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  1. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/836830/psn-pdf
    March 30, 2022 - Routine multidisciplinary review of severe maternal morbidity is associated with a reduction in preventable cases of severe maternal morbidity. March 30, 2022 Ozimek JA, Greene N, Geller AI, et al. Routine multidisciplinary review of severe maternal morbidity is associated with a reduction in preventable cases of …

  2. The Forgotten Drip | PSNet

    psnet.ahrq.gov/web-mm/forgotten-drip
    April 01, 2014 - The Forgotten Drip Citation Text: Josephson AS. The Forgotten Drip. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2008. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML EndNote 7 XML Endnote tagged PubMedId R…

  3. Secured But Not Always Safe | PSNet

    psnet.ahrq.gov/web-mm/secured-not-always-safe
    October 01, 2015 - Secured But Not Always Safe Citation Text: Jahr JS, Hosseini P. Secured But Not Always Safe. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2006. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML EndNote 7 XML …

  4. Security Lapse | PSNet

    psnet.ahrq.gov/web-mm/security-lapse
    December 18, 2019 - Security Lapse Citation Text: Mason D. Security Lapse. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2004. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML EndNote 7 XML Endnote tagged PubMedId RIS …

  5. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/44761/psn-pdf
    January 06, 2016 - Two fatal cases of accidental intrathecal vincristine administration: learning from death events. January 6, 2016 Chotsampancharoen T, Sripornsawan P, Wongchanchailert M. Two fatal cases of accidental intrathecal vincristine administration: learning from death event. Chemotherapy (Los Angel). 2016;61(2):108-110. d…

  6. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/46656/psn-pdf
    February 07, 2018 - Autopsy interrogation of emergency medicine dispute cases: how often are clinical diagnoses incorrect? February 7, 2018 Liu D, Gan R, Zhang W, et al. Autopsy interrogation of emergency medicine dispute cases: how often are clinical diagnoses incorrect? J Clin Pathol. 2018;71(1):67-71. doi:10.1136/jclinpath-2017-204…

  7. Delay in Malignancy Diagnosis Reflects Systemic Failures | PSNet

    psnet.ahrq.gov/web-mm/delay-malignancy-diagnosis-reflects-systemic-failures
    September 25, 2019 - Delay in Malignancy Diagnosis Reflects Systemic Failures Citation Text: Mieu H, Olson KA. Delay in Malignancy Diagnosis Reflects Systemic Failures. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2023. Copy Citation Format: …

  8. Endotracheal Tube Fallout in a Patient with Severe Obesity During Eye Surgery. | PSNet

    psnet.ahrq.gov/web-mm/endotracheal-tube-fallout-patient-severe-obesity-during-eye-surgery
    January 29, 2021 - Endotracheal Tube Fallout in a Patient with Severe Obesity During Eye Surgery. Citation Text: Bohringer C. Endotracheal Tube Fallout in a Patient with Severe Obesity During Eye Surgery.. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services.…

  9. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/857449/psn-pdf
    December 06, 2023 - "ChatGPT, can you help me save my child's life?" - Diagnostic accuracy and supportive capabilities to lay rescuers by ChatGPT in prehospital basic life support and paediatric advanced life support cases - an in-silico analysis. December 6, 2023 Bushuven S, Bentele M, Bentele S, et al. "ChatGPT, can you help me sa…

  10. How does robotic-assisted surgery change OR safety culture? | PSNet

    psnet.ahrq.gov/issue/how-does-robotic-assisted-surgery-change-or-safety-culture
    April 24, 2024 - Commentary How does robotic-assisted surgery change OR safety culture? Citation Text: How does robotic-assisted surgery change OR safety culture? AMA J Ethics. 2023;25(8):E615-E623. doi:10.1001/amajethics.2023.615. Copy Citation Format: DOI Google Scholar BibTeX EndNote X3 …

  11. Coronavirus Disease 2019 (COVID-19) and Safety of Older Adults Residing in Nursing Homes | PSNet

    psnet.ahrq.gov/primer/coronavirus-disease-2019-covid-19-and-safety-older-adults
    April 10, 2024 - Coronavirus Disease 2019 (COVID-19) and Safety of Older Adults Residing in Nursing Homes Citation Text: Bakerjian D. Coronavirus Disease 2019 (COVID-19) and Safety of Older Adults Residing in Nursing Homes. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health…

