38507/psn-pdf
    February 10, 2015 - From tasks to processes: the case for changing health information technology to improve health care. … From tasks to processes: the case for changing health information technology to improve health care. … https://psnet.ahrq.gov/issue/tasks-processes-case-changing-health-information-technology-improve-health … https://psnet.ahrq.gov/issue/tasks-processes-case-changing-health-information-technology-improve-health-care … https://psnet.ahrq.gov/issue/tasks-processes-case-changing-health-information-technology-improve-health-care
  13. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/36912/psn-pdf
    September 01, 2011 - Multi-level strategies to achieve resilience for an organisation operating at capacity: a case study … Multi-level strategies to achieve resilience for an organisation operating at capacity: a case study … https://psnet.ahrq.gov/issue/multi-level-strategies-achieve-resilience-organisation-operating-capacity-case … https://psnet.ahrq.gov/issue/multi-level-strategies-achieve-resilience-organisation-operating-capacity-case-study-trauma … https://psnet.ahrq.gov/issue/multi-level-strategies-achieve-resilience-organisation-operating-capacity-case-study-trauma
  14. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/41822/psn-pdf
    November 07, 2012 - A case of adverse drug reaction induced by dispensing error. … A case of adverse drug reaction induced by dispensing error. … https://psnet.ahrq.gov/issue/case-adverse-drug-reaction-induced-dispensing-error This case report discusses … https://psnet.ahrq.gov/issue/case-adverse-drug-reaction-induced-dispensing-error https://psnet.ahrq.gov
  15. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/40747/psn-pdf
    September 07, 2011 - Misdiagnosis: analysis based on case record review with proposals aimed to improve diagnostic processes … Misdiagnosis: analysis based on case record review with proposals aimed to improve diagnostic processes … https://psnet.ahrq.gov/issue/misdiagnosis-analysis-based-case-record-review-proposals-aimed-improve- … https://psnet.ahrq.gov/issue/misdiagnosis-analysis-based-case-record-review-proposals-aimed-improve-diagnostic-processes … https://psnet.ahrq.gov/issue/misdiagnosis-analysis-based-case-record-review-proposals-aimed-improve-diagnostic-processes
  16. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/42453/psn-pdf
    July 31, 2013 - Influence of state laws mandating reporting of healthcare- associated infections: the case of central … Influence of state laws mandating reporting of healthcare-associated infections: the case of central … ://psnet.ahrq.gov/issue/influence-state-laws-mandating-reporting-healthcare-associated-infections- case-central-line … https://psnet.ahrq.gov/issue/influence-state-laws-mandating-reporting-healthcare-associated-infections-case-central-line … https://psnet.ahrq.gov/issue/influence-state-laws-mandating-reporting-healthcare-associated-infections-case-central-line
  17. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/42738/psn-pdf
    December 13, 2013 - Patient safety incidents in hospice care: observations from interdisciplinary case conferences. … Patient safety incidents in hospice care: observations from interdisciplinary case conferences. … https://psnet.ahrq.gov/issue/patient-safety-incidents-hospice-care-observations-interdisciplinary-case … https://psnet.ahrq.gov/issue/patient-safety-incidents-hospice-care-observations-interdisciplinary-case-conferences … https://psnet.ahrq.gov/issue/patient-safety-incidents-hospice-care-observations-interdisciplinary-case-conferences
  18. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/40226/psn-pdf
    February 23, 2011 - Measuring inappropriate medical diagnosis and treatment in survey data: the case of ADHD among school-age … Measuring inappropriate medical diagnosis and treatment in survey data: The case of ADHD among school-age … https://psnet.ahrq.gov/issue/measuring-inappropriate-medical-diagnosis-and-treatment-survey-data-case … https://psnet.ahrq.gov/issue/measuring-inappropriate-medical-diagnosis-and-treatment-survey-data-case-adhd-among-school … https://psnet.ahrq.gov/issue/measuring-inappropriate-medical-diagnosis-and-treatment-survey-data-case-adhd-among-school
  19. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/36561/psn-pdf
    January 12, 2011 - Errors in ABO labeling of deceased donor kidneys: case reports and approach to ensuring patient safety … Errors in ABO Labeling of Deceased Donor Kidneys: Case Reports and Approach to Ensuring Patient Safety … https://psnet.ahrq.gov/issue/errors-abo-labeling-deceased-donor-kidneys-case-reports-and-approach- ensuring-patient-safety … https://psnet.ahrq.gov/issue/errors-abo-labeling-deceased-donor-kidneys-case-reports-and-approach-ensuring-patient-safety … https://psnet.ahrq.gov/issue/errors-abo-labeling-deceased-donor-kidneys-case-reports-and-approach-ensuring-patient-safety
  20. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/43008/psn-pdf
    November 21, 2014 - Understanding safety culture in long-term care: a case study. … Understanding safety culture in long-term care: a case study. … https://psnet.ahrq.gov/issue/understanding-safety-culture-long-term-care-case-study This study provides … an in-depth case report of the suboptimal safety culture at a long-term care facility for patients … https://psnet.ahrq.gov/issue/understanding-safety-culture-long-term-care-case-study https://psnet.ahrq.gov

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