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  1. In Conversation With… Abraham Verghese, MD | PSNet

    psnet.ahrq.gov/perspective/conversation-abraham-verghese-md
    November 01, 2012 - RW : Is your main concern that it has safety consequences or that it has cost consequences, or is it

  2. Risk Management and Patient Safety | PSNet

    psnet.ahrq.gov/perspective/risk-management-and-patient-safety
    December 01, 2010 - in its seminal report, To Err Is Human ( 2 ), that the issue of medical mistakes became a national concern

  3. The Evidence-Based Physical Examination as a Patient Safety Practice | PSNet

    psnet.ahrq.gov/perspective/evidence-based-physical-examination-patient-safety-practice
    November 01, 2012 - RW : Is your main concern that it has safety consequences or that it has cost consequences, or is it

  4. What Do We Know About Emergency Department Safety? | PSNet

    psnet.ahrq.gov/perspective/what-do-we-know-about-emergency-department-safety
    June 01, 2010 - timeliness not simply a determinant of patient satisfaction but also a significant safety and quality concern—delays

  5. The Risks of a Malpositioned Gastrostomy Tube and Poor Communication | PSNet

    psnet.ahrq.gov/web-mm/risks-malpositioned-gastrostomy-tube-and-poor-communication
    August 01, 2012 - surgeon, he learned that the plan was to revise the PEG tube via laparoscopic or open technique due to concern

  6. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/73334/psn-pdf
    August 01, 2024 - was related to the physical maintenance of the patient’s IV infusions, an underappreciated area of concern

  7. An Inadvertent Bolus of Norepinephrine. | PSNet

    psnet.ahrq.gov/web-mm/inadvertent-bolus-norepinephrine
    December 04, 2016 - was related to the physical maintenance of the patient’s IV infusions, an underappreciated area of concern

  8. A "Reflexive" Diagnosis in Primary Care | PSNet

    psnet.ahrq.gov/web-mm/reflexive-diagnosis-primary-care
    April 01, 2008 - SPOTLIGHT CASE A "Reflexive" Diagnosis in Primary Care Citation Text: Betjemann J, Josephson AS. A "Reflexive" Diagnosis in Primary Care. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2014. Copy Citation Format: …

  9. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/866343/psn-pdf
    December 31, 2024 - Mismanagement of Acute Decompensated Heart Failure with Hypertensive Emergency December 31, 2024 Lee J, Fernilius J, Frick W. Mismanagement of Acute Decompensated Heart Failure with Hypertensive Emergency. PSNet [internet]. 2024. https://psnet.ahrq.gov/web-mm/mismanagement-acute-decompensated-heart-failure-hyperte…

  10. Duplicate Insulin Order | PSNet

    psnet.ahrq.gov/web-mm/duplicate-insulin-order
    May 04, 2012 - Duplicate Insulin Order Citation Text: Acquisto NM, Cobaugh DJ. Duplicate Insulin Order. 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 Endn…

  11. Transitions in Adolescent Medicine | PSNet

    psnet.ahrq.gov/web-mm/transitions-adolescent-medicine
    August 04, 2021 - Transitions in Adolescent Medicine Citation Text: Okumura MJ, Williams RG. Transitions in Adolescent Medicine. 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 …

  12. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/865455/psn-pdf
    March 27, 2024 - Communication During Transitions of Care March 27, 2024 Gurses AP, Sousane Z, Mossburg S. Communication During Transitions of Care. PSNet [internet]. 2024. https://psnet.ahrq.gov/perspective/communication-during-transitions-care Introduction Inaccurate or untimely communication and ineffective teamwork in healthca…

  13. The Case of Mistaken Intubation | PSNet

    psnet.ahrq.gov/web-mm/case-mistaken-intubation
    July 01, 2016 - SPOTLIGHT CASE The Case of Mistaken Intubation Citation Text: Silveira MJ. The Case of Mistaken Intubation. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2016. Copy Citation Format: Google Scholar BibTeX End…

  14. Dangerous Shift | PSNet

    psnet.ahrq.gov/web-mm/dangerous-shift
    July 24, 2013 - SPOTLIGHT CASE Dangerous Shift Citation Text: Patterson ES. Dangerous Shift. 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 Endno…

  15. Signout Fallout | PSNet

    psnet.ahrq.gov/web-mm/signout-fallout
    November 16, 2022 - SPOTLIGHT CASE Signout Fallout Citation Text: Starmer AJ, Landrigan CP. Signout Fallout. 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…

  16. Implementing a Fall Prevention Program | PSNet

    psnet.ahrq.gov/perspective/implementing-fall-prevention-program
    November 29, 2023 - Implementing a Fall Prevention Program Frances Healey, RN, PhD | December 1, 2011  View more articles from the same authors. Citation Text: Healey F. Implementing a Fall Prevention Program. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Qualit…

  17. Unexplained Apnea Under Anesthesia | PSNet

    psnet.ahrq.gov/web-mm/unexplained-apnea-under-anesthesia
    December 01, 2005 - SPOTLIGHT CASE Unexplained Apnea Under Anesthesia Citation Text: Barach P. Unexplained Apnea Under Anesthesia. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2003. Copy Citation Format: Google Scholar BibTeX …

  18. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/50611/psn-pdf
    October 30, 2019 - The Lost Start Date: an Unknown Risk of E-prescribing October 30, 2019 Wright A, Schiff G. The Lost Start Date: an Unknown Risk of E-prescribing. PSNet [internet]. 2019. https://psnet.ahrq.gov/web-mm/lost-start-date-unknown-risk-e-prescribing Case Objectives List the most common errors associated with computerized…

  19. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/33680/psn-pdf
    March 22, 2009 - In Conversation with...Dean Schillinger, MD March 22, 2009 In Conversation with..Dean Schillinger, MD. PSNet [internet]. 2009. https://psnet.ahrq.gov/perspective/conversation-withdean-schillinger-md Editor's note: Dean Schillinger, MD, is a Professor of Medicine at University of California, San Francisco, Directo…

  20. Novel Drug Misuse | PSNet

    psnet.ahrq.gov/web-mm/novel-drug-misuse
    September 30, 2010 - SPOTLIGHT CASE Novel Drug Misuse Citation Text: Angus DC, Milbrandt EB. Novel Drug Misuse. 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 EndNo…
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