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psnet.ahrq.gov/web-mm/real-heartache
October 01, 2018 - Crossed Coverage
February 1, 2007
WebM&M Cases … Communication With Consultants
June 1, 2016
WebM&M Cases … June 26, 2019
View More
Related Resources
WebM&M Cases … Pregnant With Danger
May 1, 2005
WebM&M Cases … The Worst Headache
July 1, 2004
WebM&M Cases
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psnet.ahrq.gov/web-mm/residual-anesthesia-tepid-burn
February 10, 2010 - June 28, 2017
WebM&M Cases
Code Status vs. … Care Status
December 23, 2020
WebM&M Cases … June 1, 2012
WebM&M Cases
Right? Left? … 1, 2005
WebM&M Cases
Privacy Gone Awry
May … 1, 2004
WebM&M Cases
Fumbled Handoff
March
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psnet.ahrq.gov/web-mm/fatal-oversight-misdiagnosis-nocturnal-chest-pain-elevated-d-dimer
May 01, 2005 - April 19, 2013
WebM&M Cases
It's All in the Syringe … May 26, 2021
WebM&M Cases
Hyponatremia Secondary … to Home Parenteral Nutrition Error
May 26, 2021
WebM&M Cases … 28, 2021
WebM&M Cases
A Postpartum Woman with … October 28, 2020
WebM&M Cases
When Looks Aren’t
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psnet.ahrq.gov/web-mm/cvc-placement-speak-now-or-do-not-use-line
November 01, 2003 - September 27, 2016
WebM&M Cases
A Pill Organizing Plight … September 1, 2016
WebM&M Cases
Allergy to … Risks of Intraosseous Vascular Access
August 21, 2014
WebM&M Cases … December 1, 2012
WebM&M Cases
Peripheral IV in … Vaginal Bleeding
February 1, 2004
WebM&M Cases
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psnet.ahrq.gov/web-mm/perils-diagnosing-stroke
August 15, 2017 - May 28, 2014
WebM&M Cases
Staggered Sensitivity Results … May 1, 2013
WebM&M Cases
Total Parenteral … Nutrition, Multifarious Errors
April 1, 2013
WebM&M Cases … September 20, 2011
WebM&M Cases
Delirium or Dementia? … May 1, 2009
WebM&M Cases
The Worst Headache
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psnet.ahrq.gov/web-mm/check-bags
January 03, 2017 - January 3, 2017
WebM&M Cases
Where's the Feeding Tube … September 1, 2008
WebM&M Cases
Cups of Error … January 1, 2004
WebM&M Cases
Lost in the Black … Confusion
July 1, 2003
WebM&M Cases
Check … the Wristband
July 1, 2003
WebM&M Cases
The
-
psnet.ahrq.gov/issue/less-more-project-reduce-number-pims-potentially-inappropriate-medications-elderly-care-ward
September 27, 2017 - July 31, 2013
WebM&M Cases
“Copy and Paste” Notes and … October 20, 2021
WebM&M Cases
The “Great Pretender” ( … Syphilis) is Still Stumping Healthcare Providers
May 26, 2021
WebM&M Cases … in Emergency and Primary Care Settings
January 7, 2022
WebM&M Cases … February 1, 2012
WebM&M Cases
Hold the tPA
April
-
psnet.ahrq.gov/issue/facilitators-and-barriers-implementation-surgical-safety-checklist-ssc-integrative-review
September 07, 2016 - June 15, 2012
Assertive communication training for nurses to speak up in cases of medical … June 12, 2024
WebM&M Cases
Airway Obstruction during … Anterior Cervical Spine Surgery
February 28, 2024
WebM&M Cases … December 14, 2022
WebM&M Cases
Open wider: Failure to … December 14, 2022
WebM&M Cases
Fecal Contamination
-
psnet.ahrq.gov/issue/risk-prevention-and-surgical-checklists
November 16, 2015 - March 6, 2005
WebM&M Cases
Dying in the Hospital With … December 22, 2014
WebM&M Cases
New Patient Mistakenly … Improving Diagnostic Safety and Quality
April 26, 2023
WebM&M Cases … December 22, 2010
Wrong-site craniotomy: analysis of 35 cases and systems for prevention
-
psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.127_slideshow.ppt
May 01, 2006 - Spotlight Case
Spotlight Case May 2006
Right? Left? Neither!
