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2721. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/35662/psn-pdf
      June 25, 2010 - Debriefing after critical incidents for anaesthetic trainees. June 25, 2010 Tan H. Debriefing after critical incidents for anaesthetic trainees. Anaesth Intensive Care. 2005;33(6):768- 72. https://psnet.ahrq.gov/issue/debriefing-after-critical-incidents-anaesthetic-trainees The author surveyed Australian anesthesi…

2722. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49673/psn-pdf
      December 01, 2012 - A Real Heartache December 1, 2012 Polevoi SK. A Real Heartache. PSNet [internet]. 2012. https://psnet.ahrq.gov/web-mm/real-heartache The Case A 60-year-old man presented to the emergency department (ED) with 2 hours of burning chest pain. The pain began at rest, and it radiated to his back and left axilla. He had…

2723. Patient safety and staff competence in managing challenging behavior based on feedback from former psychiatric patients. | PSNet
      psnet.ahrq.gov/issue/patient-safety-and-staff-competence-managing-challenging-behavior-based-feedback-former
      October 15, 2016 - Study Patient safety and staff competence in managing challenging behavior based on feedback from former psychiatric patients. Citation Text: Tölli S, Kontio R, Partanen P, et al. Patient safety and staff competence in managing challenging behavior based on feedback from former psychiatr…

2724. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/36131/psn-pdf
      September 29, 2010 - Emergent CSCW systems: the resolution and bandwidth of workplaces. September 29, 2010 Xiao Y, Seagull J. Emergent CSCW systems: the resolution and bandwidth of workplaces. Int J Med Inform. 2007;76 Suppl 1:S261-6. https://psnet.ahrq.gov/issue/emergent-cscw-systems-resolution-and-bandwidth-workplaces The authors d…

2725. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/36139/psn-pdf
      September 29, 2010 - Trends influencing the cost of care and patient safety. September 29, 2010 Clark R. Trends influencing the cost of care and patient safety. Decision-making in five key areas can improve clinical and economic performance. Health management technology. 2006;27(7):18, 20-1. https://psnet.ahrq.gov/issue/trends-influenc…

2726. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/39562/psn-pdf
      June 02, 2010 - Medical errors recovered by critical care nurses. June 2, 2010 Dykes PC, Rothschild JM, Hurley A. Medical errors recovered by critical care nurses. J Nurs Adm. 2010;40(5):241-6. doi:10.1097/NNA.0b013e3181da408e. https://psnet.ahrq.gov/issue/medical-errors-recovered-critical-care-nurses This survey of critical care…

2727. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/38520/psn-pdf
      September 19, 2016 - Inpatient suicide in a general hospital. September 19, 2016 Cheng I-C, Hu F-C, Tseng M-CM. Inpatient suicide in a general hospital. Gen Hosp Psychiatry. 2009;31(2):110-5. doi:10.1016/j.genhosppsych.2008.12.008. https://psnet.ahrq.gov/issue/inpatient-suicide-general-hospital Suicide attempts by hospitalized patient…

2728. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49619/psn-pdf
      February 01, 2011 - Paradoxical Pulse February 1, 2011 Roy CL. Paradoxical Pulse. PSNet [internet]. 2011. https://psnet.ahrq.gov/web-mm/paradoxical-pulse The Case An 80-year-old man with paroxysmal atrial fibrillation and symptomatic bradycardia underwent successful pacemaker placement as an outpatient. The patient was restarted on …

2729. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49409/psn-pdf
      July 01, 2003 - Feeling No Pain July 1, 2003 Bogner MS. Feeling No Pain. PSNet [internet]. 2003. https://psnet.ahrq.gov/web-mm/feeling-no-pain The Case A 33-year-old female underwent hysterectomy for refractory endometriosis. For pain post-operatively, the patient was placed on a Patient-Controlled Analgesia (PCA) pump containin…

2730. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/34623/psn-pdf
      January 28, 2015 - Australian Commission on Safety and Quality in Health Care. January 28, 2015 Australian Commission for Safety and Quality in Health Care. https://psnet.ahrq.gov/issue/australian-commission-safety-and-quality-health-care Established in January 2006, the Commission leads and coordinates improvements in safety and qu…

