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psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.158_slideshow.ppt
September 01, 2007 - Pre-operative consultant obtained wrong pre-admission medication list (PAML) from patient
Consultant
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psnet.ahrq.gov/issue/clinical-supervision-general-practice-training-interweaving-supervisor-trainee-and-patient
October 13, 2021 - Study
Clinical supervision in general practice training: the interweaving of supervisor, trainee and patient entrustment with clinical oversight, patient safety and trainee learning.
Citation Text:
Sturman N, Parker M, Jorm C. Clinical supervision in general practice training: the interw…
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psnet.ahrq.gov/issue/incidence-origins-and-avoidable-harm-missed-opportunities-diagnosis-longitudinal-patient
December 16, 2020 - Study
Incidence, origins and avoidable harm of missed opportunities in diagnosis: longitudinal patient record review in 21 English general practices.
Citation Text:
Cheraghi-Sohi S, Holland F, Singh H, et al. Incidence, origins and avoidable harm of missed opportunities in diagnosis: lon…
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psnet.ahrq.gov/issue/use-and-impact-virtual-primary-care-quality-and-safety-publics-perspectives-during-covid-19
July 08, 2020 - Study
Use and impact of virtual primary care on quality and safety: the public's perspectives during the COVID-19 pandemic.
Citation Text:
Neves AL, van Dael J, O’Brien N, et al. Use and impact of virtual primary care on quality and safety: The public's perspectives during the COVID-19 p…
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psnet.ahrq.gov/node/49543/psn-pdf
September 01, 2007 - First, the preoperative consultant sowed the seeds of this
adverse event by obtaining the wrong preadmission … The consultant
also failed to verify the medication history; he did not contact the patient's PCP, neurologist
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psnet.ahrq.gov/node/50929/psn-pdf
February 26, 2020 - Discharged with IV antibiotics: When issues arise, who
manages the complications?
February 26, 2020
Donnelley M, Gintjee TJ, Go J. Discharged with IV antibiotics: When issues arise, who manages the
complications? PSNet [internet]. 2020.
https://psnet.ahrq.gov/web-mm/discharged-iv-antibiotics-when-issues-arise-who-…
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psnet.ahrq.gov/web-mm/inflicting-confusion
August 04, 2021 - Inflicting Confusion
Citation Text:
Scott FI, Lichtenstein GR. Inflicting Confusion. 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 EndNote 7 XML Endnote …
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psnet.ahrq.gov/perspective/what-do-we-know-about-emergency-department-safety
June 01, 2010 - Inadequate staffing with nurses, physicians, and consultants; problems with teamwork; and inadequate
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psnet.ahrq.gov/issue/junior-doctors-views-reporting-concerns-about-patient-safety-qualitative-study
June 16, 2021 - Study
Junior doctors' views on reporting concerns about patient safety: a qualitative study.
Citation Text:
Hooper P, Kocman D, Carr S, et al. Junior doctors' views on reporting concerns about patient safety: a qualitative study. Postgrad Med J. 2015;91(1075):251-6. doi:10.1136/postgradm…
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psnet.ahrq.gov/issue/burden-difficult-encounters-primary-care-data-minimizing-error-maximizing-outcomes-study
May 18, 2019 - Study
Burden of difficult encounters in primary care: data from the Minimizing Error, Maximizing Outcomes Study.
Citation Text:
An PG, Rabatin JS, Manwell LB, et al. Burden of difficult encounters in primary care: data from the minimizing error, maximizing outcomes study. Arch Intern Med…
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psnet.ahrq.gov/issue/unintended-consequences-patient-online-access-health-records-qualitative-study-uk-primary
February 02, 2022 - Study
Unintended consequences of patient online access to health records: a qualitative study in UK primary care.
Citation Text:
Turner A, Morris R, McDonagh L, et al. Unintended consequences of patient online access to health records: a qualitative study in UK primary care. Br J Gen Pra…
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psnet.ahrq.gov/issue/medication-safety-incidents-associated-remote-delivery-primary-care-rapid-review
June 29, 2022 - Review
Medication safety incidents associated with the remote delivery of primary care: a rapid review.
Citation Text:
Gleeson LL, Clyne B, Barlow JW, et al. Medication safety incidents associated with the remote delivery of primary care: a rapid review. Int J Pharm Pract. 2023;30(6):495…
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psnet.ahrq.gov/issue/early-diagnostic-suggestions-improve-accuracy-family-physicians-randomized-controlled-trial
April 07, 2021 - Study
Early diagnostic suggestions improve accuracy of family physicians: a randomized controlled trial in Greece.
Citation Text:
Kostopoulou O, Lionis C, Angelaki A, et al. Early diagnostic suggestions improve accuracy of family physicians: a randomized controlled trial in Greece. Fam P…
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psnet.ahrq.gov/web-mm/sepsis-resulting-delays-treatment-and-miscommunication-among-specialists
February 26, 2025 - models have limitations when patient complexity rises, increasing the risk of misunderstanding between consultants
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psnet.ahrq.gov/node/49485/psn-pdf
August 29, 2024 - pressure to baseline and treatment of significant anemia are frequently
suggested interventions by consultants
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psnet.ahrq.gov/web-mm/discharged-iv-antibiotics-when-issues-arise-who-manages-complications
October 10, 2017 - SPOTLIGHT CASE
Discharged with IV antibiotics: When issues arise, who manages the complications?
Citation Text:
Donnelley M, Gintjee TJ, Go J. Discharged with IV antibiotics: When issues arise, who manages the complications?. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Qu…
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psnet.ahrq.gov/issue/safety-clinical-and-non-clinical-decision-makers-telephone-triage-narrative-review
July 05, 2017 - Review
Safety of clinical and non-clinical decision makers in telephone triage: a narrative review.
Citation Text:
Wheeler SQ, Greenberg ME, Mahlmeister L, et al. Safety of clinical and non-clinical decision makers in telephone triage: a narrative review. J Telemed Telecare. 2015;21(6):3…
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psnet.ahrq.gov/issue/email-communicating-results-diagnostic-medical-investigations-patients
December 14, 2016 - Review
Email for communicating results of diagnostic medical investigations to patients.
Citation Text:
Meyer B, Atherton H, Sawmynaden P, et al. Email for communicating results of diagnostic medical investigations to patients. Cochrane Database of Systematic Reviews. 2012. doi:10.1002…
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psnet.ahrq.gov/node/49685/psn-pdf
May 01, 2013 - Polypharmacy
May 1, 2013
Guglielmo JB. Polypharmacy. PSNet [internet]. 2013.
https://psnet.ahrq.gov/web-mm/polypharmacy
The Case
A 65-year-old man with schizophrenia receives his routine outpatient psychiatric care through an agency.
His case manager visits him weekly regarding medication adherence, which include…
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psnet.ahrq.gov/node/49736/psn-pdf
June 01, 2015 - Inflicting Confusion
June 1, 2015
Scott FI, Lichtenstein GR. Inflicting Confusion. PSNet [internet]. 2015.
https://psnet.ahrq.gov/web-mm/inflicting-confusion
The Case
A 26-year-old man with recently diagnosed Crohn disease presented to the emergency department with
acute-onset abdominal pain, nausea, vomiting, an…