Source and Credits
This presentation is based on the May 2006
AHRQ WebM&M Spotlight Case
See the full article at http://webmm.ahrq.gov
CME credit is available through the Web site
Commentary by: Elizabeth A. Howell, MD, MPP; Mark R. Chassin, MD…
-
psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.206_slideshow.ppt
October 01, 2009 - Spotlight Case
Spotlight Case
Difficult Encounters:
A CMO and CNO Respond
Source and Credits
This presentation is based on the October 2009
AHRQ WebM&M Spotlight Case
See the full article at http://webmm.ahrq.gov
CME credit is available
Commentary by: Ernie Ring, MD; Jane Hirsch, RN, MS
UCSF Medical Cen…
-
psnet.ahrq.gov/web-mm/lost-transition
November 17, 2010 - In all cases, the ongoing demands of the ED necessitate that handoffs be characterized by both brevity … April 29, 2020
WebM&M Cases
Diagnostic Failure: … September 24, 2016
WebM&M Cases
One ACE Too Many … July 1, 2006
WebM&M Cases
Right? … May 1, 2006
WebM&M Cases
Deciphering the Code
-
psnet.ahrq.gov/node/46047/psn-pdf
May 17, 2017 - Medicare failed to investigate suspicious infection cases
from 96 hospitals. … https://psnet.ahrq.gov/issue/medicare-failed-investigate-suspicious-infection-cases-96-hospitals
The … https://psnet.ahrq.gov/issue/medicare-failed-investigate-suspicious-infection-cases-96-hospitals
https
-
psnet.ahrq.gov/issue/annals-clinical-decision-making-avoiding-cognitive-errors-clinical-decision-making
May 25, 2016 - July 16, 2013
View More
Related Resources
WebM&M Cases … February 22, 2023
WebM&M Cases
Delayed Diagnosis of Mesenteric … August 5, 2020
WebM&M Cases
Misleading Complaint … July 1, 2012
WebM&M Cases
Not a Miscarriage
-
psnet.ahrq.gov/web-mm/ultrasound-looked-fine-point-care-ultrasound-and-patient-safety
December 01, 2012 - Sloppy and Paste
July 1, 2012
WebM&M Cases … Situational Awareness and Patient Safety
April 1, 2016
WebM&M Cases … Infection: The Problem and Solutions
November 1, 2008
WebM&M Cases … One ACE Too Many
July 1, 2006
WebM&M Cases … Techno Trip
March 1, 2005
WebM&M Cases
-
psnet.ahrq.gov/web-mm/delayed-breast-cancer-diagnosis-false-sense-security
May 01, 2005 - in breast cancer survival is impressive, especially in resource-rich countries. 1,3
Nevertheless, cases … and commentaries from their monthly discussions of diagnosis error cases to PSNet. … December 14, 2022
WebM&M Cases
A Postpartum Woman … with an Erroneous SARS-CoV-2 Test
April 28, 2021
WebM&M Cases … April 5, 2023
WebM&M Cases
Sepsis Resulting from Delays
-
psnet.ahrq.gov/web-mm/no-blood-please
January 14, 2011 - Considerations
December 1, 2004
WebM&M Cases … Autopsy Revelation
March 1, 2004
WebM&M Cases … Undiagnosed Vaginal Bleeding
February 1, 2004
WebM&M Cases … Don't Push
November 1, 2003
WebM&M Cases … Code Status Confusion
July 1, 2003
WebM&M Cases
-
psnet.ahrq.gov/perspective/introducing-redesigned-ahrq-patient-safety-network
December 01, 2005 - The idea was to post anonymously submitted cases of medical errors or near misses, with those cases accompanied … We have published 360 cases, which have been widely used in teaching and republished by several other … built links from PSNet resources into our WebM&M commentaries, and, conversely, often cited WebM&M cases … The cases and commentaries will continue to be called "WebM&M," which will persist as a section within … journal articles, websites, conferences, primers, and the like, but also highlight relevant WebM&M cases
-
psnet.ahrq.gov/node/36178/psn-pdf
September 30, 2010 - liability insurance companies where patients were
harmed due to surgical error and reviewed these cases … The cases resulted in significant harm: 23% of the patients died, and 65% suffered
disabling injuries … Most cases involved more than one clinician, and 31% involved multiple phases of care
(eg, intraoperative
-
psnet.ahrq.gov/node/44423/psn-pdf
January 22, 2016 - patient safety: do different
levels of resident supervision affect the rate of morbidity
and mortality cases … Patient Safety: Do Different Levels of
Resident Supervision Affect the Rate of Morbidity and Mortality Cases … Furthermore, there was no evidence
of a "July Effect," as the number of morbidity and mortality cases