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  1. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49756/psn-pdf
    April 01, 2016 - Lost in Sign Out and Documentation April 1, 2016 Detsky ME. Lost in Sign Out and Documentation. PSNet [internet]. 2016. https://psnet.ahrq.gov/web-mm/lost-sign-out-and-documentation The Case A 71-year-old man presented to the emergency department with chest pain. While being evaluated by the emergency physician, …
  2. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/853772/psn-pdf
    September 27, 2023 - Insulin Administration: Pen vs Vial – Similar, but Not Interchangeable September 27, 2023 Camarillo H. Insulin Administration: Pen vs Vial – Similar, but Not Interchangeable. PSNet [internet]. 2023. https://psnet.ahrq.gov/web-mm/insulin-administration-pen-vs-vial-similar-not-interchangeable The Case A fourteen-ye…
  3. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/33705/psn-pdf
    January 01, 2011 - Risk Management and Patient Safety December 1, 2010 Manuel BM, McCarthy JL, Berry WR, et al. Risk Management and Patient Safety. PSNet [internet]. 2010. https://psnet.ahrq.gov/perspective/risk-management-and-patient-safety Perspective In 1990, a Harvard-based research team reported the incidence of medical errors …
  4. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49589/psn-pdf
    August 01, 2009 - Hiding in Plain Sight August 1, 2009 Weinberg JM. Hiding in Plain Sight. PSNet [internet]. 2009. https://psnet.ahrq.gov/web-mm/hiding-plain-sight The Case A 65-year-old woman presented to an emergency department (ED) with 48 hours of nontraumatic left lower back pain and general malaise. She was diagnosed with a …
  5. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49599/psn-pdf
    February 23, 2010 - Defensive Medicine: "Glowing" with Pain February 1, 2010 Sethi MK. Defensive Medicine: "Glowing" with Pain. PSNet [internet]. 2010. https://psnet.ahrq.gov/web-mm/defensive-medicine-glowing-pain The Case   A 31-year-old man presented to the emergency department (ED) complaining of abdominal pain and vomiting. The…
  6. psnet.ahrq.gov/web-mm/timely-diagnosis-esophageal-perforation
    September 27, 2023 - Timely diagnosis of esophageal perforation Citation Text: Utter GH, Cooke DT. Timely diagnosis of esophageal perforation. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2020. Copy Citation Format: Google Scholar BibTeX …
  7. psnet.ahrq.gov/web-mm/misleading-complaint
    December 01, 2009 - Misleading Complaint Citation Text: Soni K, Dhaliwal G. Misleading Complaint. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2012. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML EndNote 7 XML Endnote tagged …
  8. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49658/psn-pdf
    July 01, 2012 - Misleading Complaint July 1, 2012 Soni K, Dhaliwal G. Misleading Complaint. PSNet [internet]. 2012. https://psnet.ahrq.gov/web-mm/misleading-complaint The Case A 54-year-old homeless man with a history of alcoholism presented to the emergency department (ED) with complaints of knee problems. The triage nurse docu…
  9. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49500/psn-pdf
    January 01, 2006 - Confusion With Acetaminophen January 1, 2006 Heubi JE. Confusion With Acetaminophen. PSNet [internet]. 2006. https://psnet.ahrq.gov/web-mm/confusion-acetaminophen The Case Parents brought their 5-year-old son to the emergency department (ED) with a 24-hour history of fever, cough, and frontal headache. Physical e…
  10. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49647/psn-pdf
    February 01, 2012 - Amended Lab Results: Communication Slip February 1, 2012 Mohta V. Amended Lab Results: Communication Slip. PSNet [internet]. 2012. https://psnet.ahrq.gov/web-mm/amended-lab-results-communication-slip The Case A 25-year-old woman in her first pregnancy was seen at 33 weeks' gestation with new onset hypertension an…