2731. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/38138/psn-pdf
      October 22, 2008 - Pharmacists and health information technology: emerging issues in patient safety. October 22, 2008 Fuji KT, Galt KA. Pharmacists and Health Information Technology: Emerging Issues in Patient Safety. HEC Forum. 2008;20(3). doi:10.1007/s10730-008-9075-4. https://psnet.ahrq.gov/issue/pharmacists-and-health-informatio…

2732. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/36938/psn-pdf
      June 30, 2011 - The cost of pneumonia after acute stroke. June 30, 2011 Katzan IL, Dawson NV, Thomas CL, et al. The cost of pneumonia after acute stroke. Neurology. 2007;68(22). doi:10.1212/01.wnl.0000263187.08969.45. https://psnet.ahrq.gov/issue/cost-pneumonia-after-acute-stroke Neglecting measures to prevent pneumonia after str…

2733. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/36111/psn-pdf
      September 28, 2010 - Prescribing errors resulting in adverse drug events: how can they be prevented? September 28, 2010 Thürmann PA. Prescribing errors resulting in adverse drug events: how can they be prevented? Expert Opin Drug Saf. 2006;5(4):489-93. https://psnet.ahrq.gov/issue/prescribing-errors-resulting-adverse-drug-events-how-c…

2734. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/38901/psn-pdf
      September 02, 2009 - Quantitative analysis of adverse events in neurosurgery. September 2, 2009 Houkin K, Baba T, Minamida Y, et al. Quantitative analysis of adverse events in neurosurgery. Neurosurgery. 2009;65(3):587-94; discussion 594. doi:10.1227/01.NEU.0000350860.59902.68. https://psnet.ahrq.gov/issue/quantitative-analysis-adverse…

2735. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/34596/psn-pdf
      February 17, 2009 - Disclosure: what works now and what can work even better (part 3 of 3). February 17, 2009 Chicago, IL: American Society of Healthcare Risk Management;  https://psnet.ahrq.gov/issue/disclosure-what-works-now-and-what-can-work-even-better-part-3-3 A guide for communicating throughout the disclosure process, thi…

2736. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/41517/psn-pdf
      August 08, 2012 - What is preventable harm in healthcare? A systematic review of definitions. August 8, 2012 Nabhan M, Elraiyah T, Brown DR, et al. What is preventable harm in healthcare? A systematic review of definitions. BMC Health Serv Res. 2012;12:128. doi:10.1186/1472-6963-12-128. https://psnet.ahrq.gov/issue/what-preventable…

2737. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/39418/psn-pdf
      March 31, 2010 - Take Charge of Your Hospital Stay to Avoid Medical Mistakes. March 31, 2010 Clarke S, Savard M. Good Morning America. ABC News. March 22, 2010. https://psnet.ahrq.gov/issue/take-charge-your-hospital-stay-avoid-medical-mistakes This television interview offers recommendations for patients to keep themselves safe wh…

2738. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/43492/psn-pdf
      September 03, 2014 - Rethinking hospital restraints. September 3, 2014 Parikh R. The Atlantic. August 18, 2014. https://psnet.ahrq.gov/issue/rethinking-hospital-restraints The inappropriate use of physical restraints on patients is considered a sentinel event. Although restraints may be used to protect patients from harm, this magazin…

2739. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/45517/psn-pdf
      March 01, 2017 - A lost voice. March 1, 2017 Baker M. Seattle Times. February 10, 2017. https://psnet.ahrq.gov/issue/lost-voice Reporting on an incident involving a patient who died after a surgery, this news article discusses potential contributing factors in the incident such as concurrent surgeries and failure to consider patie…

2740. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/35530/psn-pdf
      March 02, 2010 - Health care provider use of private sector internal error- reporting systems. March 2, 2010 Roumm AR, Sciamanna CN, Nash DB. Health care provider use of private sector internal error-reporting systems. Am J Med Qual. 2005;20(6):304-12. https://psnet.ahrq.gov/issue/health-care-provider-use-private-sector-internal-e…