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  1. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/33743/psn-pdf
    December 01, 2012 - Quality and Safety Challenges in Critical Care: Preventing and Treating Delirium in the Intensive Care Unit December 1, 2012 Vasilevskis EE, Ely WE, Dittus RS. Quality and Safety Challenges in Critical Care: Preventing and Treating Delirium in the Intensive Care Unit. PSNet [internet]. 2012. https://psnet.ahrq.gov…

  2. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/846770/psn-pdf
    March 29, 2023 - Procedure Complications – Who is Responsible for Follow up? March 29, 2023 Chalupsky M, Wei H, Marquet E. Procedure Complications – Who is Responsible for Follow up? PSNet [internet]. 2023. https://psnet.ahrq.gov/web-mm/procedure-complications-who-responsible-follow The Case A 74-year-old man with newly diagnose…

  3. PowerPoint Presentation (ppt file)

    psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.407_slideshow.ppt
    May 01, 2017 - PowerPoint Presentation Spotlight Diagnostic Delay in the Emergency Department 1 Source and Credits This presentation is based on the May 2017 AHRQ WebM&M Spotlight Case See the full article at https://psnet.ahrq.gov/webmm CME credit is available Commentary by: Kyle Marshall, MD, Geisinger Medical Center, Danv…

  4. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/33864/psn-pdf
    January 01, 2019 - How Does Health Care Simulation Affect Patient Care? August 1, 2018 Lopreiato JO. How Does Health Care Simulation Affect Patient Care? PSNet [internet]. 2018. https://psnet.ahrq.gov/perspective/how-does-health-care-simulation-affect-patient-care Perspective Introduction Health care simulation programs have spread…

  5. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49754/psn-pdf
    February 01, 2016 - Picking Up the Cause of the Stroke February 1, 2016 Chopra V. Picking Up the Cause of the Stroke. PSNet [internet]. 2016. https://psnet.ahrq.gov/web-mm/picking-cause-stroke The Case A 62-year-old man with poorly controlled diabetes was transferred to a tertiary care center from a community hospital for management…

  6. Bowel Injury After Laparoscopic Surgery | PSNet

    psnet.ahrq.gov/web-mm/bowel-injury-after-laparoscopic-surgery
    January 19, 2016 - Bowel Injury After Laparoscopic Surgery Citation Text: Moorthy K. Bowel Injury After Laparoscopic Surgery. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2015. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML …

  7. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49762/psn-pdf
    June 01, 2016 - The Case of Mistaken Intubation June 1, 2016 Silveira MJ. The Case of Mistaken Intubation. PSNet [internet]. 2016. https://psnet.ahrq.gov/web-mm/case-mistaken-intubation Case Objectives Appreciate that most older adults and many younger chronically ill patients have discussed or documented their preferences for l…

  8. The Missing Suction Tip | PSNet

    psnet.ahrq.gov/web-mm/missing-suction-tip
    January 01, 2006 - SPOTLIGHT CASE The Missing Suction Tip Citation Text: Thomas EJ, Moore FA. The Missing Suction Tip. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2003. Copy Citation Format: Google Scholar BibTeX EndNote X3 …

  9. One Bronchoscopy, Two Errors | PSNet

    psnet.ahrq.gov/web-mm/one-bronchoscopy-two-errors
    December 09, 2020 - One Bronchoscopy, Two Errors Citation Text: Leiten E, Nielsen R. One Bronchoscopy, Two Errors. 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 XM…

  10. Don't Pick the PICC | PSNet

    psnet.ahrq.gov/web-mm/dont-pick-picc
    December 01, 2011 - Don't Pick the PICC Citation Text: McGill RL. Don't Pick the PICC. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2018. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML EndNote 7 XML Endnote tagged PubMedId RI…

  11. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/33645/psn-pdf
    February 01, 2007 - Diagnostic Errors in Medicine: What Do Doctors and Umpires Have in Common? February 1, 2007 Graber ML. Diagnostic Errors in Medicine: What Do Doctors and Umpires Have in Common? PSNet [internet]. 2007. https://psnet.ahrq.gov/perspective/diagnostic-errors-medicine-what-do-doctors-and-umpires-have-common Perspectiv…

  12. Are You Mrs. A? An Issue of Identification Over Telephone | PSNet

    psnet.ahrq.gov/web-mm/are-you-mrs-issue-identification-over-telephone
    January 01, 2016 - Are You Mrs. A? An Issue of Identification Over Telephone Citation Text: Adelman JS. Are You Mrs. A? An Issue of Identification Over Telephone. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2013. Copy Citation Format: …

  13. Lost in Sign Out and Documentation | PSNet

    psnet.ahrq.gov/web-mm/lost-sign-out-and-documentation
    January 31, 2011 - Lost in Sign Out and Documentation Citation Text: Detsky ME. Lost in Sign Out and Documentation. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2016. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML EndNote 7 …

  14. Returning Home Safely | PSNet

    psnet.ahrq.gov/web-mm/returning-home-safely
    December 22, 2018 - Returning Home Safely Citation Text: Toles M. Returning Home Safely. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2018. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML EndNote 7 XML Endnote tagged PubMedId …

  15. Add-on Case and the Missing Checklist | PSNet

    psnet.ahrq.gov/web-mm/add-case-and-missing-checklist
    September 01, 2012 - Add-on Case and the Missing Checklist Citation Text: Catchpole K. Add-on Case and the Missing Checklist. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2017. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML En…

  16. Emerging Safety Issues in Artificial Intelligence | PSNet

    psnet.ahrq.gov/perspective/emerging-safety-issues-artificial-intelligence
    February 20, 2019 - Emerging Safety Issues in Artificial Intelligence Robert Challen, MA, MBBS | July 1, 2019  View more articles from the same authors. Citation Text: Challen R. Emerging Safety Issues in Artificial Intelligence. PSNet [internet]. Rockville (MD): Agency for Healthcare…

  17. Unintentional Ketamine Overdose in the Operating Room – Mixing Up the Ampules | PSNet

    psnet.ahrq.gov/web-mm/unintentional-ketamine-overdose-operating-room-mixing-ampules
    March 25, 2020 - Unintentional Ketamine Overdose in the Operating Room – Mixing Up the Ampules Citation Text: Bohringer C. Unintentional Ketamine Overdose in the Operating Room – Mixing Up the Ampules. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2…

  18. Residual Anesthesia: Tepid Burn | PSNet

    psnet.ahrq.gov/web-mm/residual-anesthesia-tepid-burn
    February 10, 2010 - Residual Anesthesia: Tepid Burn Citation Text: Kurrek MM, Twersky RS. Residual Anesthesia: Tepid Burn. 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 EndN…

  19. In Conversation with…Donald M. Berwick, MD, MPP | PSNet

    psnet.ahrq.gov/perspective/conversation-withdonald-m-berwick-md-mpp
    November 01, 2005 - lives by identifying and intervening in patient care at the first sign of clinical deterioration or concern

  20. In Conversation with... Regina Hoffman about Building Capacity for Patient Safety | PSNet

    psnet.ahrq.gov/perspective/conversation-regina-hoffman-about-building-capacity-patient-safety
    July 31, 2023 - staff is key. 3 Another challenge that organizations may face when sharing lessons learned is the concern
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