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  1. PowerPoint Presentation (ppt file)

    psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.434_slideshow.ppt
    February 01, 2018 - PowerPoint Presentation Spotlight Signout Fallout 1 Source and Credits This presentation is based on the February 2018 AHRQ WebM&M Spotlight Case See the full article at https://psnet.ahrq.gov/webmm CME credit is available Commentary by: Amy J. Starmer, MD, MPH, and Christopher P. Landrigan, MD, MPH, Harvard M…

  2. Ambulatory Care Safety | PSNet

    psnet.ahrq.gov/primer/ambulatory-care-safety
    December 15, 2024 - Ambulatory Care Safety Citation Text: Ambulatory Care Safety. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2019. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML EndNote 7 XML Endnote tagged PubMedId RIS …

  3. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/836812/psn-pdf
    March 30, 2022 - Strategies and Approaches for Investigating Patient Safety Events March 30, 2022 Shaikh U. Strategies and Approaches for Investigating Patient Safety Events. PSNet [internet]. 2022. https://psnet.ahrq.gov/primer/strategies-and-approaches-investigating-patient-safety-events Background This primer provides a broad …

  4. Root Cause Analysis | PSNet

    psnet.ahrq.gov/primer/root-cause-analysis
    March 30, 2022 - Root Cause Analysis Citation Text: Root Cause Analysis. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2019. 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/50613/psn-pdf
    October 30, 2019 - When I first started this work, there was so much concern within the profession that patients would

  6. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/846564/psn-pdf
    March 29, 2023 - Technology as a Tool for Improving Patient Safety March 29, 2023 Holmgren AJ, McBride S, Gale B, et al. Technology as a Tool for Improving Patient Safety . PSNet [internet]. 2023. https://psnet.ahrq.gov/perspective/technology-tool-improving-patient-safety Introduction  In the past several decades, technological a…

  7. Challenges of Diabetes Management and Medication Reconciliation | PSNet

    psnet.ahrq.gov/web-mm/challenges-diabetes-management-and-medication-reconciliation
    March 15, 2023 - Importance and Impact of Medication Reconciliation Medication errors are a major patient safety concern

  8. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/861738/psn-pdf
    January 31, 2024 - Unless there is concern for infection or an open fracture, it is perfectly acceptable to provide wound

  9. Spotlight (pdf file)

    psnet.ahrq.gov/sites/default/files/2024-01/spotlight_case_laceration_needed_exam_not_x-ray_final.pdf
    January 01, 2024 - . – Unless there is concern for infection or an open fracture, it is perfectly acceptable to provide

  10. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/33828/psn-pdf
    March 01, 2017 - Our concern now is to see if we can convert that into a package that can be reproduced at the next site

  11. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/33688/psn-pdf
    October 01, 2009 - In Conversation with... Charles Ornstein October 1, 2009 In Conversation with.. Charles Ornstein . PSNet [internet]. 2009. https://psnet.ahrq.gov/perspective/conversation-charles-ornstein Editor's note: Charles Ornstein is a senior reporter at ProPublica, a nonprofit news organization in New York. Formerly with th…

  12. Spotlight (pdf file)

    psnet.ahrq.gov/sites/default/files/2022-05/final_cme_reviewed_-_spotlight_missing_a_large_vessel_occlusion_stroke_04.14.2022_-_copy.pdf
    January 01, 2022 - Spotlight Spotlight Missing a Large Vessel Occlusion Stroke in a Patient with a History of Seizures Source and Credits • This presentation is based on the May 2022 AHRQ WebM&M Spotlight Case o See the full article at https://psnet.ahrq.gov/webmm o CME credit is available o Commentary by: Kevin Keenan, MD and D…

  13. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/837215/psn-pdf
    July 08, 2022 - Missing a Large Vessel Occlusion Stroke in a Patient with a History of Seizures. July 8, 2022 Keenan KJ, Nishijima DK. Missing a Large Vessel Occlusion Stroke in a Patient with a History of Seizures. PSNet [internet]. 2022. https://psnet.ahrq.gov/web-mm/missing-large-vessel-occlusion-stroke-patient-history-seizure…

  14. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/61083/psn-pdf
    October 28, 2020 - In Conversation With... Charles A Crecelius, MD, PhD, CMD and Lori L Popejoy, PhD, RN, FAAN October 28, 2020 In Conversation With.. Charles A Crecelius, MD, PhD, CMD and Lori L Popejoy, PhD, RN, FAAN. PSNet [internet]. 2020. https://psnet.ahrq.gov/perspective/conversation-charles-crecelius-md-phd-cmd-and-lori-l-po…

  15. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49717/psn-pdf
    September 01, 2014 - A Lot of Pain (Medications) September 1, 2014 Herzig SJ. A Lot of Pain (Medications). PSNet [internet]. 2014. https://psnet.ahrq.gov/web-mm/lot-pain-medications Case Objectives Appreciate the challenges of managing acute pain in hospitalized patients on chronic opioids. Describe the importance of understanding th…

  16. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49792/psn-pdf
    May 01, 2017 - Diagnostic Delay in the Emergency Department May 1, 2017 Marshall K, Singh H. Diagnostic Delay in the Emergency Department. PSNet [internet]. 2017. https://psnet.ahrq.gov/web-mm/diagnostic-delay-emergency-department Case Objectives Appreciate the importance of a broad differential diagnosis for acute abdominal pai…

  17. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/73553/psn-pdf
    July 28, 2021 - In Conversation With... James Augustine, MD July 28, 2021 In Conversation With.. James Augustine, MD. PSNet [internet]. 2021. https://psnet.ahrq.gov/perspective/conversation-james-augustine-md Editor’s Note: James Augustine, MD, is the National Director of Prehospital Strategy at US Acute Care Solutions where he p…

  18. PSNet Curated Library (pdf file)

    psnet.ahrq.gov/print/pdf/node/865308
    January 01, 2024 - PSNet Curated Library AHRQ: Agency for Healthcare Research and Quality Organizational Learning Curated Library Foundations Organizational learning: health care leaders need to design structures and processes that enhance collective learning. Bohmer RM, Edmondson AC. Health Forum J. 2001;44:32-35. This comment…

  19. Reducing Preventable Patient Harm Due to Retained Surgical Items: The RSI Bundle | PSNet

    psnet.ahrq.gov/innovation/reducing-preventable-patient-harm-due-retained-surgical-items-rsi-bundle
    July 23, 2024 - initiate, another team member should initiate the Surgical STOP by utilizing the “Ask, Request, voice a Concern

  20. PSNet Curated Library (pdf file)

    psnet.ahrq.gov/print/pdf/node/854855
    January 01, 2024 - PSNet Curated Library AHRQ: Agency for Healthcare Research and Quality Patient as a Team Member in Clinical Care Curated Library Foundations Patient Engagement for Patient Safety: The Why, What, and How of Patient Engagement for Improving Patient Safety. Kendir C, Fujisawa R, Brito Fernandes O, et al. Paris, F…
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