  11. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49559/psn-pdf
    April 01, 2008 - The Forgotten Drip April 1, 2008 Josephson AS. The Forgotten Drip. PSNet [internet]. 2008. https://psnet.ahrq.gov/web-mm/forgotten-drip The Case A 45-year-old man was brought to the emergency department by his friends because of a 1-day history of a severe headache and "bizarre behavior." A computed tomography (C…
  12. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/33757/psn-pdf
    October 01, 2013 - Safety in Radiology October 1, 2013 Pinto A. Safety in Radiology. PSNet [internet]. 2013. https://psnet.ahrq.gov/perspective/safety-radiology Perspective The use of medical imaging to depict and to help diagnose illness and injury as well as to guide therapeutic interventions has expanded greatly during the past …
  13. psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.257_slideshow.ppt
    December 01, 2011 - Spotlight Case July 2008 Spotlight Case Order Interrupted by Text: Multitasking Mishap * * Source and Credits This presentation is based on the December 2011 AHRQ WebM&M Spotlight Case See the full article at http://webmm.ahrq.gov CME credit is available Commentary by: John Halamka, MD, MS, Chief Informa…
  14. Spotlight Case (ppt file)

    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…
  15. psnet.ahrq.gov/issue/beyond-organisational-accident-need-error-wisdom-frontline
    November 18, 2015 - Commentary Beyond the organisational accident: the need for "error wisdom" on the frontline. Citation Text: Reason J. Beyond the organisational accident: the need for "error wisdom" on the frontline. Qual Saf Health Care. 2004;13 Suppl 2:ii28-33. Copy Citation Format: Goo…
  16. psnet.ahrq.gov/issue/improving-patient-safety-radiotherapy-learning-near-misses-incidents-and-errors
    July 10, 2017 - Commentary Improving patient safety in radiotherapy by learning from near misses, incidents and errors. Citation Text: Williams M. Improving patient safety in radiotherapy by learning from near misses, incidents and errors. Br J Radiol. 2007;80(953):297-301. Copy Citation Format:…
  17. psnet.ahrq.gov/issue/obstetric-care-consensus-no-5-severe-maternal-morbidity-screening-and-review
    August 20, 2018 - Organizational Policy/Guidelines Obstetric Care Consensus No. 5: Severe Maternal Morbidity: Screening and Review. Citation Text: Obstetric Care Consensus No. 5: Severe Maternal Morbidity: Screening and Review. Obstet Gynecol. 2016;128(3):e54-60. doi:10.1097/AOG.0000000000001642. Copy C…
  18. psnet.ahrq.gov/issue/patient-harm-general-surgery-prospective-study
    November 16, 2022 - Study Patient harm in general surgery--a prospective study. Citation Text: Kaul AK, McCulloch PG. Patient Harm in General Surgery-A Prospective Study. J Patient Saf. 2008;3(1). doi:10.1097/pts.0b013e318030c2ec. Copy Citation Format: DOI Google Scholar BibTeX EndNote X3 XM…
  19. psnet.ahrq.gov/issue/american-college-radiology-white-paper-mr-safety-2004-update-and-revisions
    September 28, 2022 - Clinical Guideline American College of Radiology White Paper on MR Safety: 2004 Update and Revisions. Citation Text: doi:10.2214/ajr.182.5.182111. Copy Citation Format: DOI BibTeX EndNote X3 XML EndNote 7 XML Endnote tagged PubMedId RIS Download Citation …
  20. psnet.ahrq.gov/issue/acog-committee-opinion-no-447-patient-safety-obstetrics-and-gynecology
    July 19, 2017 - Commentary ACOG Committee Opinion No. 447: patient safety in obstetrics and gynecology. Citation Text: Improvement AC of O and GCC on PS and Q. ACOG Committee Opinion No. 447: Patient safety in obstetrics and gynecology. Obstet Gynecol. 2009;114(6):1424-7. doi:10.1097/AOG.0b013e3181c6f90…

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