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psnet.ahrq.gov/node/74178/psn-pdf
December 15, 2021 - Strategies to Improve Patient Safety: Final Report to
Congress Required by the Patient Safety and Quality
Improvement Act of 2005.
December 15, 2021
Rockville, MD: Agency for Healthcare Research and Quality; December 2021. AHRQ Publication No. 22-
0009.
https://psnet.ahrq.gov/issue/strategies-improve-patient-safe…
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psnet.ahrq.gov/web-mm/one-got-away-elopement-suicidal-patient-emergency-department
September 27, 2023 - The One That Got Away—Elopement of a Suicidal Patient in the Emergency Department.
Citation Text:
Bourgeois JA, Xiong G, Barnes DK, et al. The One That Got Away—Elopement of a Suicidal Patient in the Emergency Department.. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Depa…
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psnet.ahrq.gov/web-mm/triaging-interhospital-transfers
April 12, 2023 - By allowing for real time evaluation of patients by expert consultants in advance of transfer, telemedicine
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psnet.ahrq.gov/node/38485/psn-pdf
June 23, 2017 - Impact of a comprehensive patient safety strategy on
obstetric adverse events.
June 23, 2017
Pettker CM, Thung SF, Norwitz ER, et al. Impact of a comprehensive patient safety strategy on obstetric
adverse events. Am J Obstet Gynecol. 2009;200(5):492.e1-8. doi:10.1016/j.ajog.2009.01.022.
https://psnet.ahrq.gov/issu…
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psnet.ahrq.gov/node/46627/psn-pdf
January 30, 2018 - The lost art of doctoring: reflections of a pediatric
resident.
January 30, 2018
Mitchell SM. The Lost Art of Doctoring: Reflections of a Pediatric Resident. JAMA Pediatr. 2018;172(1):10.
doi:10.1001/jamapediatrics.2017.3247.
https://psnet.ahrq.gov/issue/lost-art-doctoring-reflections-pediatric-resident
There are…
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psnet.ahrq.gov/node/49852/psn-pdf
February 01, 2019 - By
allowing for real time evaluation of patients by expert consultants in advance of transfer, telemedicine
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psnet.ahrq.gov/web-mm/real-heartache
October 01, 2018 - February 1, 2007
WebM&M Cases
Communication With Consultants
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psnet.ahrq.gov/node/49804/psn-pdf
September 01, 2017 - patients at risk for severe bleeding
and the need for higher levels of care and early involvement of consultants
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psnet.ahrq.gov/issue/identifying-quality-markers-safe-surgical-ward-interview-study-patients-clinical-staff-and
June 17, 2015 - Consultant surgeon's contemporary experience of adverse surgical events.
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psnet.ahrq.gov/issue/effect-short-term-pretrial-practice-surgical-proficiency-simulated-environments-randomized
January 20, 2010 - January 13, 2021
Prospective evaluation of consultant surgeon sleep deprivation and outcomes
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psnet.ahrq.gov/issue/checklist-tool-error-management-and-performance-improvement
June 29, 2011 - July 3, 2016
Prospective evaluation of consultant surgeon sleep deprivation and outcomes
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psnet.ahrq.gov/issue/prescribing-errors-children-why-they-happen-and-how-prevent-them
December 13, 2017 - August 23, 2023
Prospective evaluation of consultant surgeon sleep deprivation and outcomes
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psnet.ahrq.gov/node/60543/psn-pdf
May 27, 2020 - Wrong Catheter in the Right Patient
May 27, 2020
Chia C, Molla M. Wrong Catheter in the Right Patient. PSNet [internet]. 2020.
https://psnet.ahrq.gov/web-mm/wrong-catheter-right-patient
The Case
A 55-year-old man with history of emphysema was admitted to the hospital for pneumonia. The patient had
two?peripheral…
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psnet.ahrq.gov/web-mm/polypharmacy
March 01, 2007 - Polypharmacy
Citation Text:
Guglielmo JB. Polypharmacy. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2013.
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Format:
Google Scholar BibTeX EndNote X3 XML EndNote 7 XML Endnote tagged PubMedId RIS
…
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psnet.ahrq.gov/web-mm/failure-reevaluate
February 01, 2014 - Failure to Reevaluate
Citation Text:
Wong-Beringer A. Failure to Reevaluate. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2010.
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Format:
Google Scholar BibTeX EndNote X3 XML EndNote 7 XML Endnote tagged P…
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psnet.ahrq.gov/node/49452/psn-pdf
July 01, 2004 - Allergy to Holter
July 1, 2004
Williams M. Allergy to Holter. PSNet [internet]. 2004.
https://psnet.ahrq.gov/web-mm/allergy-holter
The Case
A 52-year-old man was admitted for palpitations and chest pain. As part of the evaluation, on hospital day 4
the patient was sent to the cardiac clinic to start a continuous …
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psnet.ahrq.gov/node/49627/psn-pdf
June 01, 2011 - Once involved in a case, they may have difficult time backing off and
admitting it is time for a consultant … Call a consultant, get a test, double back
around to another consultant, cancel another test, and stop
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psnet.ahrq.gov/node/73448/psn-pdf
June 30, 2021 - A systematic review of the effect of telepharmacy
services in the community pharmacy setting on care
quality and patient safety.
June 30, 2021
Pathak S, Blanchard CM, Moreton E, et al. A systematic review of the effect of telepharmacy services in
the community pharmacy setting on care quality and patient safety. J…
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psnet.ahrq.gov/node/35742/psn-pdf
July 15, 2010 - Physician evaluation after medical errors: does having a
computer decision aid help or hurt in hindsight?
July 15, 2010
Pezzo M, Pezzo SP. Physician evaluation after medical errors: does having a computer decision aid help
or hurt in hindsight? Med Decis Making. 2006;26(1):48-56.
https://psnet.ahrq.gov/issue/physi…
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psnet.ahrq.gov/node/45891/psn-pdf
October 11, 2017 - Extent of diagnostic agreement among medical referrals.
October 11, 2017
Van Such M, Lohr R, Beckman T, et al. Extent of diagnostic agreement among medical referrals. J Eval
Clin Pract. 2017;23(4):870-874. doi:10.1111/jep.12747.
https://psnet.ahrq.gov/issue/extent-diagnostic-agreement-among-medical-referrals
Diagn…