  12. Complications of Vascular Access Procedures in Patients with Kidney Disease | PSNet

    psnet.ahrq.gov/web-mm/complications-vascular-access-procedures-patients-kidney-disease
    November 15, 2023 - Complications of Vascular Access Procedures in Patients with Kidney Disease Citation Text: Young SR, Chen I. Complications of Vascular Access Procedures in Patients with Kidney Disease. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. …

  13. Failure to Reevaluate | PSNet

    psnet.ahrq.gov/web-mm/failure-reevaluate
    February 01, 2014 - Failure to Reevaluate Citation Text: Wong-Beringer A. Failure to Reevaluate. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2010. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML EndNote 7 XML Endnote tagged P…

  14. Dangers of Missing an Epidural Abscess: Multiple Visits and Delayed Diagnosis with a Severely Negative Outcome | PSNet

    psnet.ahrq.gov/web-mm/dangers-missing-epidural-abscess-multiple-visits-and-delayed-diagnosis-severely-negative
    April 27, 2022 - SPOTLIGHT CASE Dangers of Missing an Epidural Abscess: Multiple Visits and Delayed Diagnosis with a Severely Negative Outcome Citation Text: Lantz L, Yoon J, Barnes DK. Dangers of Missing an Epidural Abscess: Multiple Visits and Delayed Diagnosis with a Severely Negative Outcome. PSNet [internet…

  15. Missed injuries in trauma patients: a literature review. | PSNet

    psnet.ahrq.gov/issue/missed-injuries-trauma-patients-literature-review
    April 01, 2009 - Review Missed injuries in trauma patients: a literature review. Citation Text: Pfeifer R, Pape H-C. Missed injuries in trauma patients: A literature review. Patient Saf Surg. 2008;2:20. doi:10.1186/1754-9493-2-20. Copy Citation Format: DOI Google Scholar PubMed BibTeX End…

  16. Prospective error recording in surgery: an analysis of 1108 elective neurosurgical cases. | PSNet

    psnet.ahrq.gov/issue/prospective-error-recording-surgery-analysis-1108-elective-neurosurgical-cases
    January 22, 2016 - Study Prospective error recording in surgery: an analysis of 1108 elective neurosurgical cases. Citation Text: Stone S, Bernstein M. Prospective error recording in surgery: an analysis of 1108 elective neurosurgical cases. Neurosurgery. 2007;60(6):1075-80; discussion 1080-2. Copy Cit…

  17. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/42035/psn-pdf
    February 13, 2013 - Using Safety Cases in Industry and Healthcare. February 13, 2013 London, UK: Health Foundation; December 2012. ISBN: 9781906461430.  https://psnet.ahrq.gov/issue/using-safety-cases-industry-and-healthcare This report details how high-risk industries use safety cases to identify, evaluate, address, and monitor …

  18. Risk assessment of the acute stroke diagnostic process using failure modes, effects, and criticality analysis. | PSNet

    psnet.ahrq.gov/issue/risk-assessment-acute-stroke-diagnostic-process-using-failure-modes-effects-and-criticality
    July 21, 2021 - Study Risk assessment of the acute stroke diagnostic process using failure modes, effects, and criticality analysis. Citation Text: Liberman AL, Holl JL, Romo E, et al. Risk assessment of the acute stroke diagnostic process using failure modes, effects, and criticality analysis. Acad Eme…

  19. Diagnostic error in the emergency department: learning from national patient safety incident report analysis. | PSNet

    psnet.ahrq.gov/issue/diagnostic-error-emergency-department-learning-national-patient-safety-incident-report
    January 12, 2022 - Study Diagnostic error in the emergency department: learning from national patient safety incident report analysis. Citation Text: Hussain F, Cooper A, Carson-Stevens A, et al. Diagnostic error in the emergency department: learning from national patient safety incident report analysis. B…

  20. How common are cognitive errors in cases presented at emergency medicine resident morbidity and mortality conferences? | PSNet

    psnet.ahrq.gov/issue/how-common-are-cognitive-errors-cases-presented-emergency-medicine-resident-morbidity-and
    May 08, 2019 - Study How common are cognitive errors in cases presented at emergency medicine resident morbidity and mortality conferences? Citation Text: Chu D, Xiao J, Shah P, et al. How common are cognitive errors in cases presented at emergency medicine resident morbidity and mortality conferences?…
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