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psnet.ahrq.gov/issue/benchmarking-surgical-incident-reports-using-database-and-triage-system-reduce-adverse
June 18, 2008 - December 22, 2010
Cognitive bias impact on management of postoperative complications, … March 21, 2016
Underreporting of robotic surgery complications. … More About The Topic
Operating Room
Quality and Safety Professionals
Surgery
Surgical Complications
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psnet.ahrq.gov/issue/40-years-behind-mask-safety-revisited
January 13, 2012 - 2019
The I-READI quality and safety framework: a health system’s response to airway complications … April 15, 2020
WebM&M Cases
Complications of Vascular … See More About The Topic
Operating Room
Physicians
Anesthesiology
Surgical Complications
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psnet.ahrq.gov/issue/skillset-obtained-surgical-simulation-transferable-operating-theatre
August 25, 2011 - Use of unsolicited patient observations to identify surgeons with increased risk for postoperative complications … Association of coworker reports about unprofessional behavior by surgeons with surgical complications … 2019
The I-READI quality and safety framework: a health system’s response to airway complications
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psnet.ahrq.gov/node/33678/psn-pdf
January 01, 2009 - In Conversation with…Thomas H. Gallagher, MD
January 1, 2009
In Conversation with…Thomas H. Gallagher, MD. PSNet [internet]. 2009.
https://psnet.ahrq.gov/perspective/conversation-withthomas-h-gallagher-md
Editor's note: Thomas H. Gallagher, MD, is Associate Professor in the Department of Medicine and the
Departme…
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psnet.ahrq.gov/node/33668/psn-pdf
May 01, 2008 - In Conversation with…David W. Bates, MD, MSc
May 1, 2008
In Conversation with…David W. Bates, MD, MSc. PSNet [internet]. 2008.
https://psnet.ahrq.gov/perspective/conversation-withdavid-w-bates-md-msc
Editor's note: Dr. David Bates is a Professor at Harvard Medical School, Medical Director of Clinical and
Quality …
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psnet.ahrq.gov/node/33841/psn-pdf
September 01, 2017 - In Conversation With… Andrew Gettinger, MD
September 1, 2017
In Conversation With… Andrew Gettinger, MD. PSNet [internet]. 2017.
https://psnet.ahrq.gov/perspective/conversation-andrew-gettinger-md
Editor's note: Dr. Gettinger is the Chief Medical Information Officer and the Executive Director of the
Office of Cli…
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psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.332_slideshow.ppt
September 01, 2014 - PowerPoint Presentation
Spotlight
A Lot of Pain (Medications)
1
This presentation is based on the September 2014
AHRQ WebM&M Spotlight Case
See the full article at http://webmm.ahrq.gov
CME credit is available
Commentary by: Shoshana J. Herzig, MD, MPH, Division of General Medicine, Beth Israel Deaconess Medic…
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psnet.ahrq.gov/node/49702/psn-pdf
March 01, 2014 - Tough Call: Addressing Errors From Previous Providers
March 1, 2014
Martinez W, Hickson GB. Tough Call: Addressing Errors From Previous Providers. PSNet [internet]. 2014.
https://psnet.ahrq.gov/web-mm/tough-call-addressing-errors-previous-providers
Case Objectives
Define what it means to be a professional.
Identi…
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psnet.ahrq.gov/sites/default/files/2024-07/spotlight_case_mismanagement_of_acute_decompensated_heart_failure_slides_final.pptx
January 01, 2024 - Spotlight
Spotlight
Mismanagement of Acute Decompensated Heart Failure with Hypertensive Emergency
1
Source and Credits
This presentation is based on the July 2024 AHRQ WebM&M Spotlight Case
See the full article at https://psnet.ahrq.gov/webmm
CME credit is available
Commentary by: Jaenic Lee, MD Josh Fernel…
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psnet.ahrq.gov/node/49720/psn-pdf
December 01, 2014 - rtPA in acute stroke have been shown to be a key step in enhancing the administration and
reducing complications … references
https://psnet.ahrq.gov//#references
https://psnet.ahrq.gov//#references
potential hemorrhagic complications
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psnet.ahrq.gov/innovation/care-managers-use-software-aided-medication-review-protocol-frail-community-dwelling
September 13, 2023 - Inappropriate use of nonsteroidal anti-inflammatory drugs (NSAIDs) in clients at risk of peptic ulcer complications … Patient Safety Innovations
Hospital at Home℠ Care Reduces Costs, Readmissions, and Complications
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psnet.ahrq.gov/web-mm/spotlight-mistaken-attribution-diagnostic-misstep
July 01, 2011 - the inpatient psychiatric unit used the case as an opportunity to broadly consider not only medical complications … that has salience for this case is communication between providers about patients who are at risk for complications
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psnet.ahrq.gov/node/848110/psn-pdf
April 26, 2023 - Her family requested comfort care and hospice;
the patient died due to complications of her hemorrhage … impairment, behavioral symptoms associated with dementia, and delirium; acute
illnesses such as infections; complications
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psnet.ahrq.gov/node/865429/psn-pdf
April 24, 2024 - Induction of general
anesthesia proceeded without further delay or complications. … Unexpected treatment outcomes should be investigated immediately to avoid recurring complications
if
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psnet.ahrq.gov/perspective/conversation-maureen-bisognano
February 26, 2025 - Hospitals
Health Care Executives and Administrators
Gynecology
Nonsurgical Procedural Complications … Surgical Complications
View More
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psnet.ahrq.gov/node/33859/psn-pdf
June 01, 2018 - recognized that with guided procedures, especially internal jugular line placement, you could decrease
complications … nonsignificant for differences in the two groups of readers with respect to high-
risk diagnoses with complications
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psnet.ahrq.gov/perspective/health-plan-patient-safety-initiatives
July 10, 2024 - patient safety indicators (PSIs) are a set of measures that use hospital administrative data to identify complications … We follow claims data and complications as they're coded, as well as unplanned care and admissions into
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psnet.ahrq.gov/perspective/conversation-withamy-helwig-about-health-plan-patient-safety-initiatives
July 10, 2024 - We follow claims data and complications as they're coded, as well as unplanned care and admissions into … patient safety indicators (PSIs) are a set of measures that use hospital administrative data to identify complications
-
psnet.ahrq.gov/innovation/johns-hopkins-venous-thromboembolism-vte-collaborative-studies-and-implements-methods
June 19, 2024 - financial penalties imposed by state and federal agencies for preventable hospital readmissions and complications … 10, 2024
Validity of 16 AHRQ Patient Safety Indicators to identify in-hospital complications
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psnet.ahrq.gov/node/42692/psn-pdf
April 21, 2015 - Surgeons rated in the lowest quartile of surgical skill had more
surgical complications, longer surgical